Aneurysmatic bone cyst of the craniocervical region: Surgical technique
A 28-year-old man presented at the emergency room with an important headache, somnolence, and nausea, but with preserved muscular strength. Concomitantly, he complained of a mass growing in the back of his head for the last 6 months and reported a severe head injury 1 year prior to admission. A CT scan was compatible with an important hydrocephalus and a posterior expansible lesion on the left side of his posterior fossa [Figures and ]. He underwent a ventriculoperitoneal shunt. MRI disclosed an expansible bone tumor, with cystic walls, filled with blood and extremely vascularized [ and ]. A surgical resection was then performed with no prior embolization. Using a head holder, the patient was positioned prone and a midline incision with a transverse extension directed to the posterior aspect of the left mastoid was performed []. The superficial skin and muscular layers were dissected from the bone, and the occipital artery was ligated at the beginning of the exposure, prior to directly entering the cyst. A subperiosteal dissection was then performed, exposing the tumor limits [Figure and ]. The bony parts of the tumor were then resected piecemeal, drilling the residual intact bone edges until total tumor resection was evident []. Once the contralateral occipitocervical junction was preserved, we opted for not fuse this patient with clinical and radiological follow-up of craniocervical instability.\nThe total surgical bleeding estimated was about 500 mL. The patient was discharged at the third day after surgery without neurological deficits. There was no recurrence after 7 months of follow-up [Figure and ].