The nuchal lines as anatomical landmarks to dissect the muscles in the far-lateral approach.

The nuchal lines as anatomical landmarks to dissect the muscles in the far-lateral approach.

World Neurosurg. 2018 Feb 22;:

Authors: Campero A, Villalonga JF, Elizalde RL, Ajler P

Abstract
BACKGROUND: A critical step in the far lateral approach (FLA) is the exposure of V3 segment of the vertebral artery (VA), located in the depth of the suboccipital triangle (SOT). A safe exposure of the SOT is achieved by means of a plane-by-plane dissection, which carries the risk of devascularization. A suitable alternative is to lift a cutaneous muscle flap including the 3 first muscle planes, and leave the deepest plane (SOT) attached to the skull base. To achieve this, it is necessary to have superficial anatomic repairs to help us identify our cleavage site.Our objective is to describe the use of the nuchal lines as a safe, effective and reproducible method to dissect the muscles in order to expose the SOT and VA.
METHODS: Eight adult cadaveric heads, fixed with formaldehyde and injected, were studied. On both sides, an FLA was simulated by using the nuchal lines as anatomic repairs to expose the SOT. This technique was later applied on 10 patients requiring a FLA.
RESULTS: The anatomic dissections performed confirmed the identification, by means of the nuchal lines, of a cleavage site, which made it possible to separate the deepest muscle plane from the rest of the flap. This technique was successfully applied on the 10 operated patients.
CONCLUSION: The nuchal lines allow to dissect the muscles in 2 groups, one superficial, and the other deep (SOT), that remains attached to the skull base. Thus, the V3 segment of the VA is easily exposed.

PMID: 29477700 [PubMed - as supplied by publisher]

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