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Academia Mexicana de Neurología, A.C.

2006, Number 2

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Rev Mex Neuroci 2006; 7 (2)

Extreme lateral approach in foramen magnum lesions

Cruz GO, Lopez FG, Fernandez MR, Diaz DD, Morales I, Prince J, Jordan J

Language: Spanish
References: 28
Page: 120-126
PDF size: 166.59 Kb.


ABSTRACT

Introduction: Extreme lateral transcondilar approach (ELA) can be used single or in combination with other approaches, and provide the access to ventral-superior channel, anterior portion of foramen magnum, medium and inferior clivus and jugular foramen. Patients and method: There were studied patients who entered in Centro de Investigaciones Medico Quirurgico (CIMEQ) and Centro Internacional de Restauración Neurológica (CIREN) from 2000 to 2005, carriers of injuries located in foramen magnum that fulfilled the inclusion criteria to be operated by a ELA combined approach. The decision of the use of ELA approach was determined by the concept of the denominated surgical corridor that corresponds to the space analyzed in image of magnetic resonance (MR) that exists between the lateral margin of the cervicobulbar union and the medial face of occipital condyle. Results: In a patient an increase of the preoperating motor deficit occurred that improved in the long term pursuit; worsening of the function of low NC happened in two patients who also improved during the first six months of the pursuit. A patient in which anatomical damage of C1 and C2 occurred maintained with left hemicranial analgesia of three months of evolution, for later appearing pain by desafferentation of left C2 territory, and took treatment with morphinic analgesic associated to infiltrations with anesthetic and steroids without favorable results, being at the moment pending of the positioning of a transcutaneous stimulating. Discussion: A great confusion with respect to the nomenclature of the ELA still exists; we thus considered it when a flap of soft parts is made, a lateral dissection with exhibition of C1 until its transversa, a lateral opening of the foramen magnum and total resección of C1 lamina, and transcondilar ELA approach when in addition to all previous the condyle and C1 facet dry total or partially. Other authors have referred modifications of this approaching, that is what has entailed to so varied nomenclatures as partial mastoidectomiy, resección of jugular tubercle or total perforation of atlas lateral mass. Conclusions: ELA transcondilar approach provides an excellent access to foramen magnum region, specifically to lesions that surround the atlanto-occipital joint, with an increase of the amplitude and the exposition angle with respect to the conventional suboccipital approach, facilitating the radical resection of the lesion, with no neural retraction and a low level of surgical complications.


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