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Updated: Jul 9, 2026
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Surgical treatment of the high jugular bulb by compressing sinus sigmoideus: two cases
Sedat Oztürkcan1, Hüseyin Katilmiş, Yilmaz Ozkul
1Department of Otorhinolaryngology and Head and Neck Surgery, Atatürk Research and Training Hospital, Ministry of Health, Izmir, Turkey. seralbercan@yahoo.com
Insights
High jugular bulb (HJB) is an anatomical variation where the jugular bulb is positioned abnormally. This report details two rare HJB cases with surgical bleeding and management strategies.
Area of Science:
- Otolaryngology
- Neurosurgery
- Anatomy
Background:
- High jugular bulb (HJB) is an anatomical variation where the jugular bulb is positioned superiorly within the temporal bone.
- This condition occurs in approximately 5% of temporal bone specimens and can be dehiscent or aberrant.
Observation:
- Two cases of HJB are presented, both experiencing intraoperative bleeding from the jugular bulb.
- Initial management involved compression with bone wax and Surgicel, followed by sigmoid sinus compression due to persistent bleeding.
Findings:
- Postoperative venous MR angiographies confirmed cessation of venous flow in both cases.
- The study highlights the challenges in managing surgical bleeding associated with HJB.
Implications:
- This case series underscores the importance of recognizing HJB during otologic and neurosurgical procedures.
- It also suggests a stepwise approach to managing intraoperative hemorrhage, including sigmoid sinus compression if primary jugular bulb control fails.
Abstract:
If the jugular bulb normally surrounded by a bony layer in jugular fossa is anatomically over the inferior surface of the bony annulus, in the middle ear or over the basal turn of cochlea, it is then named as high jugular bulb (HJB). It may be dehiscent or aberrant. It is reported to occur in 5% of the temporal bone specimens. In accordance with the literature jugular bulb compression, jugular vein ligation and embolization are suggested in such cases. In both of the presented cases, there was bleeding from jugular bulb during surgery and jugular bulb was compressed with bone wax and Surgicel, but sigmoid sinus has been compressed after failure to stop bleeding through jugular bulb compression. Venous MR angiographies showed no flow in postoperative controls. Although it is very rarely seen clinically, we present two HJB cases and different treatment perspectives accompanied by literature.
