- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University,
- Division of Neurosurgery, Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia.
Sarah A. Basindwah, Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
DOI:10.25259/SNI_361_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Aysha Hamzah Hawsawi1, Minyal Bawazir1, Sarah A. Basindwah1, Ashwag Alqurashi2, Abdulrazag Ajlan1. Modified retrosigmoid extended approach to jugular tubercle meningioma: A video abstract. 08-Jul-2022;13:289
How to cite this URL: Aysha Hamzah Hawsawi1, Minyal Bawazir1, Sarah A. Basindwah1, Ashwag Alqurashi2, Abdulrazag Ajlan1. Modified retrosigmoid extended approach to jugular tubercle meningioma: A video abstract. 08-Jul-2022;13:289. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=11711
Background: Primary jugular fossa meningiomas are one of the rarest subgroups of meningioma, with an estimated incidence of 0.7–4.3% of all skull base meningiomas. Indeed, only 145 cases of jugular foramen meningiomas have been reported in the literature to date. While meningiomas of this region are typically referred to as “jugular foramen meningiomas,” we make a distinction between meningiomas arising directly from the foramen itself, and those arising from the jugular tubercle. Jugular tubercle meningiomas, therefore, represent an even smaller subset of an already uncommon location for meningiomas. The jugular tubercle is the upper surface of the lateral parts of occipital bone presents an oval eminence, which overlies the hypoglossal canal and is sometimes crossed by an oblique groove for the glossopharyngeal, vagus, and accessory nerves. Only eight cases in the anterior foramen magnum lesions excised by a far lateral retrosigmoid approach have been described. The aim of this video article is to describe the surgical approach the senior author used to access lesion involving the jugular tubercle.
Case Description: In this surgical video, we present a case of a 56-year-old female presented to our hospital with dizziness, headache, lower cranial nerves deficits, and lower limbs weakness. On exam, she was noted to have a left paraparesis, 9th, 10th, and 11th nerves palsies. An MRI scan demonstrated a mass in the region of the left jugular tubercle. Frozen section was suggestive of meningioma and our patient underwent a successful near total resection with no permanent neurologic sequelae.
Conclusion: Jugular tubercle meningiomas are one of the rarest subgroups of meningioma. The described modified retrosigmoid approach provides outstanding access to the entire ventrolateral brainstem and cerebellopontine angle, with reduced approach related morbidity.
Keywords: Jugular tubercle, Meningiomas, Retrosigmoid approach, Supracondylar
00:00 – Clinical presentation. 00:29 – preoperative imaging. 00:51 – Rational, Positioning, and surgical planning. 01:41 – Procedure video. 07:54 – Post operative imaging. 08:21 – surgical outcome and follow up
00:00 – Clinical presentation.
00:29 – preoperative imaging.
00:51 – Rational, Positioning, and surgical planning.
01:41 – Procedure video.
07:54 – Post operative imaging.
08:21 – surgical outcome and follow up
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
1. Elarjani T, Khairy S, Alsaleh S, Ajlan A. Endoscopic transnasal resection of an anterior planum sphenoidale meningioma. Surg Neurol Int. 2020. 11: 93
2. Hoshide R, Faulkner H, Teo M, Teo C. Keyhole retrosigmoid approach for large vestibular schwannomas: Strategies to improve outcomes. Neurosurg Focus. 2018. 44: E2
3. Jannetta PJ. Neurovascular compression in cranial nerve and systemic disease. Ann Surg. 1980. 192: 518-25
4. Matsushima K, Kohno M, Nakajima N. Hearing preservation in vestibular schwannoma surgery via retrosigmoid transmeatal approach. Acta Neurochir (Wien). 2019. 161: 2265-9
5. Nowak A, Dziedzic T, Czernicki T, Kunert P, Marchel A. Surgical treatment of jugular foramen schwannomas. Neurol Neurochir Pol. 2014. 48: 188-95
6. Pai SB, Raghuram G, Keshav G, Rodrigues E. Far-lateral transcondylar approach to anterior foramen magnum lesionsOur experience. Asian J Neurosurg. 2018. 13: 651-5