AE: Arcuate eminence; IAC: Internal acoustic canal; IPS: Inferior petrosal sinus; JF: Jugular foramen; JT: Jugular tubercle; SMT: Suprameatal tubercle ; SPS: Superior petrosal sinus ; TI: Trigeminal impression.

Circumscribed lesions of the hypoglossal canal and of the jugular tubercle still remain a surgical challenge. So far, transpetrosal, transcondylar suboccipital, and extreme lateral approaches have been used to access this region. These surgical procedures bear a high risk for neurological deficits. Therefore, Gilsbach et al introduce a new minimally invasive extradural approach to the hypoglossal canal that also allows access to the lateral aspects of the jugular tubercle.