Jugular tubercle: morphometric analysis and surgical significance

Apostolos Mintelis Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina

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 M.D., Ph.D.
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Tetsuro Sameshima Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina

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Ketan R. Bulsara Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina

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Linda Gray Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina

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Allan H. Friedman Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina

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Takanori Fukushima Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina

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 M.D., D.M.Sc.
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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.

Abbreviations used in this paper:

CT = computed tomography; ELITE = extreme lateral infrajugular transcondylar–transtubercular exposure; JT = jugular tubercle; 3D = three-dimensional.
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