Midline-craniotomy of the posterior fossa with attached bone flap: experiences in paediatric and adult patients.

Abstract

Osteoplastic craniotomy in midline approaches to the posterior fossa has been proposed as an alternative to traditional osteoclastic craniectomy. Data from paediatric patients suggest that this method has advantages in terms of perioperative complications. The authors investigate midline craniotomy of the posterior fossa with a modified technique in paediatric, as well as in adult patients. The modified technique used for this study features a suboccipital bone flap attached to the atlantooccipital membrane. The bone flap is turned downwards and left in situ during the entire surgical procedure. All patients were operated on in the sitting position. Craniotomy was achieved with standard neurosurgical instruments. Eleven adult and three paediatric patients were treated this way (average age 40 years, ranging from 2-67 years). Osteoplastic craniotomy was found to be technically feasible in adult patients. The presence of the turned down, attached bone flap did not interfere with surgery. The rate of complications associated to the operative approach was found to be low (0 wound reclosures, 0 CSF-leaks, 1 pseudomeningocele). Reattachment of the bone flap was easy and stable. Midline craniotomy of the posterior fossa is feasible in adult patients, as well as in children. The technique does not seem to be associated with additional risks. Larger comparative series will be needed in order to evaluate possible advantages of the technique over osteoclastic craniectomy.