TY - JOUR
T1 - The extreme lateral approach to the craniovertebral junction: An anatomical study
AU - Signorelli, Francesco
AU - Pisciotta, Walter
AU - Stumpo, Vittorio
AU - Ciappetta, Pasquale
AU - Olivi, Alessandro
AU - Visocchi, Massimiliano
PY - 2019
Y1 - 2019
N2 - Background: The extreme lateral approach is a direct lateral approach which allows a good control of the entire length of the vertebral artery (VA), the jugular foramen, the lowest cranial nerves, and the jugular–sigmoid complex. Herein we try to exploit the variants of the approach and we identify indications, advantages, and disadvantages. Methods: All phases of the study were conducted at the Institute of Public Health Section of Legal Medicine and Insurance of the University. We performed the extreme lateral approach in four subjects, who died between 24 and 48 h before in non-traumatic circumstances (three men and one woman). Results: The great auricular nerve, the spinal accessory, the branches of the first ventral spinal nerves, the jugular vein, and the vertebral artery were identified in all the cadavers. In all cases the right VA exited from the transverse foramen of C1. The site of SCM piercing the accessory nerve was at a distance from the tip of the mastoid between 3 and 4 cm (3.3 in one case, 3.4 in 2 cases, and 3.7 in one case). No vessels and nerves have been damaged after being identified and isolated. Conclusions: Extradural lesions at the ventro-lateral aspect of the CVJ may require an extreme lateral approach, a procedure more aggressive comparing with far lateral approach, which represents a reasonable option for large anterior and anterolateral lesions when greater exposure is required.
AB - Background: The extreme lateral approach is a direct lateral approach which allows a good control of the entire length of the vertebral artery (VA), the jugular foramen, the lowest cranial nerves, and the jugular–sigmoid complex. Herein we try to exploit the variants of the approach and we identify indications, advantages, and disadvantages. Methods: All phases of the study were conducted at the Institute of Public Health Section of Legal Medicine and Insurance of the University. We performed the extreme lateral approach in four subjects, who died between 24 and 48 h before in non-traumatic circumstances (three men and one woman). Results: The great auricular nerve, the spinal accessory, the branches of the first ventral spinal nerves, the jugular vein, and the vertebral artery were identified in all the cadavers. In all cases the right VA exited from the transverse foramen of C1. The site of SCM piercing the accessory nerve was at a distance from the tip of the mastoid between 3 and 4 cm (3.3 in one case, 3.4 in 2 cases, and 3.7 in one case). No vessels and nerves have been damaged after being identified and isolated. Conclusions: Extradural lesions at the ventro-lateral aspect of the CVJ may require an extreme lateral approach, a procedure more aggressive comparing with far lateral approach, which represents a reasonable option for large anterior and anterolateral lesions when greater exposure is required.
KW - Cadaver
KW - Cervical Vertebrae
KW - Craniocervical junction
KW - Craniovertebral junction
KW - Extreme lateral approach
KW - Female
KW - Humans
KW - Jugular Veins
KW - Male
KW - Neurosurgical Procedures
KW - Peripheral Nerves
KW - Skull
KW - Vertebral Artery
KW - Cadaver
KW - Cervical Vertebrae
KW - Craniocervical junction
KW - Craniovertebral junction
KW - Extreme lateral approach
KW - Female
KW - Humans
KW - Jugular Veins
KW - Male
KW - Neurosurgical Procedures
KW - Peripheral Nerves
KW - Skull
KW - Vertebral Artery
UR - http://hdl.handle.net/10807/206787
U2 - 10.1007/978-3-319-62515-7_26
DO - 10.1007/978-3-319-62515-7_26
M3 - Article
SN - 0942-0940
VL - 125
SP - 175
EP - 178
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
ER -