[Transoral anterior approach to foramen magnum XXXX --a case report and review].

@entity1 @entity75 @entity5 @entity508 @entity16 @entity1653 @entity194 @entity2055
A case of an anteriorly located @entity1653 in the region of the foramen magnum, successfully treated by a transoral approach, is reported. A 60-year-old @entity1 was admitted to the author's department on January 19th, 1983. Six years before admission, she began to experience the gradual cold dysesthesia in the both palms, and then developed gait disturbance, clumsiness of the right hand and a stiffneck. She was found to have @entity194 , mild @entity508 , @entity2055 and hypalgesia under the bilateral C2 spinal levels. A CT scan disclosed a patchy @entity75 , which was enhanced homogenously with contrast medium, occupying almost all the intradural extramedullary space at the foramen magnum. The transoral approach was employed following preliminary tracheostomy. The @entity5 , extending about one centimeter superiorly to the basion and inferiorly to the upper border of C2 body, was removed completely, and then the dural defect was covered with a piece of fascia and gelform. An anterior occipitocervical fusion was performed extending to C2 using a block of an antogenous iliac bone. Post-operatively immobilization was secured by a Halo-Vest. But unexpectedly, CSF leakage was disclosed several days after the surgery without @entity16 . On the 17th day following first surgery, a re-operation was performed. The dural defect was successfully repaired with a piece of fascia by interrupted sutures in an illustrated fashion (Fig. 5). A piece of muscle was then placed in the epidural space created by bone removal. A fusion of the atlanto-axial joint not extending to the basiocciput was employed.(ABSTRACT TRUNCATED AT 250 WORDS)
