Skip to main content
SpringerLink
Log in

The Retrosigmoid Lateral Suboccipital Approach: Basic Approach and Variations

  • Chapter
  • First Online:
Microsurgical Anatomy and Surgery of the Posterior Cranial Fossa

  • 2283 Accesses

Abstract

Several approaches to lesions in the cerebellopontine angle (CPA) have been employed [3, 10, 11, 14, 19, 21, 22, 25]. Of these, the retrosigmoid lateral suboccipital approach (LSA) is the most convenient and frequently used. Because the bony opening is simple and intraoperative orientation easy, this approach is familiar to many neurosurgeons. LSA encompasses several approaches that vary in the application and positioning of bony openings depending on lesion location and the nature of each case. Figure 9.1 demonstrates two intraoperative views through LSA: first, a case of petrous apex meningioma in the upper CPA and second, a case of jugular foramen neurinoma in the lower CPA. Figure 9.1a, b shows the different operative views of the left CPA using the same approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Fujimaki T, Kirino T (2000) Combined trans-horizontal supracerebellar approach for microvascular decompression of trigeminal neuralgia. Br J Neurosurg 14(6):531–534

    Article  CAS  PubMed  Google Scholar 

  2. Heros RC (1991) The far lateral inferior suboccipital approach. In: Wilkins RH, Rengachary SS (eds) Neurosurgery Update II. McGraw-Hill, New York, pp 106–109

    Google Scholar 

  3. Hitotsumatsu T, Matsushima T, Inoue T (2003) Microvascular decompression for treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia: three surgical approach variations: Technical note. Neurosurgery 53:1436–1443

    Article  PubMed  Google Scholar 

  4. Kawashima M, Matsushima T, Inoue T, Mineta T, Masuoka J, Hirakawa N (2010) Microvascular decompression for glossopharyngeal neuralgia through the transcondylar fossa (supracondylar transjugular tubercle) approach. Neurosurgery 66(6 Suppl Operative):275–280, discussion 280

    PubMed  Google Scholar 

  5. Kawashima M, Matsushima T, Nakahara Y, Takase Y, Masuoka J, Ohata K (2009) Trans-cerebellomedullary fissure approach with special reference to lateral route. Neurosurg Rev 32:457–464

    Article  PubMed  Google Scholar 

  6. Kawashima M, Takase Y, Matsushima T (2013) Surgical treatment for vertebral artery–posterior inferior cerebellar artery aneurysms: special reference to the importance of the cerebellomedullary fissure dissection. J Neurosurg 118:460–464

    Article  PubMed  Google Scholar 

  7. Kuba H, Matsushima T, Matsukado K, Natori Y, Inamura T, Fukui M (2000) Surgical approach for epidermoid tumors in the posterior cranial fossa. Jpn J Neurosurg (Tokyo) 9:10–15 (in Japanese)

    Google Scholar 

  8. Matsushima K, Matsushima T, Kuga Y, Kodama Y, Inoue K, Ohnishi H, Rhoton AL Jr (2014) Classification of the superior petrosal veins and sinus based on drainage pattern. Operative Neurosurgery 10:357–367

    Article  Google Scholar 

  9. Matsushima T (1999) Surgeries of the VA-PICA junction aneurysms and saccular aneurysms of the VA. In: Miyake E (ed) Microsurgical operation of cerebral aneurysms. KINPODO, Tokyo, pp 329–338 (in Japanese)

    Google Scholar 

  10. Matsushima T (2006) Microsurgical Anatomy and Surgery of the Posterior Fossa. SciMed Publications Inc, Tokyo (in Japanese)

    Google Scholar 

  11. Matsushima T, Fukui M (1996) Lateral approach to the foramen magnum: with special reference to the transcondylar fossa approach and the transcondylar approach. Neurol Surg 24:119–124 (in Japanese)

    CAS  Google Scholar 

  12. Matsushima T, Fukui M, Fujii K, Inoue T, Suzuki S, Rhoton AL Jr (1992) Microsurgical anatomy of the veins of the posterior fossa.-special reference to bridging veins. Neurosurgeons 11:32–42 (in Japanese)

    Google Scholar 

  13. Matsushima T, Fukui M, Inoue T, Natori Y, Baba T, Fujii K (1992) Microsurgical and magnetic resonance imaging anatomy of the cerebello-medullary fissure and its application during fourth ventricle surgery. Neurosurgery 30:325–330

    Article  CAS  PubMed  Google Scholar 

  14. Matsushima T, Fukui M, Suzuki S, Rhoton AL Jr (1989) The microsurgical anatomy of the infratentorial lateral supracerebellar approach to the trigeminal nerve for tic douloureux. Neurosurgery 24:890–895

    Article  CAS  PubMed  Google Scholar 

  15. Matsushima T, Fukui M, Yamashita M (1987) Microsurgical neurovascular decompression for trigeminal neuralgia with special reference to infratentorial lateral supracerebellar approach. Neurol Surg 15:1047–1054 (in Japanese)

    CAS  Google Scholar 

  16. Matsushima T, Goto Y, Natori Y, Matsukado K, Fukui M (2000) Surgical treatment of glossopharyngeal neuralgia as vascular compression syndrome via transcondylar fossa (Supracondylar transjugular tubercle) approach. Acta Neurochir 142:1359–1363

