Variability and surgical anatomy of jugular foramen - a systematic review with a meta-analysis

The jugular foramen (JF), located at the junction of the occipital and temporal bones, exhibits significant morphological variability due to its developmental origin. It transmits key neurovascular structures, including the glossopharyngeal (IX), vagus (X), and accessory (XI) cranial nerves, as well as the internal jugular vein. Detailed anatomical knowledge of the JF is essential for planning and safely performing surgical procedures in this region. The objective of this study was to provide a comprehensive quantitative synthesis of the anatomical characteristics of the JF based on global data.

A systematic search of major medical databases (PubMed, Embase, Scopus, Web of Science, and Google Scholar) was conducted to identify studies reporting on the morphometry and surgical anatomy of the JF. Data extraction and meta-analysis were performed across seven anatomical parameters: (1) length, (2) width, (3) depth, (4) area, (5) distance to the stylomastoid foramen, (6) maximum width of the jugular fossa, and (7) minimum distance between the round window and roof of the jugular fossa.

Thirty studies met the inclusion criteria, comprising data from 5204 JFs. The analysis revealed significant asymmetry between the right and left JFs, with the right side generally larger across all measured parameters. Considerable heterogeneity was noted across populations and study types. The compiled morphometric data underscore notable geographic and demographic differences in JF anatomy.

This meta-analysis offers a detailed and up-to-date reference for the morphometric characteristics of the jugular foramen. These findings have critical implications for neurosurgeons and skull base surgeons, particularly in the management of lesions such as glomus jugulare tumors, schwannomas, or during decompressive procedures involving cranial nerves IX-XI. Enhanced anatomical awareness may contribute to improved surgical planning, reduced complication rates, and better clinical outcomes.