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Hung T. Wen, Albert L. Rhoton Jr., Toshiro Katsuta and Evandro de Oliveira

) dissection of the muscles along the posterolateral aspect of the craniocervical junction to permit an adequate lateral approach while reducing the depth of the surgical field; 2) early identification of the vertebral artery (VA) either above the posterior arch of the atlas or in its ascending course between the transverse processes of the atlas and axis; 3) a suboccipital craniectomy or craniotomy with removal of at least one-half of the posterior arch of the atlas; and 4) removal of the posterior portion of the occipital condyle to allow a more lateral approach. The

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Maysam Alimohamadi and Madjid Samii

, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction . Neurosurgery 29 : 815 – 821 , 1991 2 Matsushima K , Kawashima M , Matsushima T , Hiraishi T , Noguchi T , Kuraoka A : Posterior condylar canals and posterior condylar emissary veins—a microsurgical and CT anatomical study . Neurosurg Rev 37 : 115 – 126 , 2014 3 Matsushima K , Kohno M , Komune N , Miki K , Matsushima T , Rhoton AL Jr : Suprajugular extension of the retrosigmoid approach: microsurgical anatomy. Laboratory

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Andrew D. Fine, Alberto Cardoso and Albert L. Rhoton Jr.

dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction. Neurosurgery 29 : 815 – 821 , 1991 Bertalanffy H, Seeger W: The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction. Neurosurgery 29: 815–821, 1991 6. de Oliveira E , Rhoton AL Jr , Peace D : Microsurgical anatomy of the region of the foramen magnum. Surg Neurol 24 : 293 – 352 , 1985 de Oliveira E, Rhoton AL Jr, Peace D: Microsurgical anatomy of the region of

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Ana Rodríguez-Hernández, Albert L. Rhoton Jr. and Michael T. Lawton

; arterial dissections at the PICA-VA junction; arteriovenous malformations, which also commonly involve the other cerebellar arteries and the brainstem as well as the cerebellum; posterior fossa ischemia requiring bypass because of the PICA's easy accessibility through a suboccipital craniotomy and the proximity to the occipital artery; anomalies at the craniocervical junction, such as the Chiari malformation and osseous deformities; and dysfunction of the lower CNs such as glossopharyngeal neuralgia. The PICA can arise outside the dura, and at any point from along the

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Ken Matsushima, Kaan Yagmurlu, Michihiro Kohno and Albert L. Rhoton Jr.

anterior portion of the craniocervical junction . Neurosurgery 29 : 815 – 821 , 1991 11 Bertalanffy H , Tissira N , Krayenbühl N , Bozinov O , Sarnthein J : Inter- and intrapatient variability of facial nerve response areas in the floor of the fourth ventricle . Neurosurgery 68 : 1 Suppl Operative 23 – 31 , 2011 12 Bricolo A : Surgical management of intrinsic brain stem gliomas . Op Tech Neurosurg 3 : 137 – 154 , 2000 13 Bricolo A , Turazzi S : Surgery for gliomas and other mass lesions of the brainstem . Adv Tech Stand

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Ken Matsushima, Michihiro Kohno, Noritaka Komune, Koichi Miki, Toshio Matsushima and Albert L. Rhoton Jr.

illustrations: Miki. References 1 Bertalanffy H , Seeger W : The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction . Neurosurgery 29 : 815 – 821 , 1991 2 Bulsara KR , Sameshima T , Friedman AH , Fukushima T : Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system. Clinical article . J Neurosurg 109 : 794 – 803 , 2008 3 Chibbaro S , Mirone G , Makiese O , Bresson D , George B : Dumbbell