ORIGINAL ARTICLE
Morphometry of the Hypoglossal Canal, Occipital
Condyle, and Foramen Magnum
Emine Dondu Kizilkanat,* Neslihan Boyan,* Roger Soames,w and Ozkan Oguz*
Abstract: The present study was undertaken to determine the
detailed morphometry of occipital condyle (OC), hypoglossal
canal (HC), and foramen magnum (FM) in Turkish–Caucasian
skulls: measurements were taken from 59 dry skulls of unknown
sex. There was no significant difference (P>0.05) in measure-
ments taken from the right and left sides, consequently the
overall means and associated standard deviations were calcu-
lated. The length of the HC was 9.9 ± 1.9 mm and the HC
intracranial and extracranial diameters were 6.5 ± 1.3 mm and
6.6 ± 1.1 mm, respectively, with the angle of the HC to the
sagittal plane being 45.6 ± 4.6 degrees. The distances from the
intracranial and extracranial ends of HC to the jugular foramen
were 13.3 ± 3.3 mm and 8.4 ± 2.0 mm, respectively, whereas the
distances from the HC to the jugular tubercle, opisthion and
basion were 12.2 ± 2.2 mm, 29.2 ± 2.6 mm, and 16.5 ± 1.8 mm,
respectively. The distances from the intracranial end of the HC to
the posterior, anterior, inferior margins of the OC were
12.3 ± 2.4 mm, 11.2 ± 1.6 mm, and 9.4 ± 1.2 mm, respectively.
The anteroposterior length and transverse width of the OC were
24.5 ± 2.5 mm and 13.1 ± 1.6 mm, and the angle of the OC to the
sagittal plane 31.5 ± 5.1 degrees; the mean sagittal intercondylar
angle was 62.2 degrees. The anterior and posterior intercondylar
distances were 22.6 ± 3.9 mm and 44.2 ± 3.2 mm. The antero-
posterior and transverse diameters of the FM were 34.8 ± 2.2 mm
and 29.6 ± 2.4 mm, giving a mean FM index of 1.2. The presence
or absence of a septum in the HC, protrusion of OC into the FM
and the presence of condylar foramen were also determined.
Detailed morphometric analysis will help in the planning of
surgical intervention involving the skull base safer and easier.
Key Words: hypoglossal canal, foramen magnum, occipital
condyle, morphometry
(Neurosurg Q 2006;16:121–125)
T he base of the skull is an important area in terms of
both its anatomy and surgery. The foramen magnum
(FM) lies in the center of the skull base and through it
passes the medulla oblongata and surrounding meninges,
From the *Department of Anatomy, Faculty of Medicine, Cukurova
University, Balcali-Adana, Turkey; and wJames Cook University,
School of Veterinary and Biomedical Sciences, Townsville, Australia.
Reprints: Prof Dr Ozkan Oguz, Department of Anatomy, Faculty of
Medicine, Cukurova University, 01330 Balcali-Adana, Turkey
(e-mail: ozoguz@cu.edu.tr).
Copyright r 2006 by Lippincott Williams & Wilkins
Neurosurg Q  Volume 16, Number 3, September 2006
with the spinal roots of the accessory nerve and the
vertebral arteries. The occipital condyles (OC) are
anterolateral to the FM and participate in the articulation
of the skull with the cervical vertebral column.1,2 Current
data, obtained from morphometric studies, on the
anatomic and biomechanical properties of the craniover-
tebral junction, have made surgical intervention in the
region safer.3,4 The hypoglossal canal (HC) is located on
the OC and at the anterolateral border of the FM1: it is
not only important as a part of the occipital bone but also
in evolutionary terms. Divisions of the HC support the
basioccipital bone theory, which states that the formation
of basioccipital bone is by the union of 3 or 4 previously
separate vertebrae. According to this theory, the HC
reflects the union of the intervertebral foramen.5,6 The
HC is surrounded by cortical bone and transmits the
hypoglossal nerve, the meningeal branch of the ascending
pharyngeal artery and a venous plexus which provides
communication between the basilar venous plexus and the
marginal sinus.7 To avoid damage during surgical
intervention, a knowledge of the embryological develop-
ment of this region is equally as important as a knowledge
of the morphometry. Variations in the anatomy of this
region can best be understood and appreciated from an
embryologic viewpoint.6
Conditions such as FM tumors, HC nerve lesions,
and vertebral artery lesions are particularly important as
they present at a risky site. A sound knowledge of the
morphometry of this area can provide important benefits
in determining safe surgical zones during surgical
procedures such as transcondylar, supracondylar, and
lateral suboccipital approaches.7,8,9 Thus, a preoperative
morphometric analysis of the FM, OC, and HC will
enable the surgeon to choose the most appropriate
surgical technique and approach to be employed. The
aim of the present study is to determine and define the
detailed anatomy of the FM, OC, and HC for use in
surgical intervention in this region.
