scholarly journals SURGICAL TREATMENT OF MENINGIOMA WITH VENTRAL AND VENTROLATERAL LOCALIZATION IN THE REGION OF THE FORAMEN MAGNUM

2018 ◽  
pp. 84
Author(s):  
Luka Berilažić ◽  
Nebojša Stojanović ◽  
Radisav Mitić ◽  
Aleksandar Kostić ◽  
Zvonko Dželebdžić
Keyword(s):  
Spinal Canal ◽  
Complete Removal ◽  
Foramen Magnum ◽  
Posterolateral Approach ◽  
Surgical Approaches ◽  
Occipital Condyle ◽  
Atlantoaxial Joint ◽  
Bone Removal ◽  
Occipitocervical Fixation ◽  
Occipital Condyles

Meningiomas localized in the ventral part of the foramen magnum always represent a surgical challenge. Analysis was performed on the surgical approach to meningiomas with ventral localization in the craniocervical region in 6 patients. Two posterolateral surgical approaches were used, depending on whether the tumor was at the level of the foramen magnum or it transited into the cervical spinal canal. In the case of a tumor at the level of the foramen magnum, posterolateral approach was used, with the suboccipital bone removal, and removal of part of the occipital condyles, with the resection of the atlas arch and mobilization of a.vertbralis. In tumors propagated in the spinal canal, the same resection of the occipital bone and occipital condyle was done, with the removal of the atlas and part of the atlantoaxial joint. Due to destabilization, occipitocervical fixation was performed in the second posterolateral approach. The posterolateral approach with the suboccipital removal of the bones and the atlas or, if necessary, with the resection of the occipital condyle or atlantoaxial joint, enables a good ventral separation of the tumor attachment and subsequent gradual complete removal. Fixation is required in the event of a removal of the atlantoaxial joint or removal of more than half of the occipital condyle. Posterolateral approach is an absolute indication in all cases of the ventral and ventrolateral localization of meningiomas in the area of the cervico-occipital junction, because it provides complete visualization of the tumor and allows for its safe removal.

scholarly journals Anatomical and Radiological study of the posterior cranial base in relationship to occipital condyles and Foramen magnum

2020 ◽  
Vol 11 (3) ◽  
pp. 3528-3532
Author(s):  
Sharmila Aristotle ◽  
Balaji Ramraj ◽  
Shantanu Patil ◽  
Sundarapandian Subramanian
Keyword(s):  
Clinical Importance ◽  
Diagnostic Procedures ◽  
Cranial Base ◽  
Ct Images ◽  
Foramen Magnum ◽  
Ct Scans ◽  
Surgical Approaches ◽  
Occipital Condyle ◽  
Mortality And Morbidity ◽  
Occipital Condyles

Detailed morphometric analysis is required for various surgical approaches in the craniovertebraljunction. High mortality and morbidity are anticipated for the surgical procedures when undertaken without in-depth anatomical knowledge. With so much clinical importance in this area, our study will present a thorough understanding in terms of skull and CT values. The main aim of this study is to give the morphometric details of occipital condyles and foramen magnum in cadaveric skulls and CT scans. Seventy dried human skulls and 70 CT images on the three-dimensional volume-rendered reconstruction of the skull base was used for this study. The length and width of the occipital condyle of right and the left side was 22.21 ±5.20 mm; 22.05±4.83 mm; 12.57 ± 2.50 and 12.68 ± 2.92mm respectively in cadaver skull. The length and width of occipital condyles in CT scans for right and left side was 21.61 ± 3.09 mm; 21.58 ± 3.50 mm; 13.04 ± 1.58 mm and 13.13 ± 2.54 mm respectively. The Anteroposterior and transverse diameters of the foramen magnum in cadaveric skulls and CT images was 33.17 ± 7.23; 29.22 ± 6.17; 34.15 ± 2.88 and 28.14 ± 2.43 mm respectively. Each surgical approach and the radiological diagnostic procedures have their limitations. Moreover, analysis of cranial base dimensions of occipital condyles and foramen magnum can be considered as a reliable method for sex determination. Hence this study will a useful guide for surgeons, radiologists, anthropologists and forensic experts.

scholarly journals Anatomical and clinical correlates of the precondylar tubercle

