The Transcondylar Approach to Access Symptomatic Arachnoid Cysts of the Hypoglossal Canal

2017 ◽  
Vol 14 (2) ◽  
pp. E23-E25
Author(s):  
Jan-Karl Burkhardt ◽  
Christina Bal ◽  
Marian Christoph Neidert ◽  
Oliver Bozinov
Keyword(s):  
Skull Base ◽  
Clinical Presentation ◽  
Arachnoid Cysts ◽  
Hypoglossal Canal ◽  
Transcondylar Approach ◽  
Suboccipital Craniotomy ◽  
Skull Base Approach ◽  
Skull Base Anatomy ◽  
Surgical Corridor ◽  
Progressive Dysphagia

Abstract BACKGROUND AND IMPORTANCE A direct transcondylar approach to treat symptomatic arachnoid cysts of the hypoglossal canal has not yet been described in the literature. CLINICAL PRESENTATION Here, we present a skull base approach in 2 female patients (68 and 38 yr) with progressive dysphagia, dysarthria, half-sided weakness, and atrophy of the tongue due to an arachnoid cyst of the hypoglossal canal. After patient informed consent, both patients were successfully operated on without complications using a transcondylar approach, and their symptoms improved 3 mo after surgery; in both patients, resection of the cyst was confirmed using magnetic resonance imaging. Review of the literature revealed 4 surgically treated cases of hypoglossal cysts operated on through a paramedian suboccipital craniotomy from a medial to lateral surgical corridor. CONCLUSION This is the first description of the transcondylar surgical approach to safely operate on symptomatic arachnoid cysts located in the hypoglossal canal. The isolated transcondylar approach is useful in selective cases when the pathology is located within the hypoglossal canal only and the skull base anatomy allows a direct approach.

Surgery on a saccular vertebral artery—posterior inferior cerebellar artery aneurysm via the transcondylar fossa (supracondylar transjugular tubercle) approach or the transcondylar approach: surgical results and indications for using two different lateral skull base approaches

2001 ◽  
Vol 95 (2) ◽  
pp. 268-274 ◽  
Author(s):  
Toshio Matsushima ◽  
Koichiro Matsukado ◽  
Yoshihiro Natori ◽  
Takanori Inamura ◽  
Tsutomu Hitotsumatsu ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Skull Base ◽  
Posterior Inferior Cerebellar Artery ◽  
Surgical Results ◽  
Content Type ◽  
Hypoglossal Canal ◽  
Transcondylar Approach ◽  
Lateral Skull Base ◽  
Cerebellar Artery ◽  
Fine Print

Object. The authors report on the surgical results they achieved in caring for patients with vertebral artery—posterior inferior cerebellar artery (VA—PICA) saccular aneurysms that were treated via either the transcondylar fossa (supracondylar transjugular tubercle) approach or the transcondylar approach. In this report they clarify the characteristics of and differences between these two lateral skull base approaches. They also present the techniques they used in performing the transcondylar fossa approach, especially the maneuver used to remove the jugular tubercle extradurally without injuring the atlantooccipital joint. Methods. Eight patients underwent surgery for VA—PICA saccular aneurysms (six ruptured and two unruptured ones) during which one of the two approaches was performed. Clinical data including neurological and radiological findings and reports of the operative procedures were analyzed. The Glasgow Outcome Scale was used to estimate the activities of daily living experienced by the patients. In all cases the aneurysm was successfully clipped and no permanent neurological deficits remained, except for one case of severe vasospasm. In seven of the eight patients, the transcondylar fossa approach provided a sufficient operative field for clipping the aneurysm without difficulty. In the remaining patient, in whom the aneurysm was located at the midline on the clivus at the level of the hypoglossal canal, the aneurysm could not be found by using the transcondylar fossa approach; thus, the route was changed to the transcondylar approach, and clipping was performed below the hypoglossal nerve rootlets. Conclusions. Both approaches offer excellent visualization and a wide working field, with ready access to the lesion. This remarkably reduces the risk of development of postoperative deficits. These approaches should be used properly: the transcondylar fossa approach is indicated for aneurysms located above the hypoglossal canal and the transcondylar approach is indicated for those located below it.

