Comparison of Anterior Endoscopic Transnasal Approach and Lateral Microsurgical Approach to the Jugular Foramen: An Anatomical Study

Objective: The jugular foramen is one of the most challenging surgical regions in the skull base surgery. With the development of endoscopic skull base surgery, endoscopic endonasal approach has been undertaken to treat some lesions in this area independently or combined with open approaches. The purpose of current study is to explore the endoscopic transnasal approach to the jugular foramen and compare it with lateral microsurgical approach.

Methods: fifteen bony structures related to the jugular foramen were measure in thirty three cases of adult dry skull. Six silicon-injected adult cadaveric heads (12 sides) were dissected performing an endoscopic endonasal approach and lateral infratemporal fossa approach (type A). The jugular foramen was exposed; detailed related landmarks were demonstrated. High-quality pictures were obtained.

Results: The distances and angles data of the bone structures related to the jugular foramen were obtained. Infratemporal fossa approach type A can expose the jugular foramen from the lateral perspective. Endoscopic transnasal transmaxillary-infratemporal fossa-petrosal approach can expose the jugular foramen. In endoscopic approach dissection and transposition of facial nerve can be avoided, but to adequate expose the jugular foramen the internal carotid artery may be need to be dissected and displaced. Important anatomic landmarks in endoscopic approach include: internal carotid artery, inferior petrosal sinus, petroclival fissure, styloid process, sphenoid spine, foramen spinosum as well as ascending pharyngeal artery.

Conclusion: A deeply understanding of the complex anatomy of the jugular foramen is paramount for the safely and effectively surgically dealing with lesions located within and adjacent to the jugular foramen. Both endoscopic transnasal approach and microsurgical approach to the jugular foramen have advantages and limitations.