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1.
Korean Journal of Cerebrovascular Surgery ; : 154-159, 2011.
Article in Korean | WPRIM | ID: wpr-113501

ABSTRACT

OBJECTIVE: Since posterior circulation vascular lesions are adjacent to important structures such as the brain stem and lower cranial nerves, the acquisition of anatomical information and the careful selection of approaches are essential for the surgical treatment of these lesions. We examined the characteristics and the indications of the far lateral suboccipital approach which exposes lesions without retraction of the brain stem for the treatment of either a vertebral artery (VA) or posterior inferior cerebellar artery (PICA) aneurysm. We present the best diagnostic tool to determine the approaches. METHODS: We have reviewed 11 patients who received surgical treatments between 2005 and 2011 for VA or PICA aneurysms. All of the patients had 3-dimensional computed tomography (3DCT) angiography performed to investigate the relation of the location between the aneurysm and hypoglossal canal. RESULTS: Eight of the 11 patients were treated with the transcondylar fossa approach (TCFA) as their lesions were located proximal to the hypoglossal canal, while three were treated with the transcondylar approach (TCA) as their lesions were located distal to the hypoglossal canal. Of the three patients treated with the TCA, one had temporary palsy of the 11th cranial nerve and the others recovered without any neurological defects. 3DCT angiography showed the relation of the location between the aneurysm and hypoglossal canal. CONCLUSION: The TCFA and TCA are good approaches to expose lesions without retraction of the brain stem. To determine the approaches for the surgery of VA or PICA aneurysms, using 3DCT before surgery is advantageous in understanding the positional relations between the hypoglossal canal and the lesions. During the actual surgery, the posterior condylar canal through which the posterior condylar emissary vein passes can be used as an anatomical landmark for TCFA. With this approach, craniocervical instability can be avoided.


Subject(s)
Humans , Aneurysm , Angiography , Arteries , Brain Stem , Cranial Nerves , Paralysis , Pica , Veins , Vertebral Artery
2.
Journal of Korean Neurosurgical Society ; : 1220-1227, 1993.
Article in Korean | WPRIM | ID: wpr-120374

ABSTRACT

The authors treated 26 cases of extramedullary tumors around foramen magnum and craniocervical junction by various surgical approaches between 1982 and February 1993. They are 12 meningiomas, 9 neurinomas, 3 chordomas, 1 teratoma and 1 capillary lymphangioma. Among them, 7 cases are located at anterior portion of foramen magnum, 6 cases at anterolateral portion, 2 cases at lateral portion, 7 cases at posterolateral portion, and 4 cases are posteriorly located. These tumors were attacked via various surgical approaches. 19 cases were treated by conventional suboccipital approach, 5 cases by far lateral suboccipital approach and 2 cases of chordoma by transoral approach which was combined with far lateral suboccipital approach. So, 19 cases of tumors were removed completely, but 7 cases were subtotally removed. There was 1 case of operative mortality and in 2 cases of meningioma there was permanent lower cranial nerve palsy. Pyogenic meningitis due to CSF leakage developed in 2 cases of chordoma which were treated by transoral approach.


Subject(s)
Capillaries , Chordoma , Cranial Nerve Diseases , Foramen Magnum , Lymphangioma , Meningioma , Meningitis , Mortality , Neurilemmoma , Teratoma
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