A skull base extradural hypoglossal neurilemmoma resected via an extended posterolateral approach

The case of a 43-year-old man with a right skull base hypoglossal neurilemmoma excised via the extended posterolateral approach is presented. There is only one previous case of hypoglossal neurilemmoma in the literature. The surgical technique described is a new approach to the posterior skull base involving a suboccipital craniectomy, mastoidectomy and the removal of the lateral process of the atlas. It provides an inferior approach to the jugular foramen and hypoglossal canal that allows the lower cranial nerves to be identified as they exit from their skull base foraminae. In the discussion we compare this technique to other surgical approaches previously described for access to the region of the jugular foramen.