Intradural jugular tubercle reduction to enhance exposure via the transcondylar approach: technical note.

Abstract

The jugular tubercle can present an obstruction to adequate visualization of posteroinferior cerebellar artery (PICA) or vertebrobasilar junction aneurysms approached via a far lateral transcondylar approach. Reduction of the tubercle via an intradural approach was performed to enhance exposure. The technical details of this maneuver are discussed and demonstrated. Two patients with PICA aneurysms were treated via the far lateral transcondylar approach. Intradural reduction of the jugular tubercle was performed to enhance exposure in each case. Exposure of the parent artery and aneurysm was enhanced in each case by intradural reduction of the jugular tubercle, providing several millimeters of added space. Both PICA aneurysms were successfully clipped with no intraoperative complications. Several millimeters of additional exposure can be obtained when treating a PICA or vertebrobasilar junction aneurysm via the far lateral transcondylar approach by removing the jugular tubercle via an intradural approach.