MATERIALS AND METHODS
Measurements from 59 adult Turkish skulls of
unknown sex were undertaken in this study. Twenty
parameters (distances and angles) were measured using
standard calipers and a goniometer: all measurements
were undertaken using the protocols of Muthukumar
et al3 and Naderi et al.4 The distances measured were:
the length, intracranial and extracranial diameters of the
HC; the distances between the intracranial end of the HC
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protrusion of the OC into the FM, and the presence of a

condylar foramen (CF).

FIGURE 1. Illusturation of the HC. A, Distance of the
intracranial end of the HC to the anterior margin of the OC.
B, Distance of the intracranial end of the HC to the posterior
margin of OC. C, Anterior intercondylar distance. D, Posterior
intercondylar distance.
to the anterior, posterior, and inferior margins of the OC
and to the jugular foramen (JF); the distances between the
HC and the jugular tubercle (JT), basion and opisthion,
and the anteroposterior and transverse lengths of the OC;
and the anterior and posterior intercondylar distances
(Fig. 1); the anteroposterior and transverse widths of the
FM; the angles from the sagittal plane of the long axes of
the HC and OC; and the sagittal intercondylar angle. A
FM index was calculated from the anteroposterior and
transverse diameters of the FM. In addition, the presence
of a septum associated with the HC was noted, as was any
RESULTS
The range, mean, and associated standard deviation
of measurements taken from the right and left HC and
OC, together with those of the FM are presented in
Table 1. There was no significant difference (P>0.05) in
the mean values for measurements made bilaterally,
consequently the means and standard deviations of the
bilateral measurements were calculated. The overall
means and standard deviations of the HC dimensions
are as follows: HC length 9.9 ± 1.9 mm, HC intracranial
diameter 6.5 ± 1.3 mm, HC extracranial diameter
6.6 ± 1.1 mm, and the angle of the HC to the sagittal
plane was 45.6 ± 4.6 degrees. The overall mean distance
of the intracranial end of the HC to the JF was
13.3 ± 3.3 mm, of the extracranial end of the HC to the
JF was 8.4 ± 2.0 mm, of the HC to the JT was
12.2 ± 2.2 mm, of the HC to the opisthion
was 29.2 ± 2.6 mm, and of the HC to the basion was
16.5 ± 1.8 mm. The overall mean distance of the intra-
cranial end of the HC to the posterior margin of the
OC was 12.3 ± 2.4 mm, of the intracranial part of the HC
to the anterior margin of the OC was 11.2 ± 1.6 mm,
and of the intracranial end of the HC to the inferior
margin of the OC was 9.4 ± 1.2 mm. For the OC the
overall means and standard deviations were as follows:
anteroposterior length 24.5 ± 2.5 mm and transverse
width 13.1 ± 1.6 mm. The overall mean angle of
the OC to the sagittal plane was 31.5 ± 5.1 degrees. The
sagittal intercondylar angle was 62.2 ± 9.1 degrees,
the FM anteroposterior and transverse diameters were

TABLE 1. The Results of Measured HC, OC, FM

Minimum Maximum Mean ± SD
Variables (n: 59) Left Right Left Right Left Right
Length of HC (mm) 5.6 6.0 15.2 16.4 10.0 ± 1.9 9.8 ± 1.8
Diameter of the intracranial end of HC (mm) 4.1 4.3 9.6 11.1 6.4 ± 1.1 6.5 ± 1.4
Diameter of the extracranial end of HC (mm) 4.1 4.4 9.6 9.1 6.6 ± 1.1 6.5 ± 1.0
Angle of the HC to the sagittal plane (degrees) 30 36 55 57 45.1 ± 4.5 46.0 ± 4.2