2014 ◽  
Vol 31 (03) ◽  
pp. 182-186 ◽  
Author(s):  
A. Jaffar
Keyword(s):  
Anterior Margin ◽  
Surgical Intervention ◽  
Foramen Magnum ◽  
Occipital Condyle ◽  
Radiographic Images ◽  
Radiographic Appearance ◽  
Clinical Correlates ◽  
Clinical Community ◽  
Spiral Computerized Tomography ◽  
Occipital Condyles

Abstract Introduction: The possible presence of the precondylar tubercle should be considered in order to avoid misinterpretation in radiographic images and confusion during surgical intervention. This study is aimed to describe and report the frequency of the precondylar tubercle and similar variations at the anterior margin of foramen magnum in order to alert the clinical community of their presence and of the possible associated variations. Materials and Methods: Fifty dry skulls were examined for variations at the anterior margin of foramen magnum. One skull with bilaterally prominent precondylar tubercles was studied using a spiral computerized tomography in order to demonstrate the radiographic appearance of the tubercle. Results: Precondylar tubercles were observed in 10% of the skulls. Other simulating observations included the presence of a midline spur, bilateral depression anteromedial to the occipital condyles, third occipital condyle, and a partly divided occipital condyle. In 89% of the cases these variations were associated with septation of the hypoglossal canal. Conclusion: The presence of a mere precondylar tubercle is not expected to produce neurological manifestations. However, its possible association with other variations should be considered. The size and location of the precondylar tubercle might evade plain radiographic films, but it can be readily revealed in axial computerized tomograms.

scholarly journals Fully Endoscopic Minimally Invasive Transrectus Capitis Posterior Muscle Triangle Approach to the Posterolateral Condyle and Jugular Tubercle

2017 ◽  
Vol 78 (05) ◽  
pp. 359-370 ◽  
Author(s):  
Wang Mingdong ◽  
Roger Mathias ◽  
Eric Wang ◽  
Paul Gardner ◽  
Hong Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Fourth Ventricle ◽  
Jugular Foramen ◽  
Foramen Magnum ◽  
Endoscopic Approach ◽  
Occipital Condyle ◽  
Anatomical Landmarks ◽  
Bone Removal ◽  
Soft Tissue Dissection ◽  
Greater Occipital Nerve

Background We evaluated a transrectus capitis posterior muscle triangle approach to the posterolateral foramen magnum, occipital condyles, jugular tubercle, and the fourth ventricle. We also assessed factors that affect the amount of bone removal required. Objective To evaluate if the proposed approach is as effective as standard open approaches to expose the lateral portion of the foramen magnum. Methods The proposed minimally invasive fully endoscopic approach was performed in 15 cadaveric specimens using 4-mm (0- and 45-degree) endoscopes. Results Using a 5-cm straight paramedian incision, the rectus capitis posterior minor and major muscles were partially removed unilaterally, providing a corridor through the muscles to reach the foramen magnum region. After meticulous soft tissue dissection, key anatomical landmarks can be identified such as the greater occipital nerve, the vertebral artery that wraps around the atlanto-occipital joint, and the bony protuberance that heralds the occipital condyle. A suboccipital craniotomy associated with the transcondylar, supracondylar or paracondylar approach is performed depending on the amount of bone removal desired to maximize the surgical view. By doing so, the jugular foramen can be exposed laterally as well as the fourth ventricle medially. Conclusion The proposed endoscopic approach can provide access through the transrectus capitis posterior muscle triangle leading directly to the occipital condyle. A stepwise approach is critical to gain a surgical corridor to the inferolateral petroclival region and the fourth ventricle.

Posterior occipitocervical (C0–3) fusion using polyaxial occipital condyle to cervical spine screw and rod fixation: a radiographic and cadaveric analysis

2010 ◽  
Vol 12 (5) ◽  
pp. 509-516 ◽  
Author(s):  
Bruce M. Frankel ◽  
Michael Hanley ◽  
Alex Vandergrift ◽  
Timothy Monroe ◽  
Steven Morgan ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Instability ◽  
Occipital Condyle ◽  
Anatomical Studies ◽  
Occipitocervical Fixation ◽  
Polyaxial Screws ◽  
Occipital Condyles ◽  
Ct Studies

