Microsurgical Anatomy of the Hypoglossal Nerve in the Lateral Approaches to the Craniovertebral Junction: A Study on Fresh Non-Formalin-Fixed Human Specimens

2022 ◽  
Author(s):  
Lorenzo Pescatori ◽  
Maria Pia Tropeano ◽  
Manolo Piccirilli ◽  
Pasqualino Ciappetta
Keyword(s):  
Hypoglossal Nerve ◽  
Anatomical Study ◽  
Craniovertebral Junction ◽  
Lateral Approach ◽  
Anterolateral Approach ◽  
Microsurgical Anatomy ◽  
Arteries And Veins ◽  
Formalin Fixed

AbstractThe aim of this anatomical study is to describe the anatomy of the hypoglossal nerve (HN) from its origin to the extracranial portion as it appears by performing a combined posterolateral and anterolateral approach to the craniovertebral junction (CVJ). Twelve fresh, non-formalin-fixed adult cadaveric heads (24 sides) were analyzed for the simulation of the combined lateral approach to the CVJ. The HN is divided into three main parts: cisternal, intracanalicular, and extracranial The anatomical relationships between the HN and other nerves, muscles, arteries and veins were carefully recorded, and some measurements were made between the HN and related structures. Thus, various landmarks were determined for the easy identification of the HN. Understanding the detailed anatomy of the HN and its relationships with the surrounding structures is crucial to prevent some complications during CVJ surgery.

Comparison of the Far Lateral and Extreme Lateral Variants of the Atlanto-occipital Transarticular Approach to Anterior Extradural Lesions of the Craniovertebral Junction

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 662-675 ◽  
Author(s):  
Masatou Kawashima ◽  
Necmettin Tanriover ◽  
Albert L. Rhoton ◽  
Arthur J. Ulm ◽  
Toshio Matsushima
Keyword(s):  
Vertebral Artery ◽  
Anterior Part ◽  
Cerebrospinal Fluid Leak ◽  
Craniovertebral Junction ◽  
Lateral Approach ◽  
Sternocleidomastoid Muscle ◽  
Transoral Approach ◽  
Microsurgical Anatomy ◽  
Far Lateral Approach ◽  
Far Lateral

Abstract OBJECTIVE Managing lesions situated in the anterior aspect of the craniovertebral junction (CVJ) remains a challenging neurosurgical problem. The purposes of this study were to examine the microsurgical anatomy of the anterior extradural aspect of the CVJ and the differences in the exposure obtained by the far lateral and extreme lateral atlanto-occipital transarticular approaches. The far lateral approach, as originally described, is a lateral suboccipital approach directed behind the sternocleidomastoid muscle and the vertebral artery and just medial to the occipital and atlantal condyles and the atlanto-occipital joint. The extreme lateral approach, as originally described, is a direct lateral approach deep to the anterior part of the sternocleidomastoid muscle and behind the internal jugular vein along the front of the vertebral artery. Both approaches permit drilling of the condyles at the atlanto-occipital joint but provide a different exposure because of the differences in the direction of the approach. METHODS Fifteen adult cadaveric specimens were studied using a magnification of ×3 to ×40 after perfusion of the arteries and veins with colored silicone. The microsurgical anatomy of the extradural aspects of the CVJ and the two atlanto-occipital transarticular approaches were examined in stepwise dissections. RESULTS The far lateral atlanto-occipital transarticular approach provides excellent exposure of the extradural lesions located in the ipsilateral anterior and anterolateral aspects of the extradural region of the CVJ. The extreme lateral atlanto-occipital transarticular approach provides excellent exposure, not only on the side of the exposure, but also extending across the midline to the medial aspect of the contralateral atlanto-occipital joint and the lower clivus. CONCLUSION The far lateral and extreme lateral variants of the atlanto-occipital transarticular approach provide an alternative to the transoral approach to the anterior extradural structures at the CVJ. Compared with the transoral approach, both approaches provide a shorter operative route, avoid the contaminated nasopharynx, reduce the incidence of cerebrospinal fluid leak, and are not limited laterally by the atlanto-occipital joint.

scholarly journals Far Lateral Approach for Clipping of a Posterior Inferior Cerebellar Artery Aneurysm

2019 ◽  
Vol 80 (S 04) ◽  
pp. S343-S343
Author(s):  
Jaafar Basma ◽  
Vincent N. Nguyen ◽  
William M. Mangham ◽  
Nickalus R. Khan ◽  
Jeffrey Sorenson ◽  
...  
Keyword(s):  
Hypoglossal Nerve ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Lateral Approach ◽  
Microsurgical Anatomy ◽  
Microsurgical Clipping ◽  
Cerebellar Artery ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Clip Occlusion

