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Far Lateral Approach for Removal of Foramen Magnum Meningioma
Published in Cut Adeya Adella, Stem Cell Oncology, 2018
FM meningioma arises from the arachnoid at the craniospinal junction. The borders of this zone, as defined by George et al. (1997), range anteriorly from the lower third of the clivus, to the upper margin of the body of C2, laterally from the jugular tubercle to the upper margin of the C2 laminae, and posteriorly from the anterior edge of the squamous occipital bone to the C2 spinous process (George et al., 1997).
Successful microvascular decompression surgery for dolichoectatic vertebral artery compression of medulla oblongata in a patient with hypersomnia disorder
Published in British Journal of Neurosurgery, 2023
Mohammad Ghorbani, Maziar Azar, Karan Bavand, Hamidreza Shojaei, Reza Mollahoseini
Hongo et al. used sponge to decompress medulla oblongata in their cases which was not effective.6 In the current study, patient got advantage of microvascular decompression surgery (MVD) by using a synthetic Teflon patch and his symptoms relieved after that. Also there is an alternative method by using Gore-tex to wrap and pull away the vertebral artery by suturing to the dura mater on the posterior portion of the jugular tubercle.5
A rare cause of unilateral hypoglossal nerve palsy: case report of intraneural ganglion cyst of the hypoglossal nerve and review of the literature
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Jeremie D. Oliver, Antonio J. Forte
A midline incision was made along the avascular plane down to the C1 and C2 region to expose the sub-occipital region. The sub-occipital region was eccentrically exposed to the left side. A sub-periosteal dissection was used over C1 to get out to the vertebral groove, and the skin and musculocutaneous flap were held with self-retaining retractors. A matchstick bit was used to drill troughs in C1 to facilitate its removal in one piece. A central sub-occipital craniotomy was further exposed (same configuration as Chiari decompression) and extended this over to left side. Drilling of the jugular tubercle was performed with a 3-diamond bit over the top of the supracondylar region in addition to drilled C1 flush to the pedicle. The dura was opened in a C-shaped fashion based on the left jugular tubercle to expose the tumour. The arachnoid space was subsequently opened separately, wherein was identified the cystic tumour of CNXII filling the foramen of Lushka. Initially investigation of the cyst revealed nerve rootlets over the back side along the vertebral artery. The vertebral artery was dissected away from the cyst as well as the spinal portion of the spinal accessory nerve. The mass itself was found to be mostly cystic, decompressing quite easily. Working around the margins of the extra-foraminal portion of the tumour, all nerve rootlets were dissected away, and ultimately removed the tumour completely. Intermittent stimulation (up to 3 mA) of the capsule was performed to ensure no functional nerve roots were being taken. Interestingly, the foramen of Lushka was expanded, and given the position, we were able to look directly out it. Mobilisation of the distal portion of the capsule allowed for complete removal out of the foramen without drilling it out. It is notable that approximately three nerve rootlets of the hypoglossal nerve were preserved in the inferior aspect of the canal. Continued aggressive removal of tumour was performed until there was no evidence of further tumour. The jugular foramen contents were intact without any evidence of disruption. The spinal portion of the spinal accessory nerve was intact.