[Juxta- or trans-condylar lateral extension of the posterior suboccipital approach. Anatomical study, surgical aspects].
In order to improve the surgical approach to tumors and aneurysms of the anterior or antero-lateral aspect of the foramen magnum, some authors have proposed a lateral extension of the posterior sub-occipital approach to the occipital condyle including in some cases its partial or complete resection. The evaluation of this close medio-condylar or trans-condylar suboccipital approach has been performed on eight coloured-latex injected specimens in the conditions of a microsurgical operation. The extra- and intradural steps have been studied so as to define the optimal position of the patient's head and the surgeon and to precise the accessible anatomical structures: Vertebral artery (and its control), Cranial nerves IX, X, XI & XII, Posterior-inferior cerebellar artery and collaterals, Vertebro-basilar junction, antero-lateral aspect of the brain stem and spinal cord. Depending on the extent of the condylar resection, the lateral extension of the posterior sub-occipital approach may be defined as minimal, moderate or large. Based on anatomical and surgical constations it appears that a complete resection of the occipital condyle (resulting in occipito-cervical instability) should be reserved for those very extensive lesions. Yet a partial drilling of the condyle provides a better angle of approach, minimises the hazards of retraction of nervous structures and enables the surgeon to take the best advantage of the dissection and control of the vertebral artery.
Vallée
B
B
Service de Neurochirurgie, Hôpital Morvan, Brest.
Besson
G
G
Houidi
K
K
Person
H
H
Dam Hieu
P
P
Rodriguez
V
V
Mériot
P
P
Sénécail
B
B
D005260:Female; D005539:Foramen Magnum; D006801:Humans; D008579:Meningioma / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods*; D012888:Skull Neoplasms / Q000601:surgery*
L'extension latérale juxta- ou transcondylienne de la voie sous-occipitale postérieure. Etude anatomique, intérêt chirurgical.