Distance of the intracranial end of HC to the JF (mm) 5.2 7.3 20.4 21.2 13.1 ± 3 13.5 ± 3.2
Distance of the extracranial end of HC to the JF (mm) 5.4 5.4 15.8 16.9 8.2 ± 1.9 8.6 ± 1.9
Distance between HC and JT (mm) 5.1 6.7 17.5 17.5 12.2 ± 2.2 12.2 ± 2
Distance between HC and opisthion (mm) 21.9 24.1 34.2 37.6 29.1 ± 2.4 29 ± 2.6
Distance between HC and basion (mm) 12.1 12.1 19.7 23.7 16.4 ± 1.6 16.6 ± 1.8
Distance of the intracranial end of HC to the posterior margin of OC (mm) 8.4 8.2 17.6 17.4 12.4 ± 2.3 12.2 ± 2.2
Distance of the intracranial end of HC to the anterior margin of OC (mm) 8.2 8.1 16.9 16.9 11.3 ± 1.5 11.0 ± 1.6
Distance of the intracranial end of HC to the inferior margin of OC (mm) 6.5 6.8 11.8 12.2 9.3 ± 1.2 9.4 ± 1.1
Anteroposterior length of OC (mm) 18.2 19.7 31.1 30.7 24.6 ± 2.5 24.4 ± 2.2
Transverse width of the OC (mm) 10.1 10.3 17.2 16.9 13.1 ± 1.6 13 ± 1.5
Angle of the OC to the sagittal plane (degrees) 15 16 44 42 31.3 ± 4.8 31.6 ± 4.9
Sagittal intercondylar angle (degrees) 31 78 62.2 ± 9.1
Anterior intercondylar distance (mm) 15 32 22.6 ± 3.9
Posterior intercondylar distance (mm) 33 50 44.2 ± 3.2
Anteroposterior diameter of the FM (mm) 29.7 39.7 34.8 ± 2.2
Transverse diameter of the FM (mm) 24.4 38.6 29.6 ± 2.4
Index of FM 1 1.3 1.2 ± 0.1
Mean ± SD indicates mean ± standard deviation.

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Neurosurg Q  Volume 16, Number 3, September 2006
TABLE 2. Frequencies and Percentages of the Presence of a Septum in the HC, Protrusion of the OC into the FM, and Presence
of a Condylar Foramen
Septum of the HC
L R n %
32 54.2
+ 15 25.4
+ 7 11.9
+ + 5 8.5
L indicates left; R, right.
34.8 ± 2.2 mm and 29.6 ± 2.4 mm, respectively, and the
FM index was 1.2 ± 0.1.
There was no septum present in the HC on either
side in 54.2% of the sample, a septum on the left in
25.4%, on the right in 11.0%, and on both sides in 8.5%
(Table 2). In 66.1%, there was no protrusion of the OC
into the FM on either side, protrusion on the left side in
3.4%, on the right side in 5.1%, and on both sides in
25.4% (Table 2). The presence of a CF was observed on
both sides in 49.1%, on the left side in 17%, on the right
side in 8.5%, and on neither side in 25.4% (Table 2).
DISCUSSION
A detailed knowledge and understanding of the
morphometry of the skull base is a prerequisite for
surgical intervention in this region, especially in relation
to the transcondylar approach and its variations. Many
surgical approaches are associated with a high mortality
and morbidity when undertaken without detailed mor-
phologic analysis.9,10 Therefore, for improvements in
surgical technique and the facilitation of safe surgical
approaches to the skull base, a detailed morphometric
analysis of the presenting anatomy must be undertaken
and assessed.
Knowing the precise location of the HC is
important in understanding of the spatial relationships
of surrounding structures, and in the resection of tumors
lying close to or within the canal itself. In addition, when
drilling into the OC it is important for the surgeon to
anticipate the possible depth and direction of the HC.10 In
the present study, the mean length of the HC was 9.9 mm,
the mean intracranial diameter 6.5 mm, and the mean
extracranial diameter 6.6 mm. These measurements differ
from those of Muthukumar et al3 (12.6, 7.2, and 7.9 mm,
respectively). The mean length of the HC was reported by
Hadley and Shelton11 (11.2 mm), Berlis et al12 (7.78 mm).
