Subtonsillar approach to the foramen of Luschka: An anatomic and clinical study

Walter C. Jean, Khaled M. Abdel Aziz, Jeffrey T. Keller, Harry R. Van Loveren, Laligam N. Sekhar, M. Humayun Khalid, M. Gazi Yaşargil, Saleem I. Abdulrauf, Jeffrey S. Henn, Gerald M Lemole, Robert F. Spetzler, Bernard George

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

OBJECTIVE: Conventional approaches to tumors of the foramen of Luschka are limited because the foramen is viewed from either the fourth ventricle laterally (transvermian approach) or the cerebellopontine angle medially (suboccipital approach). The definitive approach is subtonsillar, because the foramen of Luschka is actually the end of the natural cleavage plane between the cerebellar tonsil and the medulla. We describe the microsurgical anatomic features of the foramen of Luschka region and the operative technique for the subtonsillar approach to this region. METHODS: In the anatomic study, five formalin-fixed, silicone-injected, cadaveric heads were used. In the clinical study, the records for five patients treated via the subtonsillar approach were examined; several illustrative cases are presented. RESULTS: The foramen of Luschka is formed by the tela choroidea and the rhomboid lip and exists at the lateral end of the cerebellomedullary fissure, which is a natural cleavage plane between the cerebellar tonsil and the medulla. The subtonsillar approach is performed via a suboccipital craniotomy; the patient is positioned in the lateral decubitus position, with the tumor side down. After the cerebellar tonsil is freed from arachnoid adhesions, it can be retracted rostrodorsally from the medulla, to expose the cerebellomedullary fissure. Clinically, the tela choroidea and rhomboid lip are significantly attenuated by tumor expansion. Therefore, by dissecting in a subtonsillar manner around the tumor, one can reach the foramen of Luschka without traversing any neural tissue. CONCLUSION: The subtonsillar approach yields a panoramic view to the foramen of Luschka laterally and up to the middle cerebellar peduncle superiorly. This approach minimizes the distance between the tumor and the surgeon, while maximizing neural preservation. We think this is the definitive approach to this difficult region of the posterior fossa.

Original languageEnglish (US)
Pages (from-to)860-866
Number of pages7
JournalNeurosurgery
Volume52
Issue number4
StatePublished - Apr 1 2003
Externally publishedYes

Fingerprint

Palatine Tonsil
Neoplasms
Lip
Arachnoid
Cerebellopontine Angle
Fourth Ventricle
Craniotomy
Silicones
Formaldehyde
Head
Clinical Studies

Keywords

  • Cerebellar tonsil
  • Foramen of Luschka
  • Fourth ventricle
  • Surgical approach

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Jean, W. C., Abdel Aziz, K. M., Keller, J. T., Van Loveren, H. R., Sekhar, L. N., Khalid, M. H., ... George, B. (2003). Subtonsillar approach to the foramen of Luschka: An anatomic and clinical study. Neurosurgery, 52(4), 860-866.

Subtonsillar approach to the foramen of Luschka : An anatomic and clinical study. / Jean, Walter C.; Abdel Aziz, Khaled M.; Keller, Jeffrey T.; Van Loveren, Harry R.; Sekhar, Laligam N.; Khalid, M. Humayun; Yaşargil, M. Gazi; Abdulrauf, Saleem I.; Henn, Jeffrey S.; Lemole, Gerald M; Spetzler, Robert F.; George, Bernard.

In: Neurosurgery, Vol. 52, No. 4, 01.04.2003, p. 860-866.

