The far-lateral craniotomy: tips and tricks

Abstract

This article intends to describe in a didactical and practical manner the suboccipital far-lateral craniotomy. This is then basically a descriptive text, divided according to the main stages involved in this procedure, and that describes with details how the authors currently perform this craniotomy.Keywords: neurosurgery, craniotomy, microsurgery, far-lateral approach.RESUMO O presente artigo visa descrever de forma didática e prática a realização da craniotomia suboccipital extremo-lateral. Trata-se, portanto, de um texto fundamentalmente descritivo, dividido conforme as principais etapas da realização dessa craniotomia, e que descreve com detalhes a técnica com que o presente grupo de autores evolutivamente veio a realizá-la.Palavras-chave: neurocirurgia, craniotomia, extremo-lateral, microcirurgia.Approaching lesions located in the lower clivus and at the anterior edge of foramen magnum have always presented as a challenge to the neurosurgeon. The majority of these lesions have been approached posteriorly by suboccipital or retrosigmoid craniotomies and anteriorly by trans-oral and through the paranasal sinus approaches. Nevertheless all of then have disadvantages including a great depth of surgical field and an extremely limited lateral exposure 1 . Once the high morbidity and mortality of lesions located at so an important anatomic region, the improvement of these posterior approaches is imperative, in order to increase the surgical exposure and reduce the retraction of neurovascular structures.The far lateral approach is the one composed by the dissection of occipital-cervical muscles with the exposition of suboccipital triangle, the lateral suboccipital craniotomy and finally the exposure of vertebral artery since its entrance into the dura mater 2

Early microsurgical management of ruptured intracranial aneurysm predicts better clinical outcome

“…Supratentorial aneurysms were treated preferentially by pterional, pretemporal, orbitozygomatic or inter-hemispheric approach or using a combination of techniques following the surgical steps previously published [10][11][12][13][14] . On the other hand, infratentorial aneurysms were treated preferentially by pretemporal transzygomatic 12,13,15,16 or far lateral approach 17 following the surgical steps previous…”

Orbitozygomatic craniotomy in three pieces: tips and tricks

“…The head should be held by a three-pin skull fixation device (Mayfield or Sugita model). The ipsilateral pin should be set on the mastoid region, while the two contralateral pins should be on the contralateral superior temporal line, above the temporal muscle, that should not be transfixed 17 .…”

“…The placement of wet gauze and later traction of the scalp flap can spare the use of haemostatic clips and specific staples for this purpose 8,16,17,18 .…”

Combined treatment for a hemispheric cerebellar AVM

“…The patient was operated in a semisitting position, and a wide far-lateral approach was performed. 4 2:06 Corticectomy and Dissection of the AVM. After dural opening, microsurgical corticectomy was started laterally to the AVM, and then surrounding the nidus.…”