2025 Poster Presentations
P078: EXOCRANIAL & INTRACRANIAL ANATOMY OF THE JUGULAR TUBERCLE: AN ENDOSCOPIC ENDONASAL APPROACH PROJECTION
Erik Burgos-Sosa, MD1; Jose J. Julian-Mendoza, MD1; J. Stephan Sanchez-Torrijos, AF2; Lorena Valencia-Caballero, MD2; Mario A. Taylor-Martínez, MD1; Agustín Dorantes-Argandar, MD, FAANS1; 1Skull Base & Minimally Invasive Neurosurgery, Hospital Angeles Pedregal, Mexico City; 2Department of Anatomy, National Autonomous University of Mexico
Background: The surgical anatomy of the jugular tubercle has been previously described in the literature, accompanied by some morphometric descriptions. Some previous descriptions make some relevance to the jugular tubercle approach via endoscopic endonasal approach, with anatomical descriptions of the dorsal Jugular Tubercle (dJT), with scarcity in relation to the ventral Jugular Tubercle (vJT) during visualization of an Endoscopic Endonasal Approach (EEA). In addition, it can be difficult to delimit during an EEA to the lower clivus, or it can be misunderstood due to a miss conceptualization of the key landmarks in the ventral clivus.
Methods: Specimens were obtained from the anthropology department of the Faculty of Medicine of the National Autonomous University of Mexico, and the Surgical Neuroanatomy Laboratory of the University La Salle, Mexican Faculty of Medicine. The specimens were used to get a stereoscopic visualization of the jugular tubercle, with the limits of an endoscopic visualization. Kirshners wires were applied from an endocranial projection to get the approximation limits of the JT from an EEA visualization (Ventral perspective).
Results: For the register of the anatomical limits and osseous relations, 4 skulls were used with a craniotomy site on the temporal and occipital portion to get the relation of the dorsal and ventral jugular tubercle. The four skulls used, were with the absence of the calvaria to get the better appreciation with an oblique projection between the exocranial and endocranial jugular tubercle for a better understanding of the anatomy. On the one cadaveric specimen, the jugular tubercle was visualized with an endocranial visualization after completing the approach of EEA to the lower clivus and was correlated with some anatomical osseous landmarks. The stilettos were applied in the cadaveric specimen, visualized, and correlated with the anatomical osseous landmarks. In each endocranial (dJT) and exocranial projection (vJT), the limits of the Jugular Tubercle were defined.
Conclusions: The advantages of delimiting the jugular tubercle from a ventral perspective will facilitate and enhance the EEA to the lower clivus and adjacent areas which could reduce the risk to damage of neurovascular structures. The ventral jugular tubercle visualized from an extracranial projection represents a different osseous prominence from the dorsal jugular tubercle visualized from an intracranial visualization.