Abstract Objectives To describe a far lateral approach for microsurgical clipping of a ruptured posterior inferior cerebellar artery (PICA) aneurysm involving the hypoglossal nerve, with emphasis on the microsurgical anatomy, and technique. Design A far lateral craniotomy is performed in the lateral decubitus position and the transverse and sigmoid sinuses were exposed. After opening the dura, sutures are placed to allow gentle mobilization of the sinuses. The ipsilateral cerebellar tonsil is mobilized and the PICA is followed to its junction with the vertebral artery. Hypoglossal nerve rootlets are draped over the dome of the aneurysm. Mobilization of the PICA and the hypoglossal nerve away from the lateral medulla allows microsurgical clipping of the aneurysm neck. Photographs of the region are borrowed from Dr Rhoton's laboratory to illustrate the microsurgical anatomy. Participants The senior authors performed the surgery. The video was edited by Drs. V.N. and J.B. Chart review and literature review were performed by Drs. W.M. and J.B. Outcome Measures Outcome was assessed with successful clip occlusion and postoperative neurological function. Results There was complete clip occlusion of the PICA aneurysm with no postoperative neurological deficits. The patient was discharged home after an uneventful hospital course. Conclusion The far lateral approach provides an adequate corridor to the ventrolateral brainstem for microsurgical treatment of PICA aneurysms. An adequate understanding of the relevant microsurgical anatomy is the key to safe and effective clipping in this region.The link to the video can be found at: https://youtu.be/yhjKRIG5H74.

The Extreme Lateral Approach to the Craniovertebral Junction: An Anatomical Study

2019 ◽  
pp. 175-178
Author(s):  
Francesco Signorelli ◽  
Walter Pisciotta ◽  
Vittorio Stumpo ◽  
Pasquale Ciappetta ◽  
Alessandro Olivi ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Craniovertebral Junction ◽  
Lateral Approach

Endoscopic far-lateral approach to the posterolateral craniovertebral junction: an anatomical study

2012 ◽  
Vol 36 (2) ◽  
pp. 239-247 ◽  
Author(s):  
Fuminari Komatsu ◽  
Mika Komatsu ◽  
Antonio Di Ieva ◽  
Manfred Tschabitscher
Keyword(s):  
Anatomical Study ◽  
Craniovertebral Junction ◽  
Lateral Approach ◽  
Far Lateral Approach ◽  
Far Lateral

scholarly journals Far Lateral Approach for Resection of Transverse Ligament Cyst

2020 ◽  
Author(s):  
Lattimore Madison Michael ◽  
Vincent Nguyen ◽  
Jaafar Basma ◽  
William Mangham ◽  
Nickalus Khan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Mass Effect ◽  
Lateral Approach ◽  
Microsurgical Anatomy ◽  
Transverse Ligament ◽  
Far Lateral Approach ◽  
Adequate Understanding ◽  
Far Lateral ◽  
Microsurgical Resection ◽  
Dentate Ligament

Abstract Objectives This study was aimed to describe a far lateral approach for microsurgical resection of a transverse ligament cyst, with emphasis on the microsurgical anatomy and technique. Design A far lateral craniotomy is performed in the lateral decubitus position. After opening the dura laterally, dural sutures are placed for retraction. A stitch placed through the dentate ligament is advantageous to rotate the spinal cord to allow access to the ventral cyst. The cyst is marsupirlized and mass effect on the spinal cord is relieved. Photographs of the region are borrowed from Dr Rhoton's laboratory to illustrate the microsurgical anatomy. Participants The first author performed the surgery and edited the video. Chart review and literature review were performed by the other authors. Outcome Measures Outcome was assessed with postoperative neurological function. Results The patient was discharged home after an uneventful hospital course. At short-term follow-up, the patient had a significant improvement in postoperative strength. Conclusion The far lateral approach provides an adequate corridor to the ventrolateral brainstem in combination with utilization of the dentate ligament to reach ventral cysts compressing the spinal cord. An adequate understanding of the relevant microsurgical anatomy is a key to safe surgery in this region.The link to the video can be found at: https://youtu.be/5MGVPO2Q2pI.

The blood supply of the hypoglossal nerve: The microsurgical anatomy of its cisternal segment

1997 ◽  
Vol 48 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Hirohiko Gibo ◽  
Slobodan Marinković ◽  
Ivana Nikodijević ◽  
Bojan Štimec ◽  
Atila Erden
Keyword(s):  
Blood Supply ◽  
Hypoglossal Nerve ◽  
Microsurgical Anatomy

scholarly journals The Microsurgical Relationships between Internal Carotid-Posterior Communicating Artery Aneurysms and the Skull Base