scholarly journals Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction

2005 ◽  
Vol 19 (2) ◽  
pp. 1-7 ◽  
Author(s):  
James K. Liu ◽  
William T. Couldwell
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Presentation ◽  
Benign Lesions ◽  
Endodermal Cell ◽  
Transcondylar Approach ◽  
Cervicomedullary Junction ◽  
Skull Base Approach ◽  
The Central Nervous System ◽  
Far Lateral

Neurenteric cysts are rare benign lesions of the central nervous system that are lined by endodermal cell–derived epithelium. Although they occur mostly in the spine, they can occur intracranially, most often in the posterior fossa. Neurenteric cysts that are located in the anterior cervicomedullary junction are even rarer and often require a skull base approach for adequate resection. The authors describe two cases of neurenteric cysts arising from the cervicomedullary junction that were resected via a far-lateral transcondylar approach. They discuss the surgical approach and operative nuances involved in removing these lesions, and review the clinical presentation of neurenteric cysts in this region as well as the neuroimaging characteristics, histopathological findings, and surgical management. Intraoperative videos are presented.

A Method for Cranial Nerve XI Silencing During Surgery of the Foramen Magnum Region: Technical Case Report

2018 ◽  
Vol 16 (4) ◽  
pp. E130-E133
Author(s):  
Derek G Southwell ◽  
Jonathan D Breshears ◽  
William R Lyon ◽  
Michael W McDermott
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Clinical Presentation ◽  
Obstructive Hydrocephalus ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Cerebellar Tonsil ◽  
Suboccipital Craniotomy ◽  
Far Lateral ◽  
The Right

Abstract BACKGROUND AND IMPORTANCE Skull base surgery involves the microdissection and intraoperative monitoring of cranial nerves, including cranial nerve XI (CN XI). Manipulation of CN XI can evoke brisk trapezius contraction, which in turn may disturb the surgical procedure and risk patient safety. Here we describe a method for temporarily silencing CN XI via direct intraoperative application of 1% lidocaine. CLINICAL PRESENTATION A 41-yr-old woman presented with symptoms of elevated intracranial pressure and obstructive hydrocephalus secondary to a hemangioblastoma of the right cerebellar tonsil. A far-lateral suboccipital craniotomy was performed for resection of the lesion. During the initial stages of microdissection, vigorous trapezius contraction compromised the course of the operation. Following exposure of the cranial and cervical portions of CN XI, lidocaine was applied to the course of the exposed nerve. Within 3 min, trapezius electromyography demonstrated neuromuscular silencing, and further manipulation of CN XI did not cause shoulder movements. Approximately 30 min after lidocaine application, trapezius contractions returned, and lidocaine was again applied to re-silence CN XI. Gross total resection of the hemangioblastoma was performed during periods of CN XI inactivation, when trapezius contractions were absent. CONCLUSION Direct application of lidocaine to CN XI temporarily silenced neuromuscular activity and prevented unwanted trapezius contraction during skull base microsurgery. This method improved operative safety and efficiency by significantly reducing patient movement due to the unavoidable manipulation of CN XI.

scholarly journals Morphometric evaluation of occipital condyles for a safe transcondylar approach through skull base

2018 ◽  
Vol 7 (02) ◽  
pp. 078-084
Author(s):  
Vijisha Phalgunan ◽  
Suresh Narayanan
Keyword(s):  
Skull Base ◽  
Posterior Margin ◽  
Occipital Condyle ◽  
Hypoglossal Canal ◽  
Transcondylar Approach ◽  
South Indian ◽  
Important Landmark ◽  
The Mean ◽  
Occipital Condyles ◽  
Morphometric Evaluation