Numerous conditions affect the occipitocervical junction requiring treatment with occipitocervical fixation. In this paper the authors present their technique of craniocervical fixation achieved with the cephalad extension of posterior C1–3 polyaxial screw and rods to polyaxial screws placed in the occipital condyles. They retrospectively analyzed occipital condyle morphology obtained from CT analyses of 40 patients with normal cervical spines, evaluated occipital condyle screw placement feasibility in 4 cadavers, and provided a case report of a 70-year-old woman with rheumatoid arthritis, basilar invagination, and atlantoaxial instability who was treated with this novel technique. Based on radiographic analysis of occipital condyle anatomy, they concluded that on average a 3.5-mm-diameter × 20- to 30-mm-long screw can be safely placed at an angle of 20–33° from the sagittal plane. Overall, measuring the condylar heights (mean [± SD] 10.8 ± 1.5 mm, range 8.1–15.0 mm), widths (mean 11.1 ± 1.4 mm, range 8.5–14.2 mm), lengths (20.3 ± 2.1 mm, range 15.4–24.6 mm), and angles (mean 32.8 ± 5.2°, range 20.2–45.8°) by using CT studies is an accurate and precise method. This finding correlates with the results of prior anatomical studies of occipital condyles and is important in the planning of craniovertebral junction surgery.

Management of Anterolateral Foramen Magnum Meningiomas: Surgical Vs Conservative Decision Making

2010 ◽  
Vol 67 (3) ◽  
pp. ons58-ons70 ◽  
Author(s):  
Benoit J.M. Pirotte ◽  
Jacques Brotchi ◽  
Olivier DeWitte
Keyword(s):  
Decision Making ◽  
Vertebral Artery ◽  
Close Contact ◽  
Foramen Magnum ◽  
Posterolateral Approach ◽  
Occipital Condyle ◽  
Factors Affecting ◽  
Tumor Residue ◽  
Radiological Safety ◽  
Subtotal Removal

Abstract BACKGROUND: Anterolateral meningiomas of the foramen magnum (FMMs) represent a neurosurgical challenge because they grow in close contact with osteoarticular, nervous, and vascular structures that cannot be sacrificed or retracted. OBJECTIVE: To evaluate our strategy and results in 26 patients with FMMs and analyze factors affecting the decision-making process, resection, and outcome. METHODS: Among 26 consecutive symptomatic FMM (10 anterior, 16 lateral) patients (16 women, 10 men, ages 28–82 years), 4 older than 70 years of age were untreated. Twenty-two were operated on using a posterolateral approach, with the vertebral artery transposed in 19 and the occipital condyle drilled in 10. We analyzed the characteristics and outcome of untreated cases, the utility of THE occipital condyle drilled, the difficulties of microdissection, morbidity and total removal rates, the outcome of tumor residues, and the literature on radiosurgery. RESULTS: Three of 4 untreated patients remained clinically stable at 2 to 5 years. After systematic vertebral artery medial transposition and occipital condyle drilled in 6 cases, our technique evolved with experience in the next 16 (vertebral artery transposed in 13 of 16; occipital condyle drilled in 4 of 13) for dissecting anteriorly beyond midline (anterior FMMs). Retrocondylar access was sufficient for lateral FMMs. Tumors were totally removed in 16 of 22 (73%). One patient died, and 4 had permanent deficits. Follow-up of more than 5 years in 12 patients showed no C0–1 instability, and slight increase of tumor residue size 7 years after surgery. In the literature, 15 FMMs treated with radiosurgery are reported, 13 at diagnosis and 2 at recurrence, with short-term clinical and radiological safety and efficacy. CONCLUSION: We currently recommend (1) aiming for subtotal removal in difficult cases, (2) remaining conservative in asymptomatic or elderly patients with mild symptoms, and (3) considering radiosurgery at diagnosis for small (<30 mm) symptomatic FMMs or as an adjunct for evolving residues/recurrences in poor candidates for resection.

scholarly journals An investigation of craniocervical stability post-condylectomy

2021 ◽  
Vol 12 ◽  
pp. 380
Author(s):  
Brian Fiani ◽  
Ryan Jarrah ◽  
Erika Sarno ◽  
Athanasios Kondilis ◽  
Kory Pasko ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Craniovertebral Junction ◽  
Surgical Approaches ◽  
Occipital Condyle ◽  
Neurosurgical Procedures ◽  
Occipitocervical Fusion ◽  
Surgical Access ◽  
Craniocervical Instability ◽  
Far Lateral ◽  
Occipital Condyles

