The juxtacondylar approach to the jugular foramen (without petrous bone drilling)

doi:10.1016/0090-3019(95)00174-3

Surgical Neurology

Volume 44, Issue 3, September 1995, Pages 279-284

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Cited by (68)

Rectus Capitis Lateralis Muscle: A Cadaveric Study of a Key Surgical Landmark in the Posterior and Lateral Approaches to the Jugular Foramen
2019, World Neurosurgery
Citation Excerpt :
Anteriorly CN IX can be observed running adjacent to the carotid artery while CN X, XI, and CN XII continue inferiorly as an intimate bundle posteriorly with the inferior petrosal sinus running between them to empty into the sigmoid sinus. The list of the various approaches to the JF is as complex as its anatomy.2-4,6-19 The goal of the approaches is to control the VA, CNs VII-XII, and jugular−sigmoid complex.
The rectus capitis lateralis (RCL) is a small cervical muscle that arises from the transverse process of C1 and is intimately related to the jugular process and jugular foramen. We describe its morphology, neurovascular relationships, and its utility as one of the key surgical landmarks in approaches to the jugular foramen.
Eight cadaveric heads were used to perform far-lateral and transmastoid approaches to the jugular foramen. The neurovascular relationships of the RCL were studied.
The RCL originates from the transverse process of C1 and inserts onto the jugular process. It can be found in the muscular interval between the posterior belly of the digastric muscle and the superior oblique muscle with the occipital artery coursing between it and the posterior belly of the digastric muscle. It lies directly posterior to the internal jugular vein and cranial nerves (CNs) IX–XI as they exit the jugular foramen. The vertebral artery courses medially to the RCL as it exits foramen transversarium of C1. As the facial nerve exits the stylomastoid foramen, it is anterolateral to the RCL before turning to enter the parotid gland. The CN XII is seen between the RCL and the occipital condyle from a posterior view.
The RCL usually is preserved unless jugular process needs to be removed to expose the jugular foramen. The RCL is an important surgical landmark for the early identification of the vertebral artery, internal jugular vein, facial nerve, and CNs IX–XII in approaches to the jugular foramen.
Strategy for facial nerve management during surgical removal of benign jugular foramen tumors: Outcomes and indications
2019, European Annals of Otorhinolaryngology, Head and Neck Diseases
Citation Excerpt :
In 1997, the concept of the fallopian bridge technique was proposed by Pensak and Jackler [12] to avoid rerouting the facial nerve and better preserve its function. Over the past 20 years, a number of studies have been made to avoid rerouting the facial nerve and/or to conserve the external auditory canal in the resection of JF tumors [10,15–18]. Llorente et al. [4] divided their 34 patients into two groups on the basis of the presence or absence of FN transposition.
Classical surgical management of jugular foramen (JF) tumors usually requires facial nerve rerouting which results in permanent facial palsy in most patients. The purpose of the article is to study the outcomes of different rerouting techniques, and to discuss their indications.
We retrospectively reviewed 98 patients with JF tumors operated at our center between January 2008 and December 2016 using different surgical approaches with the following procedures for facial nerve management: total anterior rerouting (TR), partial anterior rerouting (PR), and fallopian bridge (FB) technique. The data for facial nerve management, surgical outcome and postoperative facial nerve function were collected from the medical records.
In the study, there were 48 males and 50 females. Of them, 61 (62.2%) were jugular paragangliomas, 22 (22.4%) schwannomas, and 15 (15.3%) meningiomas. Total tumor removal was achieved in 95 (96.9%) patients, while near-total removal was achieved in 3 (3.1%) paragangliomas. TR was applied in 31 (31.6%) patients with PR in 26 (26.5%) patients, and FB in 41 (41.8%) patients. The mean follow-up duration was 39.4 ± 22.6 months, and 2 recurrences of paragangliomas were observed. Seventy-five patients (76.5%) had good facial function (HB I-II) at 1 year after surgery, the patients who received a TR approach presented significantly less HB I-II FN function (48.4%) than those with PR (82.6%, P < 0.05) or those with FB technique (95.1%, P < 0.001). 21 patients (21.4%) presented new-onset lower cranial nerve dysfunction of which 13 recovered at 1 year after surgery.
Facial nerve management in JF tumors should be tailored individually. No-rerouting methods, such as the fallopian bridge technique, bring significantly better results in terms of facial nerve function, which might be performed first during surgery; its indication is based mainly on the tumor type and extent.
Retrosigmoid Intradural Suprajugular Approach to Jugular Foramen Tumors with Intraforaminal Extension: Surgical Series of 19 Cases
2019, World Neurosurgery
Citation Excerpt :
The jugular foramen is difficult to access surgically because of its deep location, the presence of vital structures, and the frequent intra- and extracranial extension of the pathology, and this challenge has encouraged skull base surgeons to develop various surgical approaches.1-15
The intraforaminal component of jugular foramen tumors is difficult to access surgically, as it requires complex approaches for radical removal and leads to a high recurrence due to residual tumor. The retrosigmoid suprajugular approach, intradural drilling of the roof of the jugular foramen, has been recently proposed for removal of such intraforaminal component without sacrificing the sigmoid-jugular venous system or requiring additional approaches. This study presents our experience with this approach and introduces the use of intraoperative continuous vagus nerve monitoring.
Nineteen patients (14 with neuromas and 5 with meningiomas) were operated using this approach over a 12.5-year period. In the more recent 14 cases, continuous vagus nerve monitoring was performed with a ball-type electrode placed on the proximal vagus nerve.
More than 95% of the tumor removal was achieved in all but the first neuroma case. Extubation immediately after surgery and oral feeding within a week postoperatively was achieved in all patients. Seven of 9 patients with preoperative hearing disturbance symptomatically improved after surgery. All but the first case had no signs of recurrence during the follow-up period (average of 58 months).
The retrosigmoid suprajugular approach is safe and effective for removal of tumors extending into the jugular foramen, maintaining a chance of hearing improvement. Intraoperative continuous vagus nerve monitoring is useful to avoid postoperative complications in such surgeries.
The Anterolateral Approach, Revisited for Benign Jugular Foramen Tumors with Predominant Extracranial Extension: Microsurgical Anatomy and Case Series (SevEN-012)
2023, Operative Neurosurgery
Anterolateral (juxtacondylar) approach with limited mastoidectomy to resect a jugular foramen meningioma
2023, Acta Neurochirurgica
Extracranial Jugular Foramen Schwannomas Treated with the Extreme Lateral Juxtacondylar Approach: Surgical Technique and Our Experience
2023, Operative Neurosurgery

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Technical noteThe juxtacondylar approach to the jugular foramen (without petrous bone drilling)

First page preview

Surg Neurol

Devascularization of craniofacial tumors by percutaneous tumor puncture

AJNR

Neurinome des nerfs mixtes

Rev Neurol

Infratemporal fossa approach to lesions in the temporal bone and base of the skull

Arch Otolargyngol

Les tumeurs dîtes du glomus jugulaire

Neurochirurgie

Jugular foramen paragangliomas

Acta Neurochir (Wien)

Contrôle angiographique et chirurgical des pédicules nourriciers vertébraux et carotidiens des paragangliomes géants de la base du crâne et du cou

Ann Oto-Laryng

Technical note
The juxtacondylar approach to the jugular foramen (without petrous bone drilling)