{"id":"5f804030-5adc-4ead-91da-938abf1d9df7","slug":"limited-vertical-dural-opening-for-lesions-of-the-vermis-4th-ventricle-and-distal-pica-segments","title":"Limited vertical dural opening for lesions of the vermis, 4<sup>th</sup> ventricle, and distal PICA segments","authors":["Patrick Graupman","Archie Defillo","Leslie Nussbaum","Eric S. Nussbaum"],"abstract":"Background: Lesions of the vermis and 4th ventricle are commonly addressed through a midline suboccipital approach. Most neurosurgeons use either a Y-shaped or a curvilinear dural opening in this setting. Although these approaches offer a wide intraoperative surgical exposure, in occasion, the dural opening is difficult to repair primarily, often necessitating the use of a patch, which may increase the risk for development of CSF fistula. We are describing our experience with a limited, vertical, midline, dural opening for approaches to the vermis, tentorium, 4th ventricle, and distal posterior-inferior cerebellar artery (PICA) segments as an alternative to the classic Y-shaped or curvilinear incision. Methods: We report our experience with a limited vertical midline durotomy in five patients with posterior fossa lesions. The lesions treated included a PICA dissecting aneurysm, three metastatic lesions (located in the vermian, floor of the 4th ventricle, and undersurface of the tentorium cerebelli), and one intra-axial tumor (ependymoma). All patients were positioned prone, and the lesions were accessed without difficulty through a limited, vertical, midline durotomy. Results: Mass lesions and vascular abnormalities located from the midline as far lateral as the outlet foramina of the 4th ventricle can be accessed comfortably via a limited midline dural opening when combined with microsurgical techniques, and the use of a frameless Stealth Station Neuronavigation System (SSNS) [Medtronic Sofamor Danek, Inc., Memphis, TN]. By doing this, simple primary dural closure was achieved with a single running absorbable suture without tension in each case. Conclusion: In our experience, a suboccipital linear dural opening appears to be as effective as the more traditional Y-shaped incision, yet allows for quicker and easier primary dural repair.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/5f804030-5adc-4ead-91da-938abf1d9df7/featured/hero-1782420982705.png","publishDate":"2012-11-27T00:00:00.000Z","doi":"10.4103/2152-7806.103881","categories":["Original Article"],"fullTextUrl":"http://sni.wpengine.com/wp-content/uploads/2015/05/3481/SNI-3-141.pdf"}