Baran Bozkurt1, M Yashar S Kalani2, Kaan Yağmurlu1, Evgenii Belykh1, Mark C Preul1, Peter Nakaji1, Robert F Spetzler3. 1. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. 2. Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah, USA. 3. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@barrowneuro.org.
Abstract
OBJECTIVE: In our study, we comprehensively detail the technique of the low retrosigmoid approach to the lateral medullary area, including the inferior cerebellar peduncle, postolivary sulcus, pontomedullary sulcus, and inferior olivary nucleus, as well as the lateral recess of the fourth ventricle. METHODS: Four formalin-fixed, silicone-injected, cadaveric human heads were examined under the operating microscope to demonstrate pertinent descriptive anatomy using the low retrosigmoid approach in a stepwise manner. Clinical parameters of a patient with a lateral medullary lesion were reviewed retrospectively to describe preoperative and postoperative examination and surgical details of the approach to the lateral medulla. RESULTS: The clinical case report describes a low retrosigmoid craniotomy performed to access the exiting points of cranial nerves IX (glossopharyngeal) and X (vagus), foramen of Luschka, inferior cerebellar peduncle (lateral medullary zone), postolivary sulcus, and olivary nucleus. The lesion was exposed using the inferior cerebellar peduncle and removed using standard microsurgical technique. CONCLUSIONS: The lower retrosigmoid infratonsillar approach provides excellent exposure to medullary safe entry zones, including the transolivary, postolivary sulcus, pontomedullary sulcus, and lateral medullary (inferior cerebellar peduncle) zones, for removal of lesions in this area.
OBJECTIVE: In our study, we comprehensively detail the technique of the low retrosigmoid approach to the lateral medullary area, including the inferior cerebellar peduncle, postolivary sulcus, pontomedullary sulcus, and inferior olivary nucleus, as well as the lateral recess of the fourth ventricle. METHODS: Four formalin-fixed, silicone-injected, cadaveric human heads were examined under the operating microscope to demonstrate pertinent descriptive anatomy using the low retrosigmoid approach in a stepwise manner. Clinical parameters of a patient with a lateral medullary lesion were reviewed retrospectively to describe preoperative and postoperative examination and surgical details of the approach to the lateral medulla. RESULTS: The clinical case report describes a low retrosigmoid craniotomy performed to access the exiting points of cranial nerves IX (glossopharyngeal) and X (vagus), foramen of Luschka, inferior cerebellar peduncle (lateral medullary zone), postolivary sulcus, and olivary nucleus. The lesion was exposed using the inferior cerebellar peduncle and removed using standard microsurgical technique. CONCLUSIONS: The lower retrosigmoid infratonsillar approach provides excellent exposure to medullary safe entry zones, including the transolivary, postolivary sulcus, pontomedullary sulcus, and lateral medullary (inferior cerebellar peduncle) zones, for removal of lesions in this area.
Authors: Yang Yang; Bas van Niftrik; Xiangke Ma; Julia Velz; Sophie Wang; Luca Regli; Oliver Bozinov Journal: Neurosurg Rev Date: 2019-02-06 Impact factor: 3.042