Occipital Craniotomy

Indications

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The occipital craniotomy is a versatile approach that provides access to the occipital lobes; tentorium; torcular Herophili; transverse sinus; sigmoid sinus; and tumors, vascular malformations, or other lesions that may be associated with these structures.

Contraindications

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Cervical spine pathology that would oppose flexion of the neck
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Persistent foramen ovale (echocardiogram should be performed if the sitting or semisitting position is considered)

Planning and positioning

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Three positions may be used for the occipital craniotomy.
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  Prone position
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  Concorde position

Secure the head in a head holder before turning the head. The head is flexed, and the bed is tilted, elevating the head above the heart.
Advantages include lower incidence of air embolism than sitting (10% vs. 25%) and increased comfort for the surgeon.
Disadvantages include venous air embolism and injury to cervical spine.
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  Park bench position
This is also known as the three-quarter prone position.
The head is secured in the head holder before turning. The patient’s torso is brought to the side opposite of which the patient is turned so that when turned, the patient’s backside rests at the edge of the bed.
A roll should be placed under the dependent axilla to protect the brachial plexus. The dependent arm is placed over the end of the table, and the upper arm is supported on a pillow or roll and flexed at the elbow.
Advantages include optimal access to lesions of the median parafalcial, occipital, and pineal region, and the occipital lobe falls away from the falx, allowing for less retraction.
Disadvantages include venous congestion possibly resulting from the head turn and possible cervical injury.

Procedure

Figure 2-1:

Figure 2-1:

Tags: Core Techniques in Operative Neurosurgery

Jun 15, 2019 | Posted by drzezo in NEUROSURGERY | Comments Off

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