We described the microsurgical anatomy of the Iateral part of the foramen magnum and the transcondylar fossa approach ( TCFA ) . The TCFA proVides a wide and shallow operative field in the lateral part of the medulla oblongata at the level of the jugular foramen . Furthermore , wide dissection of the unilateral cerebello − medullary fissure is necessary to retract the cerebellum safely and manage the lesion in the wide operative field ,
Methods for safe dr111ing in a cralliotomy aI ・ ound the occipital condyle are mentioned and the differences in 亡 he operative view between before and after removal of each borly eiement are discussed . In the field obtained just after craniotomy , the latera1 rim of the foramen magnum ( posterior part of the jugular tubercle)obstructs the view toward the anterior part of the posterior fossa . Drilhng of this area , carried out by fol1Qwirlg the pQsterlor condylar emissary vein and imaging the sigmoid − magnum triangle , exposes tke lower cerebellopontine angle and the region ventral to the brainstem . In order to drill down the high jugular tubercle , dril ! ing of part of the occipital condyle is also required to make room to reach the tubercle toward its summit , as the dura covering the posterior part of the tubercle is hard to elevate 、 Additional drilling of the posterior part of the occipita !condyle makes a wider space available , especialIy around the vertebral artery . Therefore , a specifically tailored operation should be scheduled for each case , considering which bony part is to be rernoved . (
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