ABORDAJE QUIRURGICO AL CLIVUS

ABORDAJES QUIRURGICOS AL CLIVUS : 

ABORDAJES QUIRURGICOS AL CLIVUS

Slide 2: 

Cranial base approaches for petroclival and clival area lesions Anterior transpetrosal Posterior transpetrosal Retrolabyrinthine Transcrusal (partial labyrinthectomy) Transotic Transcochlear Retrosigmoid Combined

FAR LATERAL TRANSCONDYLEAR APPROACH : 

FAR LATERAL TRANSCONDYLEAR APPROACH Extensiòn suboccipital. Lesiones ventrolaterales del clivus y Foramen Yugular

Figure 1 : 

Figure 1 FIGURE 1. Skin incision for right-sided dissection. Dotted line, line of incision; A, anterior border of sternocleidomastoid muscle; B, tip of mastoid prominence; C, superior nuchal line; D, midline; E, spinous process of C3. Copyright © 2010 Neurosurgery. Published by Lippincott Williams & Wilkins. 47 Far Lateral Transcondylar Approach: Dimensional Anatomy Dowd, Gregory C.; Zeiller, Steve; Awasthi, Deepak Neurosurgery. 45(1):95, July 1999. doi:

Figure 2 : 

Figure 2 FIGURE 2. Suboccipital triangle. SO, superior oblique muscle; IO, inferior oblique muscle; RCM, rectus capitus major muscle; VA, vertebral artery; *, ventral ramus of C2 nerve root. Copyright © 2010 Neurosurgery. Published by Lippincott Williams & Wilkins. 48 Far Lateral Transcondylar Approach: Dimensional Anatomy Dowd, Gregory C.; Zeiller, Steve; Awasthi, Deepak Neurosurgery. 45(1):95, July 1999. doi:

Figure 3 : 

Figure 3 FIGURE 3. Measurements along VA. A, distance from the distal end of the C1 transverse foramen to the dural entry of the VA (22 ± 3 mm); B, distance from the dural entry of the VA until the takeoff of the PICA (17 ± 8 mm); C, first vertebral body. Copyright © 2010 Neurosurgery. Published by Lippincott Williams & Wilkins. 49 Far Lateral Transcondylar Approach: Dimensional Anatomy Dowd, Gregory C.; Zeiller, Steve; Awasthi, Deepak Neurosurgery. 45(1):95, July 1999. doi:

Figure 4 : 

Figure 4 FIGURE 4. Measurements from the FM (at posterior midline) to the OC. A, medial border of the OC (27 ± 0.5 mm); B, lateral border of the OC (40 ± 0.4 mm). Copyright © 2010 Neurosurgery. Published by Lippincott Williams & Wilkins. 50 Far Lateral Transcondylar Approach: Dimensional Anatomy Dowd, Gregory C.; Zeiller, Steve; Awasthi, Deepak Neurosurgery. 45(1):95, July 1999. doi:

Figure 5 : 

Figure 5 FIGURE 5. Angle of surgical approach. Speckled area, suboccipital craniectomy (47 ± 2 degrees); hatched area, far lateral transcondylar approach (88 ± 2 degrees); OC, occipital condyle; JT, jugular tubercle; REF, reference line for the measurement of surgical angle. A tangent line along the FM and touching the posterior border of the OC was constructed. pre, ASA to clivus before OC resection; post, ASA to JT after OC resection. The amount of OC removed for the far lateral transcondylar exposure was 17 ± 1 mm. Copyright © 2010 Neurosurgery. Published by Lippincott Williams & Wilkins. 51 Far Lateral Transcondylar Approach: Dimensional Anatomy Dowd, Gregory C.; Zeiller, Steve; Awasthi, Deepak Neurosurgery. 45(1):95, July 1999. doi: