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  Indian J Med Microbiol
 

Figure 5: Intradural dissection of craniovertebral junction and jugular foramen. (a) Overview of dissection after the removal of occipital bone, spinous process, and lamina of cervical vertebrae. Jugular tubercle is removed on the left side to compare with exposure on the right side. Dura has been opened and excised from both cerebellum and cervical spine. The left side cerebellum is gently retracted exposing VII, VIII nerve complex entering internal acoustic meatus and IX, X, XI nerves entering jugular foramen. (b) Close-up view showing lower cranial nerves entering jugular foramen. Spinal part of XI nerve can be seen passing upward to jugular foramen. Denticulate ligament can be seen arising from cervical spine and getting attached to dura matter as shiny white structure. VA artery after entering dura passes forward to medulla where it is related to fascicles of XII nerve. Vertebral artery is enclosed in bony ring formed superior to the arch of atlas on the left side. (c) C2 ganglion can be seen in relation to atlantoaxial joint. (d) Unilateral view showing relation of C2 nerve, vertebral artery, and rectus capitis lateralis muscle. (e) C2 nerve is lifted to expose atlantoaxial joint. (f) Dissection done after the removal of jugular tubercle and some parts of supracondylar bone. Internal jugular vein is slightly displaced to expose IX, X, XI, and XII cranial nerves. Lateral dissection done to expose the extradural course of lower cranial nerves in relation to occipital condyle sigmoid sinus, vertebral artery, and rectus capitis lateralis muscle. C2 gang, C2 ganglion; Den lig, dentate ligament; IAM, internal acoustic meatus; IJV, internal jugular vein; RCLa, rectus capitis lateralis; Sp co, spinal cord; VA, vertebral artery

Figure 5: Intradural dissection of craniovertebral junction and jugular foramen. (a) Overview of dissection after the removal of occipital bone, spinous process, and lamina of cervical vertebrae. Jugular tubercle is removed on the left side to compare with exposure on the right side. Dura has been opened and excised from both cerebellum and cervical spine. The left side cerebellum is gently retracted exposing VII, VIII nerve complex entering internal acoustic meatus and IX, X, XI nerves entering jugular foramen. (b) Close-up view showing lower cranial nerves entering jugular foramen. Spinal part of XI nerve can be seen passing upward to jugular foramen. Denticulate ligament can be seen arising from cervical spine and getting attached to dura matter as shiny white structure. VA artery after entering dura passes forward to medulla where it is related to fascicles of XII nerve. Vertebral artery is enclosed in bony ring formed superior to the arch of atlas on the left side. (c) C2 ganglion can be seen in relation to atlantoaxial joint. (d) Unilateral view showing relation of C2 nerve, vertebral artery, and rectus capitis lateralis muscle. (e) C2 nerve is lifted to expose atlantoaxial joint. (f) Dissection done after the removal of jugular tubercle and some parts of supracondylar bone. Internal jugular vein is slightly displaced to expose IX, X, XI, and XII cranial nerves. Lateral dissection done to expose the extradural course of lower cranial nerves in relation to occipital condyle sigmoid sinus, vertebral artery, and rectus capitis lateralis muscle. C2 gang, C2 ganglion; Den lig, dentate ligament; IAM, internal acoustic meatus; IJV, internal jugular vein; RCLa, rectus capitis lateralis; Sp co, spinal cord; VA, vertebral artery