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Erschienen in: Acta Neurochirurgica 9/2017

22.07.2017 | How I Do it -Neurosurgical Anatomy

The midline suboccipital subtonsillar approach to the cerebellomedullary cistern: how I do it

verfasst von: Stephan Herlan, Florian Roser, Florian H. Ebner, Marcos Tatagiba

Erschienen in: Acta Neurochirurgica | Ausgabe 9/2017

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Abstract

Background

Lesions lateral to the lower brainstem in an area extending from the foraminae of Luschka to the foramen magnum are rare and include different pathologies. There is no consensus on an ideal surgical approach.

Method

To gain access to this area, we use the midline suboccipital subtonsillar approach (STA). This midline approach with unilateral retraction of the cerebellar tonsil enables entry into the cerebellomedullary cistern.

Conclusions

The STA offers excellent access with a panoramic view of the cerebellomedullary cistern and its structures and therefore can be useful for a number of different pathologies in the lower petroclival area.
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Literatur
1.
Zurück zum Zitat D’Ambrosio AL, Kreiter KT, Bush CA, Sciacca RR, Mayer SA, Solomon RA, Connolly ES Jr (2004) Far lateral suboccipital approach for the treatment of proximal posteroinferior cerebellar artery aneurysms: surgical results and long-term outcome. Neurosurgery 55:39–54PubMed D’Ambrosio AL, Kreiter KT, Bush CA, Sciacca RR, Mayer SA, Solomon RA, Connolly ES Jr (2004) Far lateral suboccipital approach for the treatment of proximal posteroinferior cerebellar artery aneurysms: surgical results and long-term outcome. Neurosurgery 55:39–54PubMed
2.
Zurück zum Zitat Han S, Wang Z, Wang Y, Wu A (2013) Transcerebellomedullary fissure approach to lesions of the fourth ventricle: less is more? Acta Neurochir 155:1011–1016CrossRefPubMed Han S, Wang Z, Wang Y, Wu A (2013) Transcerebellomedullary fissure approach to lesions of the fourth ventricle: less is more? Acta Neurochir 155:1011–1016CrossRefPubMed
3.
Zurück zum Zitat Herlan S, Ebner FH, Nitz A, Hirt B, Tatagiba M, Roser F (2014) The midline suboccipital subtonsillar approach to the cerebellomedullary cistern and its structures: anatomical considerations, surgical technique and clinical application. Clin Neurol Neurosurg 125:98–105CrossRefPubMed Herlan S, Ebner FH, Nitz A, Hirt B, Tatagiba M, Roser F (2014) The midline suboccipital subtonsillar approach to the cerebellomedullary cistern and its structures: anatomical considerations, surgical technique and clinical application. Clin Neurol Neurosurg 125:98–105CrossRefPubMed
4.
Zurück zum Zitat Jean WC, Abdel Aziz KM, Keller JT, van Loveren HR (2003) Subtonsillar approach to the foramen of Luschka: an anatomic and clinical study. Neurosurgery 52:860–866CrossRefPubMed Jean WC, Abdel Aziz KM, Keller JT, van Loveren HR (2003) Subtonsillar approach to the foramen of Luschka: an anatomic and clinical study. Neurosurgery 52:860–866CrossRefPubMed
5.
Zurück zum Zitat Krayenbuhl N, Guerrero C, Krisht AF (2005) Technical strategies to approach aneurysms of the vertebral and posterior inferior cerebellar arteries. Neurosurg Focus 19:E4CrossRefPubMed Krayenbuhl N, Guerrero C, Krisht AF (2005) Technical strategies to approach aneurysms of the vertebral and posterior inferior cerebellar arteries. Neurosurg Focus 19:E4CrossRefPubMed
6.
Zurück zum Zitat Roser F, Ebner FH, Schuhmann MU, Tatagiba M (2013) Glossopharyngeal neuralgia treated with an endoscopic assisted midline suboccipital subtonsillar approach: technical note. J Neurol Surg A Cent Eur Neurosurg 74:318–320PubMed Roser F, Ebner FH, Schuhmann MU, Tatagiba M (2013) Glossopharyngeal neuralgia treated with an endoscopic assisted midline suboccipital subtonsillar approach: technical note. J Neurol Surg A Cent Eur Neurosurg 74:318–320PubMed
7.
Zurück zum Zitat Roux A, Mohr G, Hardy J (1990) Vertebro-PICA aneurysms: midline suboccipital approach and laminectomy of the atlas. Br J Neurosurg 4:113–121CrossRefPubMed Roux A, Mohr G, Hardy J (1990) Vertebro-PICA aneurysms: midline suboccipital approach and laminectomy of the atlas. Br J Neurosurg 4:113–121CrossRefPubMed
8.
Zurück zum Zitat Tatagiba M, Koerbel A, Roser F (2006) The midline suboccipital subtonsillar approach to the hypoglossal canal: surgical anatomy and clinical application. Acta Neurochir 148:965–969CrossRefPubMed Tatagiba M, Koerbel A, Roser F (2006) The midline suboccipital subtonsillar approach to the hypoglossal canal: surgical anatomy and clinical application. Acta Neurochir 148:965–969CrossRefPubMed
9.
Zurück zum Zitat Wu A, Zabramski JM, Jittapiromsak P, Wallace RC, Spetzler RF, Preul MC (2010) Quantitative analysis of variants of the far-lateral approach: condylar fossa and transcondylar exposures. Neurosurgery 6(6 Suppl Operative):191–198 Wu A, Zabramski JM, Jittapiromsak P, Wallace RC, Spetzler RF, Preul MC (2010) Quantitative analysis of variants of the far-lateral approach: condylar fossa and transcondylar exposures. Neurosurgery 6(6 Suppl Operative):191–198
10.
Zurück zum Zitat Ziyal IM, Sekhar LN, Salas E (1999) Subtonsillar-transcerebellomedullary approach to lesions involving the fourth ventricle, the cerebellomedullary fissure and the lateral brainstem. Br J Neurosurg 13:276–284CrossRefPubMed Ziyal IM, Sekhar LN, Salas E (1999) Subtonsillar-transcerebellomedullary approach to lesions involving the fourth ventricle, the cerebellomedullary fissure and the lateral brainstem. Br J Neurosurg 13:276–284CrossRefPubMed
Metadaten
Titel
The midline suboccipital subtonsillar approach to the cerebellomedullary cistern: how I do it
verfasst von
Stephan Herlan
Florian Roser
Florian H. Ebner
Marcos Tatagiba
Publikationsdatum
22.07.2017
Verlag
Springer Vienna
Erschienen in
Acta Neurochirurgica / Ausgabe 9/2017
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-017-3270-5

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