Intradural jugular tuberclectomy in a case of inadequate extradural removal

The jugular tubercles are paired protuberances that arise from the inferolateral margins of the clivus and project posterosuperiorly over the hypoglossal canal. These bony structures sometimes obscure and hinder surgical manipulation of lesions situated in the lateral and premedullary cisterns during extended far lateral suboccipital approaches. The application of intradural jugular tuberclectomy is described to remove this bony eminence.

A case of ruptured dissecting aneurysm in the vertebral artery was treated through the transcondylar approach. Extradural removal of the posterior portion of the jugular tubercle was performed. The dura over the jugular tubercle was then removed, and the anterior part of the jugular tubercle was drilled away between the intradural hypoglossal canal foramen and jugular foramen under the lower cranial nerves.

Great care was required during the intradural drilling procedure to prevent damage to the lower cranial nerves, brain stem, and jugular bulb. Intradural jugular tuberclectomy provided an adequate microscopic view of the midline anterior lower clival region.

Intradural jugular tuberclectomy is a useful technique to remove the anterior part of this bony eminence after the transcondylar approach.