Surgical approaches to the hypoglossal canal

Objective: To describe and illustrate three distinct surgical approaches that permit exposure and resection of extradural, intradural, and transdural lesions involving the hypoglossal canal. Study design: Case series. Setting: University medical center. Patients: Four patients with lesions of the hypoglossal canal were reviewed to illustrate our philosophy when selecting a surgical approach to the hypoglossal canal. Interventions: Three separate surgical approaches were used to approach lesions involving various segments of the hypoglossal canal. Main outcome measures: Initial clinical presentation, tumor type, treatment course, complications and functional outcomes of hearing, lower cranial nerves, and great vessels. Results: A modified pre- and postauricular infratemporal fossa approach was used to permit the complete resection of an extradural hypoglossal canal schwannoma. The far lateral approach was used to remove a posterior fossa meningioma that involved the intradural hypoglossal canal. A transjugular cramotomy was used to resect a jugulotympanic paraganglioma with transdural hypoglossal canal involvement. Postoperatively, there were no major complications. However, one patient had cerebrospinal. fluid rhinorrhea that resolved with lumbar subarachnoid drainage and another had a pseudomeningocele that resolved spontaneously. Dysphagia was not observed in any patient and all were discharged within 1 week of surgery. All patients are free of recurrence by clinical and radiographic examination with at least 2 years of follow-up. Conclusions: Lesions of the hypoglossal canal can be safely and effectively resected using the appropriate skull base approach. The three skull base approaches described herein provide access to selected portions of the hypoglossal canal and allow for preservation of hearing, the lower cranial nerves, and great vessels.