Abordajes antero-mediales para las lesiones del tercio inferior del clivus y parte ventral de la charnela craneocervicaI. Fundamentos embriológicos y anatómicos de interés quirúrgico

Abstract

Anterior midline approaches to the cranio-vertebral junction are increasingly used in the management of patients with a wide variety of lesions in this region. Development of high quality lighting, surgical microscope, better neuroimaging techniques and the formation of multidisciplinary teams devoted to skull base surgery have allowed early diagnosis and surgical treatment of lesions considered until recently as inaccessible. Those lesions involving the anterior part of the cranio-vertebral junction and the lower third of the divus, the «so-called» centro-medial skull base, present specific problems that can be systemized. Many anterior surgical approaches to the cranio-vertebral junction have been described. Nevertheless, the vast majority of them are based on modifications of the transoral/transpalatal approach. Our aim in this paper is to review the embryological and anatomical aspects of the cranio-vertebral region for the neurosurgeon interested in this type of surgery. We review the embryological development of the axial basicranium, viscerocranium and neocranium emphasizing the embryological aspects of sorne congenital malformations of this region. Surgical anatomy of the clivus, foramen magnum and the superior third of the cervical spine is reviewed. Arterial and venous vascularization of this region is also reviewed.