Keywords
foramen magnum - suboccipital subtonsillar approach - meningioma - concorde position
- C1 laminectomy - operative video
Publication Comments
In this video, the authors describe the use of the midline sub occipital subtonsillar
approach with c1 laminectomy for the resection of a foramen magnum meningioma in a
symptomatic 77-year-old patient. This video highlights the importance of this approach
in the armamentarium of a skull base surgeon as well it enhances the close relationship
of these tumors with critical neurovascular structures. I congratulate the authors
for the surgical result and the surgeon's mastery.
Diego Mendez Rosito, MD
CMN 20 de Noviembre
Mexico City, Mexico
Fig. 1 Preoperative MRI and postoperative CT and MRI studies. The meningioma originated
from the right epicondylar region just inferior to the jugular tubercle and occupied
the anterolateral aspect of the foramen magnum. CT, computed tomography; MRI, magnetic
resonance imaging.
Fig. 2 (A) anatomical dissection (fixed, silicone-injected human cadaver), depicting a right-sided
craniocervical junction from the level of the jugular foramen to the posterior arch
of C1. (B and C) operative still images of the suboccipital subtonsillar approach; (B) the meningioma occupies the anterolateral aspect of the foramen magnum on the right
side. Hypoglossal nerve and vertebral artery (V4 segment) are being transposed anteriorly,
the posterior inferior cerebellar artery and fascicles of the accessory nerve are
being transposed posteriorly. (C) After complete microsurgical excision and bipolar coagulation of the dural attachment
sites, the hypoglossal nerve and the vertebral artery can be seen in the depth of
the surgical field.
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