George B, Lot G, Tran Ba Huy P
Service de Neurochirurgie, Hôpital Lariboisière, Paris, France.
Surg Neurol. 1995 Sep;44(3):279-84. doi: 10.1016/0090-3019(95)00174-3.
Surgical access to the jugular foramen is generally realized through the infratemporal approach, requires petrous bone drilling with facial nerve exposure and sometimes transposition. This is a rather complex and time-consuming technique that exposes the patient to complications such as deafness and facial nerve palsy.
The juxtacondylar approach we propose in this paper needs only a partial mastoidectomy and exposure of the distal cervical segment of the vertebral artery (above C2). The transverse process of the atlas is completely removed so as to permit progress upward along the lateral mass of the atlas and the occipital condyle. The vertebral artery rarely has to be transposed.
The main indication for the juxtacondylar approach is neurinoma and meningioma of the jugular foramen. For tumors like paraganglioma extending into the petrous bone, the juxtacondylar approach can be combined with an infratemporal approach. The juxtacondylar approach has been used in seven cases including three neurinomas, three paragangliomas and one meningioma. Exposure was quite satisfactory on both intra- and extradural parts in all cases.
The juxtacondylar approach is a different way to expose the jugular foramen region. Compared to the standard infratemporal approach, it is a complementary rather than an alternative technique; the exposure is rather on the posteroinferior side for the juxtacondylar approach and on the anterosuperior side for the infratemporal approach.
通常通过颞下入路实现对颈静脉孔的手术入路，这需要磨除岩骨并暴露面神经，有时还需要进行面神经移位。这是一种相当复杂且耗时的技术，会使患者面临耳聋和面神经麻痹等并发症。
我们在本文中提出的髁旁入路仅需进行部分乳突切除术并暴露椎动脉颈段远端（C2 以上）。完全切除寰椎横突，以便沿寰椎侧块和枕髁向上推进。椎动脉很少需要移位。
髁旁入路的主要适应证是颈静脉孔神经鞘瘤和脑膜瘤。对于延伸至岩骨的副神经节瘤等肿瘤，髁旁入路可与颞下入路联合使用。髁旁入路已应用于 7 例患者，包括 3 例神经鞘瘤、3 例副神经节瘤和 1 例脑膜瘤。所有病例的硬膜内和硬膜外部分暴露均相当满意。
髁旁入路是暴露颈静脉孔区域的一种不同方法。与标准颞下入路相比，它是一种补充技术而非替代技术；髁旁入路的暴露位于后下方，而颞下入路的暴露位于前上方。
