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Atlas of Craniocervical Junction and Cervical Spine Surgery.

By: Contributor(s): Material type: TextTextPublisher: Cham : Springer International Publishing AG, 2017Copyright date: ©2017Edition: 1st edDescription: 1 online resource (229 pages)Content type:
  • text
Media type:
  • computer
Carrier type:
  • online resource
ISBN:
  • 9783319427379
Subject(s): Genre/Form: Additional physical formats: Print version:: Atlas of Craniocervical Junction and Cervical Spine SurgeryDDC classification:
  • 617.53
LOC classification:
  • RD592.5-596
Online resources:
Contents:
Intro -- Acknowledgment -- Contents -- Contributors -- Part I: Anatomy -- 1: Anatomy of Craniocervical Junction -- 1.1 Osseous Anatomy -- 1.1.1 Occipital Bone -- 1.1.2 Atlas (Fig. 1.1) -- 1.1.3 Axis (Fig. 1.2) -- 1.2 Articular and Ligamentous Anatomy -- 1.2.1 Transverse Ligament -- 1.2.2 Alar Ligament -- 1.2.3 Transverse Occipital Ligament -- 1.2.4 Accessory Atlantoaxial Ligament -- 1.2.5 Lateral Atlanto-Occipital Ligament -- 1.2.6 Barkow Ligament -- 1.2.7 Apical Ligament -- 1.2.8 Tectorial Membrane -- 1.2.9 Posterior Atlanto-Occipital Membrane -- 1.2.10 Anterior Atlanto-Occipital Membrane -- 1.2.11 Nuchal Ligament -- 1.3 Muscular Anatomy -- 1.4 The Arterial System -- 1.4.1 V1 Segment -- 1.4.2 V2 Segment -- 1.4.3 V3 Segment -- 1.4.4 Anatomical Variation -- 1.5 The Venous System -- 1.6 Neural Tissue -- References -- 2: Anatomy of the Subaxial Cervical Spine -- 2.1 Bony Anatomy -- 2.1.1 C3-C6 -- 2.1.2 C7: Vertebra Prominens -- 2.2 Joints and Ligamentous Anatomy -- 2.2.1 Anterior Longitudinal Ligament -- 2.2.2 Posterior Longitudinal Ligament -- 2.2.3 Ligamentum Flavum -- 2.2.4 Interspinous Ligaments -- 2.2.5 Ligamentum Nuchae -- 2.3 Muscular Anatomy -- 2.4 The Arterial System -- 2.5 The Venous System -- 2.6 The Cervical Spinal Nerves -- References -- 3: Anatomy of the Neck -- 3.1 Topographic Anatomy -- 3.2 Muscles of the Neck -- 3.2.1 Platysma -- 3.2.2 Sternocleidomastoid Muscle -- 3.2.3 Suprahyoid Muscles (Fig. 3.3) -- 3.2.4 Infrahyoid Muscles ("Strap Muscles") (Fig. 3.3) -- 3.2.5 Omohyoid (Fig. 3.4) -- 3.3 Vascular Supply: Arteries and Veins (Fig. 3.5) -- 3.3.1 Arteries -- 3.3.2 Important Anatomical Variation of the Arteries of the Neck -- 3.3.2.1 Lusory Artery -- 3.3.2.2 Veins (Fig. 3.7) -- 3.4 Nerves -- 3.4.1 Vagus -- 3.4.2 Superior Laryngeal Nerve.
