The transcondylar approach to the jugular foramen: a comparative anatomic study.

The standard neurosurgical approach to the jugular foramen involves suboccipital craniectomy with access along the petrous bone. However, even after wide removal of the foramen magnum, only limited access into the infratemporal fossa can be obtained. The neurootologic exposures provide excellent infratemporal access but limited exposure to the posterior fossa, resulting in hearing loss and facial paresis or paralysis. Using cadaver specimens, we exposed the jugular foramen region by the transcondylar approach. A retromastoid incision is extended into the neck. The transverse foramen of the atlas is opened and the vertebral artery transposed medially, thereby providing exposure into the infratemporal fossa. A suboccipital craniectomy extending anterior to the sigmoid sinus is performed, and the posterolateral occipital condyle is resected. After resection of the sigmoid sinus, cranial nerves 9 through 12 are easily identified extracranially in the infratemporal fossa and can be followed proximally through their foramina to the brain stem. We compared the transcondylar approach to three standard approaches, morphometrically and anatomically, and found that the transcondylar approach not only compares favorably but also offers advantages in that it preserves auditory and facial nerve function and is useful for one-stage tumor resection.