Jugular tubercle: morphometric analysis and surgical significance

Abstract

Object Maximizing intradural exposure via the extreme lateral infrajugular transcondylar–transtubercular exposure (ELITE) approach depends on understanding the fundamental anatomy of the jugular tubercle (JT). Drilling the JT can maximize the extent of exposure achieved with the ELITE approach. Removing the JT is critical for optimizing access to the inferior and midclival areas, vertebrobasilar artery junction, and ventral pons and medulla. Methods In this cadaveric study, the individual structural variations in the JT were evaluated in 100 split occipital bones. The mean length of the JT was 1.65 ± 0.36 cm (range 1.2–3 cm); its mean width was 1.15 ± 0.16 cm (range 0.7–1.7 cm); and its mean thickness was 0.61 ± 0.15 cm (range 0.2–1 cm). The authors analyzed the difference in morphometric data with regard to right and left sides and found no statistically significant difference between the two sides. Furthermore, data from the morphometric study were compared with the results of 20 measurements obtained from three-dimensional computed tomography (3D CT) scans. Accordingly, the mean length of the JT was 1.35 ± 0.15 cm (range 1–2.8 cm); the mean width, 1.10 ± 0.12 cm (range 0.8–1.3 cm); and the mean thickness, 0.51 ± 0.18 cm (range 0.2–1 cm). Conclusions Morphometric data on the JT contribute significantly to the neurosurgeon’s task of skull base drilling. The 3D CT scans were useful in the preoperative planning.