Surgery on a saccular vertebral artery—posterior inferior cerebellar artery aneurysm via the transcondylar fossa (supracondylar transjugular tubercle) approach or the transcondylar approach: surgical results and indications for using two different lateral skull base approaches

Abstract

Both approaches offer excellent visualization and a wide working field, with ready access to the lesion. This remarkably reduces the risk of development of postoperative deficits. These approaches should be used properly; the transcondylar fossa approach is indicated for aneurysms located above the hypoglossal canal and the transcondylar approach is indicated for those located below it.

Supracondylar transjugular tubercle approach to intradural lesions anterior or anterolateral to the craniocervical junction without resection of the occipital condyle

“…The condylar fossa superior to the posterior condylar canal, which is the posterior portion of the jugular tubercle, is drilled extradurally and removed with the canal in sight as an anatomic landmark (13)(14)(15)(16). The key point of our preferred approach is the bony removal along the canal anteriorly resulting in removing the posterior part of the jugular tubercle and the atlanto-occipital joint can be kept intact (13,15).…”

“…Matsushima et al (13) in 1996, first proposed the supracondylar transjugular approach, which can also be called the transcondylar fossa approach. They has applied this approach to surgery for VA-PICA aneurysm (15,16), microvascular decompression for glossopharyngeal neuralgia (14,15), and removal of intradural tumors around the jugular tubercle or the hypoglossal canal (9). Gilsbach et al (8) also reported the supracondylar approach as a minimally invasive extradural approach.…”

“…Perneczky's posterolateral approach (19) and Salas' retrocondylar approach (21) are also almost similar to the transcondylar fossa approach. The most important point, when applying the supracondylar transjugular approach is drilling of the condylar fossa, namely, the posterior portion of the jugular tubercle extradurally and the the atlanto-occipital joint should kept intact (13)(14)(15)(16). The posterior condylar canal and the emissary vein in the canal both play an important role as intraoperative anatomic landmarks differentiating the jugular tubercle and the occipital condyle from outside (15).…”

“…The posterior condylar canal and the emissary vein in the canal both play an important role as intraoperative anatomic landmarks differentiating the jugular tubercle and the occipital condyle from outside (15). The supracondylar transjugular approach provides an entire view of the cerebellomedullary cistern including the VA, the anterior and lateral medullary segments of the PICA, and the cisternal portion of the 9th, 10th, 11th and 12th cranial nerves (13)(14)(15)(16). Furthermore, when the cerebellomedullary fissure is dissected, the surgical field becomes larger and the lateral part of the fourth ventricle can be exposed (13,15).…”

“…It not only offered good control of the vertebral artery proximal to the aneurysm but also gave good access to the distal portion of the artery up to the vertebrobasilar junction (15,16). Both Bertalanffy et al (5), who used the transcondylar approach, and Matsushima et al (13)(14)(15)(16), who used the transcondylar or transcondylar fossa approach, reported that operative morbidity and mortality were relatively low. Matsushima also noted (16) that surgical approach for VA aneurysms depended on the locations of aneurysms, when an aneurysm was located in the midline or below the hypoglossal canal, the transcondylar approach was preferred.…”