METHOD OF SURGICAL ACCESS TO THE REGION OF THE CRANIOVERTEBRAL JUNCTION Russian patent published in 2023 - IPC A61B17/00 A61B17/56 

FIELD: medicine; neurosurgery.

SUBSTANCE: invention can be used for surgical access to the region of the craniovertebral junction. Dissection of the skin and subcutaneous tissue is performed along the line between the external occipital protrusion of the occipital bone and the mastoid process of the temporal bone from the level of the base of the mastoid process down 4 cm to the intersection of the splenius muscle of the neck and semispinalis muscle. An intermuscular fascial approach to the deep layer of the neck muscles is performed. The splenius head muscle and the posterior rectus major muscle at the point of attachment to the occipital bone are cut in a sharp way for 1.5 cm in the direction from the inner edge of the muscles laterally, leaving a muscle cuff 0.5 cm thick. The posterior rectus major muscle is retracted medially, forming a corridor for approaching the site of attachment of the inferior oblique muscle of the head to the transverse process of the C1 vertebra. A fascial dissection is performed along the lower edge of the inferior oblique muscle of the head to the point of its attachment to the transverse process of the C1 vertebra, then the inferior oblique muscle of the head is crossed, departing 1 cm from the point of attachment to the transverse process of the C1 vertebra, and retracted medially, exposing the lamellar part of the C2 vertebral arch and transverse process of C1 vertebra. After partial cutting off of the large posterior rectus muscle of the head from the place of its attachment to the occipital bone, the ipsilateral half of the posterior half-ring of the C1 vertebra and the posterior edge of the foramen magnum are visualized. Bone landmarks help to determine the position of the V3 segment of the vertebral artery. At the level of C2 vertebrae, subperiosteal skeletonization of the upper edge of the lamellar part of the arch is performed with the transition to the vertebral pedicle and then laterally to the articular process until the medial edge of the opening of the vertebral artery is determined. At the level of the C1 vertebra, subperiosteal skeletonization of the posterior half-ring is performed from its middle in the lateral direction with the transition to the pedicle of the C1 vertebra at the level of the notch of the vertebral artery, skeletonization is continued in the lateral direction to the base of the transverse process. The ipsilateral half of the posterior semicircle of the C1 vertebra and the pedicle of the C1 vertebra are resected. The vertebral artery is mobilized from the vertebral foramen in the transverse process of the C1 vertebra. The posterior edge of the foramen magnum and the posterior third of the condyle of the occipital bone are resected on the access side. The DM is opened with a longitudinal linear incision on its lateral surface 5 mm above the entry point of the vertebral artery.

EFFECT: method ensures radical removal of tumors in the area of the craniovertebral junction and reduction of trauma due to the possibility of safe visualization and mobilization of the V3 segment of the vertebral artery at the stage of approach to the pathological focus.

1 cl, 1 ex