Abstract
Objective The jugular foramen is one of the most challenging surgical regions in skull base
surgery. With the development of endoscopic techniques, the endoscopic endonasal approach
(EEA) has been undertaken to treat some lesions in this area independently or combined
with open approaches. The purpose of the current study is to describe the anatomical
steps and landmarks for the EEA to the jugular foramen and to compare it with the
degree of exposure obtained with the lateral infratemporal fossa approach.
Materials and Methods A total of 15 osseous structures related to the jugular foramen were measured in
33 adult dry skulls. Three silicone-injected adult cadaveric heads (six sides) were
dissected for EEA and three heads (six sides) were used for a lateral infratemporal
fossa approach (Fisch type A). The jugular foramen was exposed, relevant landmarks
were demonstrated, and the distances between relevant landmarks and the jugular foramen
were obtained. High-quality pictures were obtained.
Results The jugular foramen was accessed in all dissections by using either approach. Important
anatomical landmarks for EEA include internal carotid artery (ICA), petroclival fissure,
inferior petrosal sinus, jugular tubercle, and hypoglossal canal. The EEA exposed
the anterior and medial parts of the jugular foramen, while the lateral infratemporal
fossa approach (Fisch type A) exposed the lateral and posterior parts of the jugular
foramen. With EEA, dissection and transposition of the facial nerve was avoided, but
the upper parapharyngeal and paraclival ICA may need to be mobilized to adequately
expose the jugular foramen.
Conclusion The EEA to the jugular foramen is anatomically feasible but requires mobilization
of the ICA to provide access to the anterior and medial aspects of the jugular foramen.
The lateral infratemporal approach requires facial nerve transposition to provide
access to the lateral and posterior parts of the jugular foramen. A deep understanding
of the complex anatomy of this region is paramount for safe and effective surgery
of the jugular foramen. Both techniques may be complementary considering the different
regions of the jugular foramen accessed with each approach.
Keywords
jugular foramen - internal carotid artery - infratemporal fossa - endoscopic - endonasal
- microscopic - skull base surgery
