THE TRANSCONDYLAR APPROACH TO THE JUGULAR FORAMEN - A COMPARATIVE ANATOMIC STUDY

The standard neurosurgical approach to the jugular foramen involves su boccipital craniectomy with access along the petrous bone. However, ev en after wide removal of the foramen magnum, only limited access into the infratemporal fossa can be obtained. The neurootologic exposures p rovide excellent infratemporal access but limited exposure to the post erior fossa, resulting in hearing loss and facial paresis or paralysis . Using cadaver specimens, we exposed the jugular foramen region by th e transcondylar approach. A retromastoid incision is extended into the neck. The transverse foramen of the atlas is opened and the vertebral artery transposed medially, thereby providing exposure into the infra temporal fossa. A suboccipital craniectomy extending anterior to the s igmoid sinus is performed, and the posterolateral occipital condyle is resected. After resection of the sigmoid sinus, cranial nerves 9 thro ugh 12 are easily identified extracranially in the infratemporal, foss a and can be followed proximally through their foramina to the brain s tem. We compared the transcondylar approach to three standard approach es, morphometrically and anatomically, and found that the transcondyla r approach not only compares favorably but also offers advantages in t hat it preserves auditory and facial nerve function and is useful for one-stage tumor resection.