Supracondylar transjugular tubercle approach to intradural lesions anterior or anterolateral to the craniocervical junction without resection of the occipital condyle

Abstract

To clarify the usefulness of supracondylar transjugular tubercle approach for treatment intradural lesions anterior and anterolateral to foramen magnum, in which the posterior portion of the jugular tubercle is removed extradurally through the condylar fossa with the atlanto-occipital joint intact. The supracondylar transjugular tubercle approach was applied to 28 craniocervical junction surgeries. These surgeries included clipping a vertebral artery aneurysm in 12 cases and removing intradural tumors ventral and ventrolateral to foramen magnum in 16 cases. The approach offered very good visualization of the anterior and anterolateral part of the craniocervical junction region and sufficient working space. These surgeries were performed safely without major complications. In all 12 cases, the aneurysm was easily clipped without any problems. In 16 cases of tumors, 14 tumors were totally removed, the remaining 2 cases achieved subtotal resection due to medullary invasion of tumors. Supracondylar transjugular tubercle approach offered very good visualization of the anterior and anterolateral part of the craniocervical junction region and can be an ideal approach for accessing intradural lesions anterior and anterolateral part of the craniocervical junction region.