THE JUXTACONDYLAR APPROACH TO THE JUGULAR FORAMEN (WITHOUT PETROUS BONE DRILLING)

BACKGROUND Surgical access to the jugular foramen is generally realize d through the infratemporal approach, requires petrous bone drilling w ith facial nerve exposure and sometimes transposition. This is a rathe r complex and time-consuming technique that exposes the patient to com plications such as deafness and facial nerve palsy. METHODS The juxtac ondylar approach we propose in this paper needs only a partial mastoid ectomy and exposure of the distal cervical segment of the vertebral ar tery (above C2). The transverse process of the atlas is completely rem oved so as to permit progress upward along the lateral mass of the atl as and the occipital condyle. The vertebral artery rarely has to be tr ansposed. RESULTS The main indication for the juxtacondylar approach i s neurinoma and meningioma of the jugular foramen. For tumors like par aganglioma extending into the petrous bone, the juxtacondylar approach can be combined with an infratemporal approach, The juxtacondylar app roach has been used in seven cases including three neurinomas, three p aragangliomas and one meningioma. Exposure was quite satisfactory on b oth intra- and extradural parts in all cases. CONCLUSIONS The juxtacon dylar approach is a different way to expose the jugular foramen region . Compared to the standard infratemporal approach, it is a complementa ry rather than an alternative technique; the exposure is rather on the posteroinferior side for the juxtacondylar approach and on the antero superior side for the infratemporal approach.