Abstract Aims and Objectives: Occipital condyle is an important landmark in transcondylar approach for surgery of lesions ventral to the brainstem, hence it is imperative to understand the anatomical aspects of occipital condyle. The aim of the present study is to analyse the morphometrical aspects of occipital condyle and to highlight its importance in surgical resection. Materials and method: Hundred occipital condyles of fifty dry skulls were used for this study. Twenty-six parameters were measured. The measurements were made separately for right and left sides. Results: The mean length of occipital condyle was found to be 22.92mm. The distance between the intracranial orifice of the hypoglossal canal and the posterior margin of occipital condyle was 12.55±0.05mm. The commonest location of intracranial orifice and extracranial orifice of hypoglossal canal was found to be at location 3 and location 2 respectively. Occipital condyle was oval in most skulls. Conclusion: Occipital condyle can be safely drilled for a distance of 12 mm from the posterior margin before encountering the hypoglossal canal. Surgeons operating in this area must consider the variations of parameters of south Indian skulls.

scholarly journals The Extended Pterional Craniotomy: A Contemporary and Balanced Approach

2019 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Aaron A Cohen-Gadol
Keyword(s):  
Virtual Reality ◽  
Skull Base ◽  
Multimedia Presentation ◽  
Normal Anatomy ◽  
3 Dimensional ◽  
Pterional Craniotomy ◽  
Balanced Approach ◽  
Skull Base Approach ◽  
Cranial Fossa ◽  
Surgical Corridor

Abstract Pterional craniotomy is the workhorse approach among cranial operative corridors. It is a highly flexible skull base approach that affords excellent exposure of the anterior cranial fossa, the circle of Willis, and the interpeduncular region. Its strategic use via dynamic retraction can obviate the need to use a more extensive skull base route, such as orbitozygomatic osteotomy, in select cases. The focus of the surgeon should be reaching the surgical target effectively while minimizing disruption of normal anatomy. In other words, the focus should be less on “how to get there” and more on “what to do when you are there.” This multimedia presentation summarizes an efficient execution of this route and its expansion and demonstrates the surgical corridor via 3-dimensional virtual reality models.

scholarly journals Cranial base strategies for resection of craniopharyngioma in children

2005 ◽  
Vol 18 (6) ◽  
pp. 1-9 ◽  
Author(s):  
James K. Liu ◽  
Chad D. Cole ◽  
John R. W. Kestle ◽  
Douglas L. Brockmeyer ◽  
Marion L. Walker
Keyword(s):  
Skull Base ◽  
Postoperative Morbidity ◽  
Hormone Replacement ◽  
Total Removal ◽  
Complete Excision ◽  
Skull Base Approach ◽  
Microsurgical Techniques ◽  
Microsurgical Resection ◽  
Surgical Corridor ◽  
Neurovascular Structures

The optimal treatment of craniopharyngioma in children remains a challenge. The use of complete excision to minimize recurrence continues to be controversial because of the risk of postoperative morbidity and death. Advances in skull base approaches, modern microsurgical techniques, neuroimaging, and hormone replacement therapy, however, have allowed safe gross- or near-total resection in the majority of cases. Total removal of these tumors, if possible, offers the best chance of cure for the patient. Although craniopharyngiomas are not strictly tumors of skull base origin, their intimate relationship with the neurovascular structures of this region often requires a skull base approach to maximize the surgical corridor and facilitate adequate microsurgical resection. In this review, the authors focus on commonly used skull base approaches for the surgical management of craniopharyngioma. They discuss the relative indications, advantages, disadvantages, and complications associated with each approach. Illustrative cases and intra-operative videos are presented.

Skull Base Anatomy in Charge Patients with Bilateral Choanal Atresia

2020 ◽  
Author(s):  
Christopher Pool ◽  
Roshan Nayak ◽  
Meghan Wilson
Keyword(s):  
Skull Base ◽  
Choanal Atresia ◽  
Skull Base Anatomy
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