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The strategy of drilling the occipital condyle and muscle dissection in far-lateral approach for anterior foramen magnum lesions: 28 cases report
EANS Academy. Liu X. Sep 27, 2019; 276018; EP04103
Abstract
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Objective: The far-lateral approach is complex and excellent approach for anterior foramen magnum lesions. But there are several different methods to design the scalp incision, dissection of the neck muscle, identify and expose the vertebral artery, and drilling the occipital condyle. The purpose of this study is to introduce a new strategy to dissect the neck muscle, expose the vertebral artery and drill the occipital condyle.
Methods: 28 patients who had anterior foramen magnum lesions admitted to our department from 2015-2018. All the patients underwent the micro neurosurgery by far-lateral approach to remove the lesions. We used a big 'C' shape scalp flap that was reflected forward and dissect the neck muscle together toward downward and medially without layer by layer. The vertebral artery was identified by the transvers process of C 1 and the fat pad around the artery. The strategy of drilling the occipital condyle was according to the relationship between the lesion and the vertebral artery.
All the clinical data of the 28 patients were recorded and analyzed.
Results: Gross total removal of tumors was obtained in 26 patients. The other 2 giant posterior inferior cerebellar artery aneurysms were clipped safely. All the patients did not have new neurological dysfunction.The most common complication was leakage of CSF. 2 patients had this complication. There were no deaths in this study.
Conclusion: Our strategy and method to dill the occipital condyle, muscle dissection and identify the vertebral artery could contribute to more safe and effective surgery for the far lateral approach.
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