Background: Occipital condylectomy is often necessary to gain surgical access to various neurological pathologies. As the lateral limit of the craniovertebral junction (CVJ), partial condylectomy can lead to iatrogenic craniocervical instability. What was once considered an inoperable location is now the target of various complex neurosurgical procedures such as tumor resection and aneurysm clipping. Methods: In this study, we will review the anatomical structure of the CVJ and provide the first comprehensive assessment of studies investigating craniovertebral stability following condylectomy with the transcondylar surgical approaches. Furthermore, we discuss future considerations that must be evaluated to optimize the chances of preserving craniocervical stability postcondylectomy. Results: The current findings postulate upward of 75% of the occipital condyle can be resected without significantly affecting mobility of the CVJ. The current findings have only examined overall dimensions and have not established a significant correlation into how the shape of the occipital condyles can affect mobility. Occipitocervical fusion should only be considered after 50% condyle resection. In terms of indicators of anatomical stability, components of range of motion (ROM) such as the neutral zone (NZ) and the elastic zone (EZ) have been discussed as potential measures of craniocervical mobility. These components differ by the sense that the NZ has little ligament tension, whereas the EZ does represent ROM where ligaments experience tension. NZ is a more sensitive indicator of instability when measuring for instability postcondylectomy. Conclusion: Various transcondylar approaches have been developed to access this region including extreme-lateral and far-lateral condylectomy, with hopes of preserving as much of the condyle as possible and maintaining postoperative craniocervical stability.

scholarly journals Estimating Sex of Modern Greeks Based on the Foramen Magnum Region

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Maria-Eleni Chovalopoulou ◽  
Andreas Bertsatos
Keyword(s):  
Sex Determination ◽  
Foramen Magnum ◽  
Occipital Condyle ◽  
Discriminant Functions ◽  
Human Skeletal Remains ◽  
Mean Values ◽  
Modern Greek ◽  
The Mean ◽  
Occipital Condyles

Sex determination is one of the principal aims when examining human skeletal remains. One method for sex determination is based on metric criteria using discriminant functions. However, discriminant function sexing formulas are population-specific. In the present study, we determined the use of the foramen magnum as well as the occipital condyles for sex determination on adults from a modern Greek population. Seven parameters were examined (4 obtained from the foramen magnum; 3 obtained from the occipital condyles) and the sample consisted of 154 adult crania (77 males and 77 females). The results indicate that the foramen magnum region exhibits sexual dimorphism and the mean values for all parameters were higher in males than females. In comparison, the occipital condyles provide a higher determination of the correct sex than the foramen magnum. The combination of the occipital condyle variables allowed for the development of discriminant functions that predicted the correct sex in 74% of all cases. Finally, although other anatomical regions can discriminate the sexes with higher accuracy, the functions developed in this study could be cautiously used in cases of fragmented crania.

Occipital Cervical Stabilization Using Occipital Condyles for Cranial Fixation: Technical Case Report

Neurosurgery ◽  
2009 ◽  
Vol 65 (6) ◽  
pp. E1216-E1217 ◽  
Author(s):  
Juan S. Uribe ◽  
Edwin Ramos ◽  
Ali Baaj ◽  
A. Samy Youssef ◽  
Fernando L. Vale
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Occipital Condyle ◽  
Occipitocervical Fixation ◽  
Vehicle Accident ◽  
Successful Case ◽  
Feasible Option ◽  
Craniocervical Instability ◽  
Fixation Points ◽  
Occipital Condyles

Abstract OBJECTIVE Presentation of a successful case of craniocervical stabilization involving a novel surgical technique using the occipital condyles as the sole cranial fixation points. CLINICAL PRESENTATION A 22-year-old man presented in a delayed fashion with neck pain after a motor vehicle accident. Evaluation revealed a type 2 odontoid fracture with pseudarthrosis and displacement of the dens superiorly and cranial settling of the dens. INTERVENTION The patient underwent posterior occipitocervical fixation with a polyaxial screw rod construct using the occipital condyle, C1 lateral mass, and C2 pars articularis for fixation. The patient had no immediate postoperative deficits. At the time of the 12-month follow-up examination, the patient was neurologically intact with a solid occipitocervical fusion. CONCLUSION Craniocervical stabilization using occipital condyle screws as the sole cephalad fixation points is a feasible option and can be used safely without neurovascular complication in the treatment of craniocervical instability.

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