Intradural jugular tuberclectomy in a case of inadequate extradural removal.
BACKGROUND
The jugular tubercles are paired protuberances that arise from the inferolateral margins of the clivus and project posterosuperiorly over the hypoglossal canal. These bony structures sometimes obscure and hinder surgical manipulation of lesions situated in the lateral and premedullary cisterns during extended far lateral suboccipital approaches. The application of intradural jugular tuberclectomy is described to remove this bony eminence.


METHODS
A case of ruptured dissecting aneurysm in the vertebral artery was treated through the transcondylar approach. Extradural removal of the posterior portion of the jugular tubercle was performed. The dura over the jugular tubercle was then removed, and the anterior part of the jugular tubercle was drilled away between the intradural hypoglossal canal foramen and jugular foramen under the lower cranial nerves.


RESULTS
Great care was required during the intradural drilling procedure to prevent damage to the lower cranial nerves, brain stem, and jugular bulb. Intradural jugular tuberclectomy provided an adequate microscopic view of the midline anterior lower clival region.


CONCLUSIONS
Intradural jugular tuberclectomy is a useful technique to remove the anterior part of this bony eminence after the transcondylar approach.
Mori
Kentaro
K
Department of Neurosurgery, Juntendo University, Izunagaoka Hospital, Shizuoka 410-2295, Japan. kmori1919@hkg.odn.ne.jp
Nakao
Yasuaki
Y
Yamamoto
Takuji
T
Maeda
Minoru
M
D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D003391:Cranial Nerves / Q000033:anatomy & histology / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods; D004388:Dura Mater / Q000033:anatomy & histology / Q000601:surgery; D004824:Epidural Space / Q000033:anatomy & histology / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007601:Jugular Veins / Q000033:anatomy & histology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009777:Occipital Bone / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000639:trends; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D020217:Vertebral Artery Dissection / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*