[Lateral Suboccipital Approach]

Abstract

The lateral suboccipital approach is a fundamental surgical method for accessing the cerebellopontine angle. This article outlines critical aspects, including anatomical landmarks, surgical positioning, and techniques for craniotomy and dural opening, based on practices at our institution. Important landmarks include the mastoid process, asterion, and suboccipital triangle, which contains critical structures such as the vertebral artery. Preoperative three-dimensional computed tomography imaging significantly aids surgical planning through visualizing bone landmarks and venous sinus positioning. Optimal patient positioning, involving careful head flexion and rotation in the park-bench position, is essential to minimize complications such as airway edema. Accurate muscle dissection and careful handling of the mastoid emissary vein are detailed to prevent venous sinus occlusion. Significant complications associated with this procedure include cerebrospinal fluid (CSF) leakage, vertebral artery injury, and venous sinus injury. Strategies for preventing CSF leakage include meticulous dural closure using artificial dura and fat grafts. While rare, vertebral artery injury demands precise handling to prevent severe ischemic complications. Overall, careful anatomical understanding, rigorous preoperative planning, and a meticulous surgical technique are paramount to minimize complications associated with the lateral suboccipital approach.