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J Neurol Surg B Skull Base 2017; 78(05): 359-370
DOI: 10.1055/s-0037-1601369
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Fully Endoscopic Minimally Invasive Transrectus Capitis Posterior Muscle Triangle Approach to the Posterolateral Condyle and Jugular Tubercle

Wang Mingdong
1   Department of Neurological Surgery, Affiliated Hospital of HeBei University, Baoding, China
,
Juan C. Fernandez-Miranda
2   Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Roger Neves Mathias
3   Department of Neurological Surgery, State University of Campinas, Sao Paulo, Brazil
,
Eric Wang
2   Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Paul Gardner
2   Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Hong Wang
4   Department of Neurosurgery, Hebei College of Traditional Chinese Medicine, Hebei, China
› Author Affiliations
Further Information

Publication History

18 September 2016

17 February 2017

Publication Date:
18 April 2017 (online)

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Abstract

Background We evaluated a transrectus capitis posterior muscle triangle approach to the posterolateral foramen magnum, occipital condyles, jugular tubercle, and the fourth ventricle. We also assessed factors that affect the amount of bone removal required.

Objective To evaluate if the proposed approach is as effective as standard open approaches to expose the lateral portion of the foramen magnum.

Methods The proposed minimally invasive fully endoscopic approach was performed in 15 cadaveric specimens using 4-mm (0- and 45-degree) endoscopes.

Results Using a 5-cm straight paramedian incision, the rectus capitis posterior minor and major muscles were partially removed unilaterally, providing a corridor through the muscles to reach the foramen magnum region. After meticulous soft tissue dissection, key anatomical landmarks can be identified such as the greater occipital nerve, the vertebral artery that wraps around the atlanto-occipital joint, and the bony protuberance that heralds the occipital condyle. A suboccipital craniotomy associated with the transcondylar, supracondylar or paracondylar approach is performed depending on the amount of bone removal desired to maximize the surgical view. By doing so, the jugular foramen can be exposed laterally as well as the fourth ventricle medially.

Conclusion The proposed endoscopic approach can provide access through the transrectus capitis posterior muscle triangle leading directly to the occipital condyle. A stepwise approach is critical to gain a surgical corridor to the inferolateral petroclival region and the fourth ventricle.

Keywords

posterolateral condyle - jugular tubercle - minimally invasive - transrectus capitis posterior muscle triangle - fully endoscopic
 

