We have located links that may give you full text access.
The midline suboccipital subtonsillar approach to the cerebellomedullary cistern and its structures: anatomical considerations, surgical technique and clinical application.
Clinical Neurology and Neurosurgery 2014 October
OBJECTIVE: Lesions of the cerebellomedullary cistern lateral to the lower brainstem in an area extending from the foraminae of Luschka to the foramen magnum are rare and can be caused by various sources. There is no consensus on an ideal surgical approach. We describe the anatomical features and the surgical technique of the midline suboccipital subtonsillar (STA) approach to the cerebellomedullary cistern and its pathologies.
METHODS: The study was performed on three alcohol (ETOH)-fixed specimens (6 sides), and the technique of the approach was highlighted. The tonsillar retraction needed to view the important structures was measured. Additionally, the records of 31 patients who underwent the STA procedure were evaluated. We provide three clinical cases as examples.
RESULTS: Tonsillar retraction of 0.3cm (SD±0.1cm) exposed the PICA with its telo-velo-tonsillar and cortical branches. Retraction of 0.4cm (SD±0.2cm) exposed the spinal root of CN XI. Retraction of 0.9cm (SD±0.01cm) exposed the hypoglossal canal. Retraction of 1.3cm (SD±0.2cm) exposed the root exit zone of the glossopharyngeal nerve. Retraction of 1.6cm (SD±0.3cm) exposed the jugular foramen (JF), and retraction of 2.4cm (SD±0.2cm) exposed the inner auditory canal (IAC). In all of the selected cases, the pathology could be reached and exposed using the STA.
CONCLUSIONS: We recommend STA as a straightforward, easy-to-learn and therefore time-saving and safe procedure compared with other standard approaches to the cerebellomedullary cistern and its pathologies.
METHODS: The study was performed on three alcohol (ETOH)-fixed specimens (6 sides), and the technique of the approach was highlighted. The tonsillar retraction needed to view the important structures was measured. Additionally, the records of 31 patients who underwent the STA procedure were evaluated. We provide three clinical cases as examples.
RESULTS: Tonsillar retraction of 0.3cm (SD±0.1cm) exposed the PICA with its telo-velo-tonsillar and cortical branches. Retraction of 0.4cm (SD±0.2cm) exposed the spinal root of CN XI. Retraction of 0.9cm (SD±0.01cm) exposed the hypoglossal canal. Retraction of 1.3cm (SD±0.2cm) exposed the root exit zone of the glossopharyngeal nerve. Retraction of 1.6cm (SD±0.3cm) exposed the jugular foramen (JF), and retraction of 2.4cm (SD±0.2cm) exposed the inner auditory canal (IAC). In all of the selected cases, the pathology could be reached and exposed using the STA.
CONCLUSIONS: We recommend STA as a straightforward, easy-to-learn and therefore time-saving and safe procedure compared with other standard approaches to the cerebellomedullary cistern and its pathologies.
Full text links
Related Resources
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app