Original ArticleRectus Capitis Lateralis Muscle: A Cadaveric Study of a Key Surgical Landmark in the Posterior and Lateral Approaches to the Jugular Foramen
Introduction
The jugular process forms the posterior margin of the jugular foramen (JF) and is attached to the posterior half of the occipital condyle. The rectus capitis lateralis (RCL) is attached to the jugular process and it is 6.2 mm posterior to the internal carotid artery.1 The medial, lateral, and posterior surgical corridors are the most used surgical corridors in accessing tumors surrounding the JF. Infrequently the JF is approached endoscopically.2 The key in these approaches is the identification of a reliable surgical landmark to avoid injuries to critical adjacent neurovascular structures.3, 4 In this study, we describe the morphology of the RCL, its neurovascular relationships, and its utility as a surgical landmark in the posterior and lateral approaches to the JF.
Section snippets
Specimen Preparation and Anatomical Study
Eight cadaveric heads (16 sides) semifixed with formaldehyde were used for this study. The arteries and veins were washed and injected with red (arteries) and blue (veins) silicone (Dow Corning, Midland, Michigan, USA). The dissections were performed under 3–40× magnification Zeiss microscope (Carl Zeiss Co., Oberkochen, Germany). Posterior and lateral approaches were performed on all the cadaveric heads on both sides. Bone dissection was carefully performed with a high-speed drill (Medtronic,
The Morphology of RCL
The cranial end of the RCL approximates the roughly square shape of the bony prominence of jugular process (Figure 1). Conversely, the inferior end of the muscle is flat as it attaches to the transverse process of C1. In the 8 heads studied, the average craniocaudal length of the RCL was 21.3 mm (range 20–23 mm). The distance from the posterior margin to the anterior aspect of the RCL was 6.5 mm (range 6–7 mm) at the cephalad end where it inserts to the jugular process.
The Relationship
The RCL is located
Discussion
The list of the various approaches to the JF is as complex as its anatomy.2, 3, 4, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 The goal of the approaches is to control the VA, CNs VII-XII, and jugular−sigmoid complex. The workhorse of most of the JF tumors is the far lateral approach with its variants and or combination with the transmastoid approaches.20 The endoscopic endonasal approach is rarely used for primary JF tumors except for those that extend from the petroclival region to the
Conclusions
The RCL represents an important anatomic landmark for early identification of VA, IJV, facial nerve, and CNs IX–XII. It is the boundary between posterior and lateral approach to JF, typically the far lateral approaches and transmastoid approaches.
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Cited by (2)
The Jugular Process: A Key Anatomical Landmark for Approaches to the Jugular Foramen
2020, World NeurosurgeryCitation Excerpt :The protuberances are most likely produced by the muscular traction from the RCL. Any surgical manipulation beyond the lateral margin of the RCL and lateral occipital ligament may injure the facial nerve.17-19 The JP, lateral occipital ligament, and the RCL should be considered the transition or watershed area for safe preservation of the facial nerve in posterior approaches to the JF.
Anatomical study of a surgical approach through the neck to the jugular foramen under endoscopy
2021, Surgical and Radiologic Anatomy
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.