The mean intracranial diameter 4.66 mm and the mean
extracranial diameter 5.51 mm was reported by Berge and
Bergman.13 These differing results probably reflect racial
differences in the populations studied. The mean sagittal
plane angle of the hypoglossal in the present study is 45.6
degrees, a figure similar to the angle of 45 degrees of Wen
et al7 and 44.9 degrees of Berlis et al,12 but less than the 49
degrees of Muthukumar et al.3 Nevertheless, these
findings suggest that there are similarities as well as
r 2006 Lippincott Williams & Wilkins
Morphometric Analysis of Skull Base
Protrusion of the OC into FM Presence of CF
n % n %
39 66.1 15 25.4
2 3.4 10 17
3 5.1 5 8.5
15 25.4 29 49.1
differences, between races. The findings on the mean
distance of the intracranial part of HC to the posterior,
anterior, and inferior margins of the OC (12.3, 11.2, and
9.4 mm, respectively) differ slightly from the values
reported by Muthukumar et al3 (12.2, 12.6, and
11.9 mm, respectively). Given the above observations, it
is suggested that surgical approaches to the HC may be
undertaken to within 10.8 mm anterior to and 9 mm
inferior to the OC: in contrast Muthukumar et al,3
suggested a minimum distance of 12 mm to the OC to be a
safe surgical zone. The difference in lengths and distances
between studies is measured in millimeters; therefore,
during surgical intervention these small variations must
be borne in mind. Notwithstanding these suggestions the
detailed individual anatomy of this region should be
assessed using morphometric methods prior surgical
intervention.
The mean distances between the intracranial and
extracranial ends of the HC and the JF in the present
study were greater than the values reported by Muthu-
kumar et al3 (13.3 mm and 10.0 mm from the intracranial
end, and 8.4 mm and 5.0 mm from the extracranial end,
respectively). The differences probably reflect the greater
length of the HC reported by Muthukumar et al.3
The JT lies medially on the inferior part of the
petrooccipital sulcus overlaying the HC on the medial
edge of the JF.7 It has been reported that by removing the
JT a gap can be created, sufficient for the surgical
manipulation of neurinomas, epidermoid cysts, or similar
noninvasive lesions,8 without the need to drill into the
petrous part of the temporal bone. Consequently, data on
the distance between the JT and the HC are of clinical
importance. In the present study this distance was
12.2 mm, similar to the value of 11.7 mm reported by
Muthukumar et al.3 The clinical and surgical importance
of this distance in the drilling of the JT has been
emphasized.3,14 The distance between the HC observed
here was 29.2 mm, whereas Muthukumar et al3 found it to
be slightly less (27.5 mm).
The HC can be partially or completely divided by a
bony septum: the importance of a complete septum is that
it separates the canal into 2 parts and has implications for
surgery involving the HC.10,15 Of the skulls examined in
the present study, in 54.2% there was no septum present
in the HC, whereas 11.9% had septum on the right only,
25.4% on the left only, and 8.5% had bilateral septum.
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Kizilkanat et al
The percentages of skulls having a septum on the right
side only and of bilateral septa are similar to those
reported by Bastianini et al5 and Hauser et al,6 however,
both reported a higher percentage of skulls with no septa
(66.2% to 77.8%5 depending on race and sex and 66.2%6)
and a lower percentage with a septum on the left side only
(9.6% to 14.3%5 depending on race and sex and 17.7%6).
The entry positions of the hypoglossal nerve
fascicles into the canal, their course within the canal
and that where within the distal part of the canal they
approach each other to become a single fiber is a practical
importance for the surgeon. A venous plexus and the
meningeal branch of the ascending pharyngeal artery are
also contents of the canal and their position also needs to
be known. Venous bleeding may occur when trying to
avoid compressing the hypoglossal nerve: this is often
difficult as the venous plexus is usually the initially
structure encountered when entering the canal. The close
association of the HC with other hemostatic structures
material is potentially hazardous.10 It is, therefore, clear
that knowledge of the possible positions of the HC when
drilling into the occipital bone is extremely important
during surgical intervention.