    Article  CAS  PubMed  Google Scholar 

  17. Matsushima T, Hitotsumatsu T, Inamura T, Natori Y, Inoue T, Fukui M (2001) Pitfalls associated with MVD for hemifacial spasm and their overcome. Jpn J Neurosurg 10:164–172 (in Japanese)

    Google Scholar 

  18. Matsushima T, Hitotsumatsu T, Miyazono M, Inamura T, Natori Y, Inoue T (2001) Lateral suboccipital approach based on the anatomy – its variation and pitfalls, Surgical Anatomy for Microneurosurgery XIII. SciMed Publications Inc, Tokyo, pp 105–116 (in Japanese)

    Google Scholar 

  19. Matsushima T, Inoue T, Natori Y, Fukui M (1994) Microsurgical anatomy of cerebellopontine angle, Surgical Anatomy for Microneurosurgery VI. SciMed Publications Inc, Tokyo, pp 134–145 (in Japanese)

    Google Scholar 

  20. Matsushima T, Inoue T, Suzuki S, Fujii K, Fukui M, Rhoton AL Jr (1992) Microsurgical anatomy of the cranial nerves and vessels in the cerebellopontine angle – Differences between the MVD for trigeminal neuralgia and the MVD for hemifacial spasm, Surgical Anatomy for Microneurosurgery IV. SciMed Publications Inc, Tokyo, pp 45–55 (in Japanese)

    Google Scholar 

  21. Matsushima T, Katsuta T, Natori Y, Fukui M (1997) Microsurgical anatomy of the cerebellopontine angle –Variations in the Lateral suboccipital approach, Surgical Anatomy for Microneurosurgery IX. SciMed Publications Inc, Tokyo, pp 103–110 (in Japanese)

    Google Scholar 

  22. Matsushima T, Katsuta T, Natori Y, Fukui M, Rhoton AL Jr (1999) Posterior transpetrosal approach, Surgical Anatomy for Microneurosurgery XI. SciMed Publications Inc, Tokyo, pp 187–196 (in Japanese)

    Google Scholar 

  23. Matsushima T, Kawashima M, Inoue K, Matsushima K (2014) Anatomy of the superior petrosal veins and their exposure and management during petrous apex meningioma surgery using the lateral suboccipital retrosigmoid approach. Neurosurg Rev 37:535–546. doi:10.1007/s10143-014-0548-4

    Article  PubMed  Google Scholar 

  24. Matsushima T, Kawashima M, Inoue K, Matsushima K, Miki K (2014) Exposure of wide cerebellomedullary cisterns for vascular lesion surgeries in cerebellomedullary cisterns: Opening of unilateral cerebellomedullary fissures (unilateral trans-CMF approach) combined with lateral foramen magnum approach. World Neurosurg. doi:10.1016/j.wneu.2014.04.064

    Google Scholar 

  25. Matsushima T, Kawashima M, Masuoka J, Mineta T, Inoue T (2010) Transcondylar fossa (Supracondylar transjugular tubercle) approach: Anatomic basis for the approach, surgical procedures, and surgical experience. Skull Base 20:83–92

    Article  PubMed Central  PubMed  Google Scholar 

  26. Matsushima T, Matsukado K, Natori Y, Inamura T, Hitotsumatsu T, Fukui M (2001) Surgery on a saccular vertebral artery-posterior inferior cerebellar artery aneurysm via the transcondylar fossa (supracondylar transjugular tubercle) approach or the transcondylar approach: surgical results and indications for using two different lateral skull base approaches. J Neurosurg 95:268–274

    Article  CAS  PubMed  Google Scholar 

  27. Matsushima T, Natori Y, Katsuta T, Ikezaki K, Fukui M, Rhoton AL Jr (1998) Microsurgical anatomy for lateral approaches to the foramen magnum with special reference to transcondylar fossa (Supracondylar transjugular tubercle) approach. Skull Base Surg 8:119–125

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Matsushima T, Rhoton AL Jr., Oliveira ED, Peace D (1983) Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg 59:63–105

    Article  CAS  PubMed  Google Scholar 

  29. Matsushima T, Suzuki S, Fukui M, Rhoton AL Jr, Oliveria ED, Ono M (1989) Microsurgical anatomy of the tentorial sinuses. J Neurosurg 71:923–928

    Article  CAS  PubMed  Google Scholar 

  30. Sasaki T (1998) Lateral suboccipital approach. In: Matsutani M, Asano T, Hori T (eds) Anatomy for Neurological Surgery. Medical View, Tokyo, pp 62–73 (in Japanese)

    Google Scholar 

  31. Seoane ER, Rhoton AL Jr (1999) Suprameatal extension of the retrosigmoid approach: microsurgical anatomy. Neurosurgery 44:553–560

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery Faculty of Medicine, Saga University, Saga, Japan

    Toshio Matsushima

Authors
  1. Toshio Matsushima
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Japan

About this chapter

Cite this chapter

Matsushima, T. (2015). The Retrosigmoid Lateral Suboccipital Approach: Basic Approach and Variations. In: Microsurgical Anatomy and Surgery of the Posterior Cranial Fossa. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54183-7_9

Download citation

  • DOI: https://doi.org/10.1007/978-4-431-54183-7_9

  • Published:

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-54182-0

  • Online ISBN: 978-4-431-54183-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation