Minimally Invasive Posterior Fossa Decompression and Duraplasty: A Step-by-Step Technique

Introduction: Minimally invasive surgery (MIS) for spinal decompressions has become increasingly popular. However, it is not clear if this MIS is suitable for posterior fossa decompression for Chiari malformation. The feasibility of duraplasty is also obscure.

Objective: To describe step-by-step technique to perform minimally invasive decompression of the posterior fossa (MIPFD).

Methods: We performed MIPFD in six cadaveric heads with different incision sizes. A 1-cm or 1.5-cm or 2-cm midline skin incisions were centered at a point precisely overlying the atlantooccipital interval. A midline dissection was performed in the standard fashion with the assistance of a high-power microscope. Exposure was compared using a Medtronic Stealth Station Surgical Navigation system. A craniotomy was performed, and craniotomy sizes were compared.

Results: Frequent adjustments to the microscope angle in a 360° fashion around the patient were necessary for undermining the soft tissues and subsequent exposure. Progressively longer 90° Gelpi retractors were deployed until the caudal occipital bone, C1 posterior arch, and rostral C2 lamina were exposed. Measurements and detailed angulation was measured by neuronavigation probe with microscope and endoscope visualization. The 2 cm incision offered the better working channel and allowed the performance of a 3 × 3 standard craniotomy. The duraplasty was performed with nonpenetrating titanium clips.

Conclusion: Minimally invasive posterior fossa decompression with duraplasty is feasible and may be an alternative for Chiari I malformation patients ([Fig. 1]).

Fig. 1

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 February 2022