Research output: Contribution to journalArticle

Jean, WC, Abdel Aziz, KM, Keller, JT, Van Loveren, HR, Sekhar, LN, Khalid, MH, Yaşargil, MG, Abdulrauf, SI, Henn, JS, Lemole, GM, Spetzler, RF & George, B 2003, 'Subtonsillar approach to the foramen of Luschka: An anatomic and clinical study', Neurosurgery, vol. 52, no. 4, pp. 860-866.
Jean WC, Abdel Aziz KM, Keller JT, Van Loveren HR, Sekhar LN, Khalid MH et al. Subtonsillar approach to the foramen of Luschka: An anatomic and clinical study. Neurosurgery. 2003 Apr 1;52(4):860-866.
Jean, Walter C. ; Abdel Aziz, Khaled M. ; Keller, Jeffrey T. ; Van Loveren, Harry R. ; Sekhar, Laligam N. ; Khalid, M. Humayun ; Yaşargil, M. Gazi ; Abdulrauf, Saleem I. ; Henn, Jeffrey S. ; Lemole, Gerald M ; Spetzler, Robert F. ; George, Bernard. / Subtonsillar approach to the foramen of Luschka : An anatomic and clinical study. In: Neurosurgery. 2003 ; Vol. 52, No. 4. pp. 860-866.
@article{2f3a749593654c709c4d1874a80626cb,
title = "Subtonsillar approach to the foramen of Luschka: An anatomic and clinical study",
abstract = "OBJECTIVE: Conventional approaches to tumors of the foramen of Luschka are limited because the foramen is viewed from either the fourth ventricle laterally (transvermian approach) or the cerebellopontine angle medially (suboccipital approach). The definitive approach is subtonsillar, because the foramen of Luschka is actually the end of the natural cleavage plane between the cerebellar tonsil and the medulla. We describe the microsurgical anatomic features of the foramen of Luschka region and the operative technique for the subtonsillar approach to this region. METHODS: In the anatomic study, five formalin-fixed, silicone-injected, cadaveric heads were used. In the clinical study, the records for five patients treated via the subtonsillar approach were examined; several illustrative cases are presented. RESULTS: The foramen of Luschka is formed by the tela choroidea and the rhomboid lip and exists at the lateral end of the cerebellomedullary fissure, which is a natural cleavage plane between the cerebellar tonsil and the medulla. The subtonsillar approach is performed via a suboccipital craniotomy; the patient is positioned in the lateral decubitus position, with the tumor side down. After the cerebellar tonsil is freed from arachnoid adhesions, it can be retracted rostrodorsally from the medulla, to expose the cerebellomedullary fissure. Clinically, the tela choroidea and rhomboid lip are significantly attenuated by tumor expansion. Therefore, by dissecting in a subtonsillar manner around the tumor, one can reach the foramen of Luschka without traversing any neural tissue. CONCLUSION: The subtonsillar approach yields a panoramic view to the foramen of Luschka laterally and up to the middle cerebellar peduncle superiorly. This approach minimizes the distance between the tumor and the surgeon, while maximizing neural preservation. We think this is the definitive approach to this difficult region of the posterior fossa.",
keywords = "Cerebellar tonsil, Foramen of Luschka, Fourth ventricle, Surgical approach",
author = "Jean, {Walter C.} and {Abdel Aziz}, {Khaled M.} and Keller, {Jeffrey T.} and {Van Loveren}, {Harry R.} and Sekhar, {Laligam N.} and Khalid, {M. Humayun} and Yaşargil, {M. Gazi} and Abdulrauf, {Saleem I.} and Henn, {Jeffrey S.} and Lemole, {Gerald M} and Spetzler, {Robert F.} and Bernard George",
year = "2003",
month = "4",
day = "1",
language = "English (US)",
volume = "52",
pages = "860--866",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Subtonsillar approach to the foramen of Luschka

T2 - An anatomic and clinical study

AU - Jean, Walter C.

AU - Abdel Aziz, Khaled M.

AU - Keller, Jeffrey T.

AU - Van Loveren, Harry R.

AU - Sekhar, Laligam N.

AU - Khalid, M. Humayun

AU - Yaşargil, M. Gazi

AU - Abdulrauf, Saleem I.

AU - Henn, Jeffrey S.

