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116 Section II: Intracranial Procedures

neck slightly arched to afford better access to the occipital bone and Surgical Technique (Video 12.1)
foramen magnum. The patient is secured in this position with tape, A fat graft is harvested. This procedure is performed first and
sandbags, or a head restraint device, avoiding any direct pressure on gloves and instruments are discarded prior to beginning the
the jugular veins. The site is clipped and aseptically prepared over craniectomy approach. The fat is wrapped in a warm saline‐soaked
the dorsal aspect of the head and cervical area. The prepared area gauze sponge and preserved until later in the procedure [9]. A dor-
should extend rostrally to caudally from the bregma to the level of sal midline incision is made, extending from 1–2 cm rostral to the
the fourth cervical vertebra and the width should be just lateral to external occipital protuberance to the caudal aspect of the spinous
the width of the wings of the atlas on each side. An area over the process of C2. The subcutaneous tissues and fat are incised along
dorsal aspect of the ilial wing is also clipped and prepared for har- the midline and retracted, exposing the underlying superficial
vesting a fat graft to be used over the FMD [2,4]. Tilting the patient’s cervical musculature. The superficial cervical musculature is
head 30° away from the side of the lesion increases exposure of incised using an electroscalpel along the median raphe. This
structures lateral to the midline [7,8]. exposes the deeper cervical muscles and the dissection continues

Figure 12.2 Transverse T2‐weighted MRI of a cystic cerebellar mass Figure 12.4 Sagittal T1‐weighted MRI of a subarachnoid diverticulum
(arrow). (arrow) showing severe compression of the cerebellum.

A B

Figure 12.3 (A) Transverse and (B) dorsal T1‐weighted postcontrast MRI of meningioma located in the cerebello‐pontomedullary angle. This mass was
biopsied and partially removed prior to patient undergoing radiation therapy.