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J Neurol Surg B Skull Base 2017; 78(05): 359-370
DOI: 10.1055/s-0037-1601369
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Fully Endoscopic Minimally Invasive Transrectus Capitis Posterior Muscle Triangle Approach to the Posterolateral Condyle and Jugular Tubercle

Wang Mingdong
1   Department of Neurological Surgery, Affiliated Hospital of HeBei University, Baoding, China
,
Juan C. Fernandez-Miranda
2   Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Roger Neves Mathias
3   Department of Neurological Surgery, State University of Campinas, Sao Paulo, Brazil
,
Eric Wang
2   Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Paul Gardner
2   Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Hong Wang
4   Department of Neurosurgery, Hebei College of Traditional Chinese Medicine, Hebei, China
› Institutsangaben
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Publikationsverlauf

18. September 2016

17. Februar 2017

Publikationsdatum:
18. April 2017 (online)

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Abstract

Background We evaluated a transrectus capitis posterior muscle triangle approach to the posterolateral foramen magnum, occipital condyles, jugular tubercle, and the fourth ventricle. We also assessed factors that affect the amount of bone removal required.

Objective To evaluate if the proposed approach is as effective as standard open approaches to expose the lateral portion of the foramen magnum.

Methods The proposed minimally invasive fully endoscopic approach was performed in 15 cadaveric specimens using 4-mm (0- and 45-degree) endoscopes.

Results Using a 5-cm straight paramedian incision, the rectus capitis posterior minor and major muscles were partially removed unilaterally, providing a corridor through the muscles to reach the foramen magnum region. After meticulous soft tissue dissection, key anatomical landmarks can be identified such as the greater occipital nerve, the vertebral artery that wraps around the atlanto-occipital joint, and the bony protuberance that heralds the occipital condyle. A suboccipital craniotomy associated with the transcondylar, supracondylar or paracondylar approach is performed depending on the amount of bone removal desired to maximize the surgical view. By doing so, the jugular foramen can be exposed laterally as well as the fourth ventricle medially.

Conclusion The proposed endoscopic approach can provide access through the transrectus capitis posterior muscle triangle leading directly to the occipital condyle. A stepwise approach is critical to gain a surgical corridor to the inferolateral petroclival region and the fourth ventricle.

Keywords

posterolateral condyle - jugular tubercle - minimally invasive - transrectus capitis posterior muscle triangle - fully endoscopic
 

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