AU - Lemole, Gerald M

AU - Spetzler, Robert F.

AU - George, Bernard

PY - 2003/4/1

Y1 - 2003/4/1

N2 - OBJECTIVE: Conventional approaches to tumors of the foramen of Luschka are limited because the foramen is viewed from either the fourth ventricle laterally (transvermian approach) or the cerebellopontine angle medially (suboccipital approach). The definitive approach is subtonsillar, because the foramen of Luschka is actually the end of the natural cleavage plane between the cerebellar tonsil and the medulla. We describe the microsurgical anatomic features of the foramen of Luschka region and the operative technique for the subtonsillar approach to this region. METHODS: In the anatomic study, five formalin-fixed, silicone-injected, cadaveric heads were used. In the clinical study, the records for five patients treated via the subtonsillar approach were examined; several illustrative cases are presented. RESULTS: The foramen of Luschka is formed by the tela choroidea and the rhomboid lip and exists at the lateral end of the cerebellomedullary fissure, which is a natural cleavage plane between the cerebellar tonsil and the medulla. The subtonsillar approach is performed via a suboccipital craniotomy; the patient is positioned in the lateral decubitus position, with the tumor side down. After the cerebellar tonsil is freed from arachnoid adhesions, it can be retracted rostrodorsally from the medulla, to expose the cerebellomedullary fissure. Clinically, the tela choroidea and rhomboid lip are significantly attenuated by tumor expansion. Therefore, by dissecting in a subtonsillar manner around the tumor, one can reach the foramen of Luschka without traversing any neural tissue. CONCLUSION: The subtonsillar approach yields a panoramic view to the foramen of Luschka laterally and up to the middle cerebellar peduncle superiorly. This approach minimizes the distance between the tumor and the surgeon, while maximizing neural preservation. We think this is the definitive approach to this difficult region of the posterior fossa.

AB - OBJECTIVE: Conventional approaches to tumors of the foramen of Luschka are limited because the foramen is viewed from either the fourth ventricle laterally (transvermian approach) or the cerebellopontine angle medially (suboccipital approach). The definitive approach is subtonsillar, because the foramen of Luschka is actually the end of the natural cleavage plane between the cerebellar tonsil and the medulla. We describe the microsurgical anatomic features of the foramen of Luschka region and the operative technique for the subtonsillar approach to this region. METHODS: In the anatomic study, five formalin-fixed, silicone-injected, cadaveric heads were used. In the clinical study, the records for five patients treated via the subtonsillar approach were examined; several illustrative cases are presented. RESULTS: The foramen of Luschka is formed by the tela choroidea and the rhomboid lip and exists at the lateral end of the cerebellomedullary fissure, which is a natural cleavage plane between the cerebellar tonsil and the medulla. The subtonsillar approach is performed via a suboccipital craniotomy; the patient is positioned in the lateral decubitus position, with the tumor side down. After the cerebellar tonsil is freed from arachnoid adhesions, it can be retracted rostrodorsally from the medulla, to expose the cerebellomedullary fissure. Clinically, the tela choroidea and rhomboid lip are significantly attenuated by tumor expansion. Therefore, by dissecting in a subtonsillar manner around the tumor, one can reach the foramen of Luschka without traversing any neural tissue. CONCLUSION: The subtonsillar approach yields a panoramic view to the foramen of Luschka laterally and up to the middle cerebellar peduncle superiorly. This approach minimizes the distance between the tumor and the surgeon, while maximizing neural preservation. We think this is the definitive approach to this difficult region of the posterior fossa.

KW - Cerebellar tonsil

KW - Foramen of Luschka

KW - Fourth ventricle

KW - Surgical approach

UR - http://www.scopus.com/inward/record.url?scp=0037383158&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037383158&partnerID=8YFLogxK

M3 - Article

C2 - 12657182

AN - SCOPUS:0037383158

VL - 52

SP - 860

EP - 866

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 4

ER -