Cargando…

One burr-hole craniotomy: Suboccipital midline approach to the fourth ventricle in Helsinki neurosurgery

BACKGROUND: In this video-abstract, we present one burr-hole craniotomy for the standard suboccipital midline approach developed in Helsinki neurosurgery for the microsurgical management of forth ventricle lesions, distal posterior inferior cerebellar artery aneurysms, and tumoral and vascular lesio...

Descripción completa

Detalles Bibliográficos
Autores principales: Choque-Velasquez, Joham, Hernesniemi, Juha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122287/
https://www.ncbi.nlm.nih.gov/pubmed/30210903
http://dx.doi.org/10.4103/sni.sni_194_18
_version_ 1783352624673718272
author Choque-Velasquez, Joham
Hernesniemi, Juha
author_facet Choque-Velasquez, Joham
Hernesniemi, Juha
author_sort Choque-Velasquez, Joham
collection PubMed
description BACKGROUND: In this video-abstract, we present one burr-hole craniotomy for the standard suboccipital midline approach developed in Helsinki neurosurgery for the microsurgical management of forth ventricle lesions, distal posterior inferior cerebellar artery aneurysms, and tumoral and vascular lesions of the vermis, cisterna magna region, and posterior brainstem as well. CASE DESCRIPTION: We prefer to position the patient in sitting praying position. A midline straight single-layer incision starts on the inion and extends caudally toward the level of C2. The muscles are divided with diathermia along the occipital bone. Three curved retractors, two upward and one downward, provide a wide clean space for the craniotomy. Finger palpation and blunt dissection with cottonoids balls provide identification of the foramen magnum and the spinous process of C1. A burr-hole is made 1 cm lateral and below the level of the transverse sinus. After the detachment of the dura with a curved angled dissector, two cuts from both sites of the burr-hole are made with the craniotome. In case of an adherent dura particularly present in elderly patients, a long blunt flexible dissector (yasargil dissector) is used for the detachment of the bone from the dura. A craniotomy around the midline overlying the occipital sinus and the falx cerebelli is performed to expose medial aspects of cerebellar tonsils, the medulla oblongata, and the occipital sinus. Special care should be taken to avoid damaging the vertebral artery and the epidural sinuses running at the foramen magnum. A few drill holes are made for tack-up sutures. After a craniocervical-based opening of the dura, the fourth ventricle is accessed directly by telovelar route. CONCLUSION: The described one burr-hole craniotomy may represent the more efficient manner for performing the suboccipital midline approach to the fourth ventricle. VIDEOLINK: http://surgicalneurologyint.com/videogallery/suboccipital-midline-approach/
format Online
Article
Text
id pubmed-6122287
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Medknow Publications & Media Pvt Ltd
record_format MEDLINE/PubMed
spelling pubmed-61222872018-09-12 One burr-hole craniotomy: Suboccipital midline approach to the fourth ventricle in Helsinki neurosurgery Choque-Velasquez, Joham Hernesniemi, Juha Surg Neurol Int General Neurosurgery: Video Abstract BACKGROUND: In this video-abstract, we present one burr-hole craniotomy for the standard suboccipital midline approach developed in Helsinki neurosurgery for the microsurgical management of forth ventricle lesions, distal posterior inferior cerebellar artery aneurysms, and tumoral and vascular lesions of the vermis, cisterna magna region, and posterior brainstem as well. CASE DESCRIPTION: We prefer to position the patient in sitting praying position. A midline straight single-layer incision starts on the inion and extends caudally toward the level of C2. The muscles are divided with diathermia along the occipital bone. Three curved retractors, two upward and one downward, provide a wide clean space for the craniotomy. Finger palpation and blunt dissection with cottonoids balls provide identification of the foramen magnum and the spinous process of C1. A burr-hole is made 1 cm lateral and below the level of the transverse sinus. After the detachment of the dura with a curved angled dissector, two cuts from both sites of the burr-hole are made with the craniotome. In case of an adherent dura particularly present in elderly patients, a long blunt flexible dissector (yasargil dissector) is used for the detachment of the bone from the dura. A craniotomy around the midline overlying the occipital sinus and the falx cerebelli is performed to expose medial aspects of cerebellar tonsils, the medulla oblongata, and the occipital sinus. Special care should be taken to avoid damaging the vertebral artery and the epidural sinuses running at the foramen magnum. A few drill holes are made for tack-up sutures. After a craniocervical-based opening of the dura, the fourth ventricle is accessed directly by telovelar route. CONCLUSION: The described one burr-hole craniotomy may represent the more efficient manner for performing the suboccipital midline approach to the fourth ventricle. VIDEOLINK: http://surgicalneurologyint.com/videogallery/suboccipital-midline-approach/ Medknow Publications & Media Pvt Ltd 2018-08-22 /pmc/articles/PMC6122287/ /pubmed/30210903 http://dx.doi.org/10.4103/sni.sni_194_18 Text en Copyright: © 2018 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle General Neurosurgery: Video Abstract
Choque-Velasquez, Joham
Hernesniemi, Juha
One burr-hole craniotomy: Suboccipital midline approach to the fourth ventricle in Helsinki neurosurgery
title One burr-hole craniotomy: Suboccipital midline approach to the fourth ventricle in Helsinki neurosurgery
title_full One burr-hole craniotomy: Suboccipital midline approach to the fourth ventricle in Helsinki neurosurgery
title_fullStr One burr-hole craniotomy: Suboccipital midline approach to the fourth ventricle in Helsinki neurosurgery
title_full_unstemmed One burr-hole craniotomy: Suboccipital midline approach to the fourth ventricle in Helsinki neurosurgery
title_short One burr-hole craniotomy: Suboccipital midline approach to the fourth ventricle in Helsinki neurosurgery
title_sort one burr-hole craniotomy: suboccipital midline approach to the fourth ventricle in helsinki neurosurgery
topic General Neurosurgery: Video Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122287/
https://www.ncbi.nlm.nih.gov/pubmed/30210903
http://dx.doi.org/10.4103/sni.sni_194_18
work_keys_str_mv AT choquevelasquezjoham oneburrholecraniotomysuboccipitalmidlineapproachtothefourthventricleinhelsinkineurosurgery
AT hernesniemijuha oneburrholecraniotomysuboccipitalmidlineapproachtothefourthventricleinhelsinkineurosurgery