Commentary “Surgical Approaches to the Hypoglossal Canal”

Calzada and colleagues provide a practical review of three surgical approaches for pathology in the hypoglossal canal region. Although it is useful to compartmentalize each approach to a given tumor location, the reader must keep in mind that larger tumors such as giant intra- and extradural tumors of the skull base may require use of combination approaches, which may occur over a single or multiple stages. Moreover, the authors point out that large extra- and intradural dumbbell-shaped lesions may require combined approaches. Notably, they also contend that for asymmetric dumbbell lesions in which only the larger lobule is symptomatic, the approach solely for the larger lesion can be selected, with close monitoring or stereotactic radiosurgery considered for the smaller lobe. Given the potential for morbidity using these procedures, even in the best of hands, this strategy is a reasonable one as well. These tumors emphasize the importance of team-based neurotology and neurosurgery approaches.