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[Microsurgical approach to the ambient cistern].
Pablo Ajler1, Michael Cruz Bravo1, Lucas Garategui1
1Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Surgical Neurology International
|December 22, 2016
Summary
This study details the suboccipital retrosigmoid supracerebellar infratentorial (RSI) approach for accessing the ambient cistern. The modified RSI technique provides a safe and effective surgical corridor, particularly for infratentorial lesions.
Area of Science:
- Neurosurgery
- Surgical Anatomy
- Minimally Invasive Techniques
Background:
- The ambient cistern is a critical neurosurgical space.
- Accessing the ambient cistern can be challenging due to surrounding anatomical structures.
Purpose of the Study:
- To present a detailed, step-by-step description of the suboccipital retrosigmoid supracerebellar infratentorial (RSI) approach.
- To highlight modifications enabling safe access to the ambient cistern.
Main Methods:
- Utilizing a semi-sitting position.
- Performing an extended craniotomy-craniectomy exposing the transverse sinus.
- Mobilizing the dura superiorly.
- Opening the cerebellomedullary cistern for cerebrospinal fluid drainage.
- Careful management of arachnoidal adhesions and bridging veins.
Main Results:
- The described modifications create a wide surgical corridor.
- The approach facilitates safe access to the ambient cistern.
Conclusions:
- The suboccipital retrosigmoid supracerebellar infratentorial (RSI) approach offers a safe method for reaching the ambient cistern.
- This technique is particularly advantageous for accessing the infratentorial portion of the ambient cistern.
