Midline suboccipital burr hole for posterior fossa craniotomy

Abstract

Posterior fossa craniotomy is generally done starting with two lateral burr holes. Single midline burr hole is often avoided for the fear of injury to the venous sinuses. In this paper, we retrospectively evaluated the risk of dural tear or venous sinus injury with the latter approach. Patients who had a posterior fossa craniotomy at the Children's Hospital of Michigan between 2003 and 2009 were analyzed. Seventy-one patients had been operated for a posterior fossa lesion, and 154 had a Chiari I decompression. Suboccipital craniotomy was performed utilizing a starting midline suboccipital burr hole. The craniotomy was completed using Midas Rex with B1 footplate starting laterally from the burr hole and then over to the foramen magnum including the foramen magnum lip. Inpatients who had a tumor resection, the bone flap was replaced and secured with plates on both sides. One patient had a dural tear along the inferior aspect of the craniotomy not extending into the foramen magnum. There was no instance of venous sinus injury or undue bleeding from the burr hole. none of the patients had an infection requiring removal of the bone flap. This paper confirms the safety of utilizing midline burr hole for starting a posterior fossa craniotomy.