Abstract
Background
The anterolateral (juxtacondylar) approach with limited mastoidectomy is a suitable option to expose the postero-inferior part of the jugular foramen (JF). It is particularly indicated for tumors extending in the neck beyond the jugular foramen, especially in those cases necessitating both neck control as well as control of the mastoid segment of facial nerve.
Method
We describe here the steps to safely perform an anterolateral approach with mastoidectomy along with a brief description of its indications and limits.
Conclusion
This approach represents a valid option to reach the JF. Its knowledge can improve the process of optimal approach selection when dealing with complex pathology involving the JF.
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Key Points
The anterolateral approach is an option to expose the postero-inferior part of the jugular foramen (JF). It is particularly indicated for tumors extending beyond the JF requiring neck control and facial nerve decompression.
Neuromonitoring is mandatory to clearly confirm a proper identification of all the delicate neural structures exposed through this complex approach.
Extensive tumors may require combining this approach with other complementary alternatives such as the endoscopic endonasal approach to address the aspect of the JF.
Partial mastoidectomy and limited petrous bone drilling can be added to control the facial nerve and improve the visualization of the JF.
VA is identified in the suboccipital triangle and facilitated by palpation of the transverse process of C1. The periosteal sheath around the VA should be preserved to avoid major bleeding from the venous plexuses. Drilling of the condyle is usually unnecessary.
The medial wall of the IJV is kept intact and used as a “protection” during the resection of the tumor inside the JF.
This article is part of the Topical Collection on Tumor—Meningioma
Supplementary Information
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Supplementary file1 Video illustrating in details the surgical procedure (MP4 79127 KB)
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Giammattei, L., Passeri, T., di Russo, P. et al. Anterolateral (juxtacondylar) approach with limited mastoidectomy to resect a jugular foramen meningioma. Acta Neurochir 165, 1309–1314 (2023). https://doi.org/10.1007/s00701-022-05482-6
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DOI: https://doi.org/10.1007/s00701-022-05482-6