Anatomical features and landmarks of transcondylar fossa approach (supracondylar transjugular tubercle)
Background. Lateral surgical access to the posterior cranial fossa are well known and have been proven in the surgical treatment of a large group of ventral surface of the medulla oblongata and vertebral artery pathologies. However, the transcondylar fossa surgical access is gaining popularity and can be considered a modification of the classical transcondylar surgical access. One is preferred for surgical treatment of vertebral artery aneurysms, microvascular decompression of glossopharyngeal neuralgia, and intradural removal of lesions located in the jugular tubercle. Objective. To perform a comparative anatomical study of the craniovertebral junction region in the context of the group of lateral approaches to the posterior cranial fossa using anatomical and cadaveric specimen, to describe the main anatomical features and landmarks and the technique of transcondylar fossa access. Material and methods. The study was performed on 5 anatomical and 15 cadaveric specimens. Results. When performing transcondylar fossa surgical access, the condylar fossa, the posterior condylar canal and the posterior condylar eminence vein are used as the main anatomical landmarks. In the transcondylar fossa approach, in addition to the lateral partial suboccipital craniotomy (with or without possible additional atlas laminectomy), the fossa and the posterior part of the jugular tubercle are extradurally resected up to hypoglossal canal, which is a feature that distinguishes this surgical access from other lateral one to the posterior cranial fossa. Conclusion. A comparative anatomical study of the craniovertebral junction region in the context of the group of lateral surgical accesses to the posterior cranial fossa has been performed using anatomical and cadaveric specimen; the main anatomical features and landmarks and the technique of transcondylar fossa approach have been described. A weak point of this surgical access is insufficient visualizations of a group of pathologies located below the edges of the greater occipital foramen or lower medially to the vertebral artery. The main advantage of the transcondylar fossa approach consists in avoiding the injury to the atlanto-occipital joint, which is inevitable in the conventional transcondylar surgical access.