Acta Neurochir (2017) 159:1613–1617 DOI 10.1007/s00701-017-3270-5 HOW I DO IT -NEUROSURGICAL ANATOMY The midline suboccipital subtonsillar approach to the cerebellomedullary cistern: how I do it 1,2 3 1 1 Stephan Herlan & Florian Roser & Florian H. Ebner & Marcos Tatagiba Received: 9 May 2017 /Accepted: 5 July 2017 /Published online: 22 July 2017 Springer-Verlag GmbH Austria 2017 Abstract Relevant surgical anatomy Background Lesions lateral to the lower brainstem in an area extending from the foraminae of Luschka to the foramen mag- The cerebellomedullary cistern borders the cerebellopontine num are rare and include different pathologies. There is no cistern cranially, the prepontine cistern anterior-medially and consensus on an ideal surgical approach. the foramen magnum caudally. It is covered dorsally by the Method To gain access to this area, we use the midline cerebellar tonsils and parts of the suboccipital cerebellar sur- suboccipital subtonsillar approach (STA). This midline ap- face. The lower cranial nerves (CN IX, X and the medullary proach with unilateral retraction of the cerebellar tonsil en- portion of XI and XII) originate medially from the brainstem ables entry into the cerebellomedullary cistern. and lead through the cistern to reach the jugular foramen or Conclusions The STA offers
Acta Neurochirurgica – Springer Journals
Published: Jul 22, 2017
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