2017 ◽  
Vol 79 (05) ◽  
pp. 427-436 ◽  
Author(s):  
Noritaka Komune ◽  
Ryosuke Tsuchimochi ◽  
Yasutoshi Kai ◽  
Kenichi Matsumoto ◽  
Sei Haga ◽  
...  
Keyword(s):  
Skull Base ◽  
Clinical Characteristics ◽  
Internal Carotid ◽  
Posterior Communicating Artery ◽  
Microsurgical Anatomy ◽  
Anterior Clinoid Process ◽  
Anterior Clinoidectomy ◽  
Close Relationship ◽  
Anatomical Relationship ◽  
Formalin Fixed

Objective This study aimed to review the anatomical and clinical characteristics of internal carotid-posterior communicating artery (IC-PC) aneurysms, especially those located close to the skull base. Methods The microsurgical anatomy around the posterior communicating artery (PComA) was examined in a dry skull and five formalin-fixed human cadaveric heads. The clinical characteristics of 37 patients with 39 IC-PC aneurysms, who were treated microsurgically between April 2008 and July 2016, were retrospectively reviewed. Results The anterior clinoid process (ACP), as well as the anterior petroclinoidal dural fold (APF), which forms part of the oculomotor triangle, are closely related to the origin of the PComA. Among the 39 IC-PC aneurysms, anterior clinoidectomy was performed on 4 (10.3%) and a partial resection of the APF was performed on 2 (5.1%). Both of these aneurysms projected inferior to the tentorium, or at least part of the aneurysm's dome was inferior to the tentorium. Conclusion Proximally located IC-PC aneurysms have an especially close relationship with the ACP and APF. We should be familiar with the anatomical relationship between IC-PC aneurysms and the structures of the skull base to avoid hazardous complications.

scholarly journals Arterial diameter of the celiac trunk and its branches: anatomical study

2009 ◽  
Vol 24 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Luís Augusto da Silveira ◽  
Fernando Braga Cassiano Silveira ◽  
Valéria Paula Sassoli Fazan
Keyword(s):  
Hepatic Artery ◽  
Celiac Trunk ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Left Gastric Artery ◽  
Gastric Artery ◽  
Arterial Diameter ◽  
Significant Difference ◽  
Diameter Reduction ◽  
Formalin Fixed

PURPOSE: Despite the fact that anatomical variations of the celiac trunk are well explored in the literature, information on these vessels diameters is scanty. The aims of the present study were to describe the arterial diameters of the celiac trunk and its main branches, and to investigate if these diameters are altered in those cases presenting anatomical variations of these vessels. METHODS: Twenty-one formalin fixed adult male cadavers were appropriately dissected for the celiac trunk identification and arterial diameter measurements. Arteries measured included the celiac trunk and its main branches (splenic artery, left gastric artery and common hepatic artery), as the proper hepatic artery, right gastric artery, the left and right hepatic arteries and the gastroduodenal artery. RESULTS: From the 21 cadavers, 6 presented anatomical variations of, at least, one of the above mentioned branches. The average arterial diameter comparisons between groups (normal and variable) clearly showed smaller diameters for variable vessels, but with no significant difference. CONCLUSION: Our data indicates the possibility of a diameter reduction of the celiac trunk main branches in the presence of anatomical variations. This should be taken into account on the selection for the liver transplantation donors.

Microsurgical Anatomy and Surgical Exposure of the Petrous Segment of the Internal Carotid Artery

2008 ◽  
Vol 63 (suppl_4) ◽  
pp. ONS210-ONS239 ◽  
Author(s):  
Shigeyuki Osawa ◽  
Albert L. Rhoton ◽  
Necmettin Tanriover ◽  
Satoru Shimizu ◽  
Kiyotaka Fujii
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Lateral Wall ◽  
Common Trunk ◽  
Microsurgical Anatomy ◽  
Carotid Canal ◽  
Complex Relationships ◽  
Arteries And Veins

Abstract Objective: The petrous segment of the internal carotid artery has been exposed in the transpetrosal, subtemporal, infratemporal, transnasal, transmaxillary, transfacial, and a variety of transcranial approaches. The objective of the current study was to examine anatomic features of the petrous carotid and its branches as related to the variety of approaches currently being used for its exposure. Methods: Twenty middle fossae from adult cadaveric specimens were examined using magnification of ×3 to ×40 after injection of the arteries and veins with colored silicone. Results: The petrous carotid extends from the entrance into the carotid canal of the petrous part of the temporal bone to its termination at the level of the petrolingual ligament laterally and the lateral wall of the sphenoid sinus medially. The petrous carotid from caudal to rostral was divided into 5 segments: posterior vertical, posterior genu, horizontal, anterior genu, and anterior vertical. Fourteen (70%) of the 20 petrous carotids had branches. The branch that arose from the petrous carotid was either a vidian or periosteal artery or a common trunk that gave rise to both a vidian and 1 or more periosteal arteries. The most frequent branch was a periosteal artery. Conclusion: An understanding of the complex relationships of the petrous carotid provides the basis for surgically accessing any 1 or more of its 5 segments.

Sign in / Sign up

Export Citation Format

Share Document