Lateral Suboccipital Approach

Abstract

In the pioneering days of neurosurgery, lesions in the clivai region were still considered inoperable (Cushing and Eisenhardt 1938; Castellano and Ruggiero 1953; Olivecrona 1967). The few cases in which tumor extirpations were carried out by Cushing in 1914 and Olivecrona in 1927 did not end in success, which comes as no surprise considering that mortality in cases of acoustic neurinoma was far more than 10% (Krause 1904; Cushing 1917; Dandy 1917, 1941). Improved diagnostic techniques and the development of more sophisticated surgical techniques led to Dandy’s unilateral suboccipital approach to the cerebellopontine angle (Dandy 1925, 1941; Dandy et al. 1963). However, despite progress in this field, tumors of the clivus continued to be regarded as inoperable (Castellano and Ruggiero 1953; Olivecrona 1967), with very few exceptions (Dechaume and Wertheimer 1936). The introduction of microsurgical techniques and, as a consequence, better results in acoustic neurinoma surgery (Rand and Kurze 1965; Malis 1975; Ya§argil 1976, Yasargil et al. 1977, 1980; Koos and Perneczky 1982, 1985; Koos et al. 1976, 1985; Rand and di Tullio 1985; Samii 1981, 1985) made it possible to reach petroclival and clivai tumors by means of a lateral suboccipital approach.