  • References

  • 1 Victor AM, Fernandez-Miranda JC, Daniel MP. , et al. “Far-medial” expanded endonasal approach to the inferior third of the clivus: the transcondylar and transjugular tubercle approaches [comments]. J Neurosurg 2010; 66: 211-220
    PubMedGoogle Scholar
  • 2 Lan Q, Gong Z, Quian Z. , et al. 's arteritis. Kato TKY. Minimally Invasive Neurosurgery and Multidisciplinary Neurotraumatology. Tokyo, Japan: Springer-Verlag; 2006: 202-211
    CrossrefGoogle Scholar
  • 3 Stippler M, Gardner PA, Snyderman CH, Carrau RL, Prevedello DM, Kassam AB. Endoscopic endonasal approach for clival chordomas. Neurosurgery 2009; 64 (02) 268-277 , discussion 277–278
    CrossrefPubMedGoogle Scholar
  • 4 Borba LA, de Oliveira JG, Giudicissi-Filho M, Colli BO. Surgical management of foramen magnum meningiomas. Neurosurg Rev 2009; 32 (01) 49-58 , discussion 59–60
    CrossrefPubMedGoogle Scholar
  • 5 Karam YR, Menezes AH, Traynelis VC. Posterolateral approaches to the craniovertebral junction. Neurosurgery 2010; 66 (3, Suppl): 135-140
    CrossrefPubMedGoogle Scholar
  • 6 Pirotte BJ, Brotchi J, DeWitte O. Management of anterolateral foramen magnum meningiomas: surgical vs conservative decision making. Neurosurgery 2010; 67 (3, Suppl Operative): ons58-ons70 , discussion ons70
    PubMedGoogle Scholar
  • 7 Talacchi A, Biroli A, Soda C, Masotto B, Bricolo A. Surgical management of ventral and ventrolateral foramen magnum meningiomas: report on a 64-case series and review of the literature. Neurosurg Rev 2012; 35 (03) 359-367 , discussion 367–368
    CrossrefPubMedGoogle Scholar
  • 8 Mohamed SE, Eric CP, Roberto CH, Jacques JM. Far lateral approach and transcondylar and supracondylar extensions for aneurysms of the vertebrobasilar junction. Alfredo QH. Schmidek and Sweet's Operative Neurosurgical Techniques. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012: 951-958
    Google Scholar
  • 9 Kassam AB, Snyderman C, Gardner P, Carrau R, Spiro R. The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery 2005; 57 (1, Suppl): E213 , discussion E213
    PubMedGoogle Scholar
  • 10 Arnautović KI, Al-Mefty O, Husain M. Ventral foramen magnum meninigiomas. J Neurosurg 2000; 92 (1, Suppl): 71-80
    PubMedGoogle Scholar
  • 11 Rhoton Jr AL. The far-lateral approach and its transcondylar, supracondylar, and paracondylar extensions. Neurosurgery 2000; 47 (3, Suppl): S195-S209
    CrossrefPubMedGoogle Scholar
  • 12 Muthukumar N, Swaminathan R, Venkatesh G, Bhanumathy SP. A morphometric analysis of the foramen magnum region as it relates to the transcondylar approach. Acta Neurochir (Wien) 2005; 147 (08) 889-895
    CrossrefPubMedGoogle Scholar
  • 13 Zhang HZ, Lan Q. Design and microsurgical anatomy of the retrosigmoid-retrocondylar keyhole approach without occipital condyle removal. Minim Invasive Neurosurg 2006; 49 (01) 49-54
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Gilsbach JM, Sure U, Mann W. The supracondylar approach to the jugular tubercle and hypoglossal canal. Surg Neurol 1998; 50 (06) 563-570
    CrossrefPubMedGoogle Scholar
  • 15 Goel A, Desai K, Muzumdar D. Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: a report on an experience with 17 cases. Neurosurgery 2001; 49 (01) 102-106 , discussion 106–107
    PubMedGoogle Scholar
  • 16 Nanda A, Vincent DA, Vannemreddy PS, Baskaya MK, Chanda A. Far-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle. J Neurosurg 2002; 96 (02) 302-309
    CrossrefPubMedGoogle Scholar
  • 17 Banerji D, Behari S, Jain VK, Pandey T, Chhabra DK. Extreme lateral transcondylar approach to the skull base. Neurol India 1999; 47 (01) 22-30
    PubMedGoogle Scholar
  • 18 Henn JS, Lemole Jr GM, Spetzler RF. Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: A report on an experience with 17 cases [comment]. J Neurosurg 2001; 49: 107
    PubMedGoogle Scholar
  • 19 Suhardja A, Agur AMR, Cusimano MD. Anatomical basis of approaches to foramen magnum and lower clival meningiomas: comparison of retrosigmoid and transcondylar approaches. Neurosurg Focus 2003; 14 (06) e9
    PubMedGoogle Scholar
  • 20 Kryzanski JT, Robertson JH, Heilman CB. A minimal access far-lateral approach to foramen magnum lesions. J Neurol Surg B Skull Base 2014; 75 (04) 236-242
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Nader S, Alim M, Robert S. Surgical management of midbasilar and lower basilar aneurysms. Alfredo QH. Schmidek and Sweet's Operative Neurosurgical Techniques. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012: 925-936
    Google Scholar
  • 22 Rhoton Jr AL. The far-lateral approach and its transcondylar, supracondylar, and paracondylar extensions. Cranial Anatomy and Surgical. Vol. 47, No. 3 Hagerstown, MD: Lippincott Williams & Wilkins; September; 2000. :(Suppl): S1-S298
    Google Scholar
  • 23 Nevo M, Lesser J, Singer M, Sen C. Lateral approach to anterolateral tumors at the foramen magnum: factors determining surgical procedure. J Neurosurg 2005; 56 (ONS Suppl 2): 324-336
    PubMedGoogle Scholar
  • 24 Vishteh AG, Crawford NR, Melton MS, Spetzler RF, Sonntag VK, Dickman CA. Stability of the craniovertebral junction after unilateral occipital condyle resection: a biomechanical study. J Neurosurg 1999; 90 (1, Suppl): 91-98
    PubMedGoogle Scholar
  • 25 Wholey MH, Bruwer AJ, Baker Jr HL. The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology 1958; 71 (03) 350-356
    CrossrefPubMedGoogle Scholar
  • 26 Harris Jr JH, Carson GC, Wagner LK. Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 1994; 162 (04) 881-886
    CrossrefPubMedGoogle Scholar
  • 27 Harris Jr JH, Carson GC, Wagner LK, Kerr N. Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 1994; 162 (04) 887-892
    CrossrefPubMedGoogle Scholar
  • 28 Gregory GH, Michael TL, Richard Winn H, Peter DL. Surgical approaches to intracranial aneurysms. Winn HR. Youmans Neurological Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2011: 3801-3823
    Google Scholar
  • 29 Matsushima K, Funaki T, Komune N, Kiyosue H, Kawashima M, Rhoton Jr AL. Microsurgical anatomy of the lateral condylar vein and its clinical significance. Neurosurgery 2015; 11 (02) (Suppl. 02) 135-145 , discussion 145–146
    PubMedGoogle Scholar
  • 30 Bruneau M, George B. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature. Neurosurg Rev 2008; 31 (01) 19-32 , discussion 32–33
    CrossrefPubMedGoogle Scholar
  • 31 Kano T, Kawase T, Horiguchi T, Yoshida K. Meningiomas of the ventral foramen magnum and lower clivus: factors influencing surgical morbidity, the extent of tumour resection, and tumour recurrence. Acta Neurochir (Wien) 2010; 152 (01) 79-86 , discussion 86
    CrossrefPubMedGoogle Scholar
  • 32 Laura BN, Mirza NB, Manish KA, Antonio Chiocca E. Cerebellar tumors in adults. Alfredo QH. Schmidek and Sweet's Operative Neurosurgical Techniques. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012: 169-177
    Google Scholar
  • 33 Martins C, Campero A, Yasuda A. , et al. Anatomical basis of skull base surgery: skull osteology. Stamm AC. Transnasal Endoscopic Skull Base and Brain Surgery. New York, NY: Thieme Stuttgart; 2011: 3-13
    Google Scholar