Far Lateral Craniotomy Closure Technique for Preservation of Suboccipital Musculature

Abstract

The far lateral approach is used for accessing pathology at the craniovertebral junction but can be complicated by postoperative suboccipital muscle atrophy. In addition to significant cosmetic deformity, this atrophy can lead to head and neck pain and potentially could contribute to cranio-cervical instability. To address this issue, the senior author began using a single myocutaneous flap without a muscle cuff and securing it directly to the bone using predrilled holes in the bone that resemble a chevron. The method is described and illustrated with an example case. Results from seven consecutive cases are reported since the technique was adopted. Muscle atrophy was measured by calculating area at the level of the occipital condyle and compared with the contralateral side. No significant differences were noted. In conclusion, we have found this to be an excellent closure technique and wanted to present our initial results for consideration by other skull base surgeons.

Keywords

far lateral - transcondylar - muscle atrophy - modified far lateral - extreme lateral - technique

^* Authors contributed equally to this study.

Publikationsverlauf

Eingereicht: 07. April 2020

Angenommen: 22. Juni 2020

Artikel online veröffentlicht:
20. August 2020

• References

• 1 Rhoton Jr AL. The far-lateral approach and its transcondylar, supracondylar, and paracondylar extensions. Neurosurgery 2000; 47 (03) S195-S209
• 2 George B, Dematons C, Cophignon J. Lateral approach to the anterior portion of the foramen magnum. Application to surgical removal of 14 benign tumors: technical note. Surg Neurol 1988; 29 (06) 484-490
• 3 Heros RC. Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg 1986; 64 (04) 559-562
• 4 Lau T, Reintjes S, Olivera R, van Loveren HR, Agazzi S. C-shaped incision for far-lateral suboccipital approach: anatomical study and clinical correlation. J Neurol Surg B Skull Base 2015; 76 (02) 117-121
• 5 Moscovici S, Umansky F, Spektor S. “Lazy” far-lateral approach to the anterior foramen magnum and lower clivus. Neurosurg Focus 2015; 38 (04) E14
• 6 Sanai N, McDermott MW. A modified far-lateral approach for large or giant meningiomas of the posterior fossa. J Neurosurg 2010; 112 (05) 907-912
• 7 Ogiwara T, Goto T, Aoyama T. et al. Relationship between muscle dissection method and postoperative muscle atrophy in the lateral suboccipital approach to vestibular schwannoma surgery. World Neurosurg 2016; 94: 426-431
• 8 Koperer H, Deinsberger W, Jödicke A, Böker DK. Postoperative headache after the lateral suboccipital approach: craniotomy versus craniectomy. Minim Invasive Neurosurg 1999; 42 (04) 175-178
• 9 McPartland JM, Brodeur RR, Hallgren RC. Chronic neck pain, standing balance, and suboccipital muscle atrophy--a pilot study. J Manipulative Physiol Ther 1997; 20 (01) 24-29