When OC resection and/or a lateral approach to the
FM is required, an intimate knowledge of the dimensions
of the condyle is a necessary for a safe resection to
be undertaken.3,4,9 In the present study, the mean
anteroposterior length of the OC was 24.5 mm, a value
larger than those reported by Muthukumar et al3
(23.6 mm), Naderi et al4 (23.4 mm), and Wanebo and
Chicoine9 (23.0 mm), whereas the mean transverse width
was 13.1 mm was less than that reported by Muthukumar
et al3 (14.7 mm). The mean sagittal plane angle of the OC
in the present study was 31.5 degrees, with the sagittal
intercondylar angle (62.2 degrees) being similar to that
observed by Naderi et al4 (59.3 degrees). In the present
study, the anterior and posterior intercondylar distances
were 22.6 mm and 44.2 mm, respectively: Naderi et al4
reported distances of 21 mm and 41.6 mm, respectively.
The lengths, widths, and the sagittal angles of the
OC, together with the intercondylar distances are
important when determining the quantity of bone to
removed during resection16: less bone will need to be
removed in individuals with a wide intercondylar gap
and more bone with a smaller intercondylar gap. There-
fore, if condylar resection is to be undertaken the location
of the HC and the sagittal OC angle must both be taken
into consideration.
Lesions involving the FM pose special problems due
to its deep location and the many associated structures:
medulla oblongata and spinalis, upper spinal nerves,
vertebral artery and its branches, veins and dural sinuses,
as well as the atlas, axis, and occipital bone all of which
have important ligamentous and muscular attachments.
These features and factors must all be reviewed during the
surgical planning process owing to their close relationship
to the FM. Anterior or posterior approaches can be used
to access the FM, with the posterior approach generally
chosen for intradural lesions and the anterior approach
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Neurosurg Q  Volume 16, Number 3, September 2006
for extradural lesions in front of the FM.7,9,14,15,17
The anteroposterior (34.8 mm) and transverse (29.6 mm)
diameters of the FM reported in this study are
similar to those reported by Muthukumar et al3
(33.3 mm and 27.9 mm), Naderi et al4 (anteroposterior
distance 34.7 mm), Wanebo and Chicoine9 (36.0 mm and
31.0 mm), Berge and Bergman13 (33.8 mm and 28.3 mm),
de Olivera et al15 (34.5 mm and 29.4 mm). When the FM
index is greater than 1.2 the FM is oval in shape3: in the
present study the mean FM index was 1.2. The shape of
FM is important in determining the amount of bone to be
removed, as too much may encroach on the OC and HC.
The transcondylar approach is suitable for patients with a
small FM as the gap between foramen and brain stem is
small.9 Knowledge of the FM index is, therefore,
important in determining which surgical technique to use.
In the present study, 66.1% of the skulls showed no
protrusion of the OC into the FM, 5.1% showed
protrusion on the right side only, 3.4% on the left side
only, and 25.4% had bilateral protrusions. Muthukumar
et al3 reported that 20% of skulls examined had
significant protrusions into the FM. Because of the need
to remove a greater amount of bone when the OC
protrudes into the FM the transcondylar approach is not
appropriate in such individuals.3 A condylar fossa may be
present running anteromedially from the posterolateral
side of the OC: it may transmit an emissary in which case
it communicates with the sigmoid sinus it transmits
complete through which passes an emissary vein, which in
turn communicates with the sigmoid sinus. There may be
one or more such CF on each side or merely blind ending
condylar fossae.3,13,15,18 In the present study, 25.4% of
the skulls had showed no CF, 8.5% had one on the right
side only, 17% on the left side only, and 49.1% showed
CF bilaterally. Muthukumar et al3 observed CF in 60%
of skulls examined, Berge and Bergman13 in 72%, and de
Oliveira et al15 in 80% on the left and 72% on the right.
In this study, a morphometric analysis of the FM,
OC, and HC in skulls of Turkish origin has been
undertaken. Comparison with other studies shown both
similarities and differences in the measurements taken
were observed, highlighting the need to be aware of racial
differences in some measurements. The data presented
here will provide additional information on the complex
morphology of this region of the base of the skull, which
will help in reducing the mortality and morbidity during
surgical intervention.
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