Mori Kentaro, Nakao Yasuaki, Yamamoto Takuji, Maeda Minoru
Department of Neurosurgery, Juntendo University, Izunagaoka Hospital, Shizuoka 410-2295, Japan.
Surg Neurol. 2005 Oct;64(4):347-50; discussion 350. doi: 10.1016/j.surneu.2004.12.027.
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.
颈静脉结节是成对的隆起，从斜坡的下外侧边缘发出，并向后上方突出于舌下神经管上方。在扩大的远外侧枕下入路手术中，这些骨性结构有时会遮挡并妨碍对位于外侧和延髓前池的病变进行手术操作。本文描述了硬膜内颈静脉结节切除术以去除这一骨性隆起。
通过经髁入路治疗1例椎动脉夹层动脉瘤破裂患者。硬膜外切除颈静脉结节后部。然后切除颈静脉结节上方的硬脑膜，并在硬膜内舌下神经管孔和下颅神经下方的颈静脉孔之间磨除颈静脉结节前部。
在硬膜内磨除过程中需要格外小心，以防止损伤下颅神经、脑干和颈静脉球。硬膜内颈静脉结节切除术提供了对斜坡前下部中线区域足够的显微镜视野。
硬膜内颈静脉结节切除术是经髁入路后切除该骨性隆起前部的一种有用技术。
