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The first 25 slides, exactly as they appear. The full deck has 56 content slides.
Neurosurgery
Surgical Resection of Lower ClivusAnterior Foramen Magnum
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
7 sections · 56 slides
Overview
- What this deck teaches, step by step
The problem
What anterior foramen magnum meningiomas are and why they endanger the patient
- What is an anterior foramen magnum meningioma?
- How these tumors are classified — by where they attach
- The scale of the problem
- Two approaches, one decision
Patient selection
Who has symptoms, who should be operated, and who can be watched
- How these tumors announce themselves
- What is the classic 'foramen magnum syndrome'?
- Who to operate on — and who to watch
Preoperative preparation
Reading the anatomy before a single incision
- Imaging the tumor and the nerves
- Reading the bone — and a hidden trap
- Mapping the arteries and the veins
The far-lateral approach
Coming in from behind and to the side, with control of the vertebral artery
- Anesthesia and intraoperative monitoring
- Positioning: the lateral park bench
- Park bench position and inverted horseshoe incision
- Skin incision and soft-tissue dissection
- Isolating the vertebral artery — two safe routes
- How far to free the artery depends on the plan
- Vertebral artery loop in far-lateral exposure
- Bone removal: the suboccipital craniectomy
- Far-lateral suboccipital craniectomy
- Retrocondylar vs partial transcondylar drilling
- The hypoglossal canal: the anterior stop line
- Opening the dura and removing the tumor
- Far-lateral retrocondylar resection (video)
- When the anatomy is distorted
- Closure of the far-lateral approach
- Postoperative management
- Advantages and limitations of the far-lateral approach
- Far-lateral vs posterior suboccipital outcomes
- Meningioma encasing the vertebral artery
The endonasal transclival approach
Reaching the tumor head-on, through the nose
- When to choose the endonasal route
- Anesthesia, monitoring, positioning
- Building the corridor through the nose
- Endonasal transclival approach (video)
- The parapharyngeal carotid artery — the key danger
- Tortuous parapharyngeal carotid artery on CT angiogram
- Exposing the clivus and finding the nerve landmarks
- Endonasal exposure of longus capitis
- Drilling the clivus and its extensions
- Exposed clival dura after drilling
- Opening the dura and removing the tumor
- Closure — sealing a large defect from the front
- Advantages and limitations of the endonasal approach
- Anterior meningioma via endonasal corridor
Choosing between the two approaches
Matching the route to the tumor
- Far-lateral vs endoscopic endonasal transclival
- Take-home messages
- References (1/2)
- References (2/2)
- Neurosurgical Operative Atlas: Neuro-Oncology