3.4.3 Inferior Laryngeal Nerve or Recurrent Laryngeal Nerve -- 3.4.4 Nonrecurrent Inferior Laryngeal Nerve -- 3.4.5 Spinal Accessory Nerve (Fig. 3.17) -- 3.4.6 Hypoglossum (Fig. 3.18) -- 3.4.7 Glossopharyngeal Nerve -- 3.4.8 Cervical Plexus -- 3.4.9 The Cervical Phrenic Nerve -- 3.4.10 Cervical Sympathetic Trunk -- 3.5 Fascias of the Neck -- 3.5.1 Superficial Cervical Fascia -- 3.5.2 Deep Cervical Fascia -- 3.5.3 Superficial Layer of Deep Cervical Fascia -- 3.5.4 Middle Layer of Deep Cervical Fascia -- 3.5.4.1 Muscular Layer -- 3.5.4.2 Visceral Layer -- 3.5.4.3 Buccopharyngeal Fascia -- 3.5.5 Deep Layer of Deep Cervical Fascia -- References -- Part II: Planning -- 4: Interventional Radiology: Presurgical Selective Angiographic Embolization (SAE) in Hypervascular Cervical Spine Tumours -- 4.1 Introduction: Anatomy -- 4.1.1 Cervical Vascularization -- 4.1.2 Anatomy of the Anterior Spinal Artery (ASA) at Cervical Level -- 4.1.3 Anatomy of the Cervical Posterior Spinal Arteries -- 4.1.4 Radicular Arteries or Lateral Spinal Arteries at Cervical Level -- 4.2 Diagnostic Angiography of Spinal Cord: Technique -- 4.2.1 Technical Considerations on Super-­Selective Catheterization -- 4.2.2 Embolic Agents and Techniques -- 4.2.2.1 Micro-particles -- Injection of Micro-particles: Technique -- Flow Control Technique -- 4.2.2.2 Acrylic Glue (Glubran 2®) -- Glubran2® Injection Technique -- 4.2.2.3 Coils -- Presurgical Occlusion of Vertebral Arteries: Technical Notes -- 4.3 Exemplificative Cases -- Selected References -- 5: Anesthesiological Management and Patient Positioning -- References -- 6: Cervical Spine Instrumentation -- 6.1 Anterior Instrumentation -- 6.1.1 Anterior Cervical Discectomy and Fusion (ACDF) -- 6.1.2 Cervical Interbody: Cages and Grafting -- 6.1.3 Anterior Cervical Corpectomy and Fusion (ACCF).
6.1.4 Reconstruction of the Anterior Column -- 6.1.4.1 Graft Selection for Anterior Interbody Fusion: Autograft Versus Allograft? -- 6.1.5 Supplemental Posterior Fixation for Multilevel ACCF -- 6.1.6 Anterior Cervical Plating -- 6.1.7 Motion Sparing Techniques: Cervical Disc Prosthesis -- 6.2 Posterior Instrumentation -- 6.2.1 Occipital Plate -- 6.2.2 Segmental Screw Fixation -- 6.2.2.1 C1 Lateral Mass Screws (Goel, Harms, and Melcher) -- 6.2.2.2 C2 Pedicle Screws (Judet) -- 6.2.2.3 C2 Translaminar Screw Fixation (Wright) -- 6.2.2.4 Subaxial Lateral Mass Screws (Magerl) -- 6.2.2.5 C7 Transpedicular Screw -- 6.2.3 Laminoplasty -- 6.2.3.1 Kurokawa Modification -- 6.2.3.2 Tomita Modification -- 6.3 Focus on C1-C2 Fusion Techniques -- 6.3.1 Posterior C1-C2 Wiring (Gallie technique -- Brooks and Jenkins technique) -- 6.3.2 Posterior C1-C2 Transarticular Screws (Magerl and Seeman) -- 6.3.3 Posterior C1-C2 Fusion Using Rod and Polyaxial Screw Construct (Harms Technique) -- References -- 7: Tracheotomy Surgical Technique -- 7.1 Surgical Technique -- 7.1.1 Landmarks on the Skin -- 7.1.2 1st Surgical Step: Incision of the Skin -- 7.1.2.1 Anatomical Key Points (Fig. 7.2) -- 7.1.2.2 Pearls and Potential Complications -- 7.1.3 2nd Surgical Step: Incision of SLDCF and Identification of Median Line -- 7.1.3.1 Anatomical Key Points -- 7.1.3.2 Pearls and Potential Complications -- 7.1.4 3rd Surgical Step: Incision of MLDCF and Identification of Thyroid Gland and Trachea -- 7.1.5 4th Surgical Step: Incision of the Trachea -- 7.1.5.1 Pearls and Possible Complications -- 8: Surgical Planning in Cervical Spine Oncologic Patients -- 8.1 Epidemiology -- 8.2 Clinical Findings and Imaging -- 8.3 Biopsy -- 8.4 Oncological Staging -- 8.4.1 Benign Tumors -- 8.4.2 Malignant Tumors -- 8.5 Margins and Surgical Planning -- 8.6 Terminology.
8.7 Intralesional Excision -- 8.8 En Bloc Resection -- 8.9 Palliative Procedure -- 8.9.1 Surgical Techniques: En Bloc Resections in the Cervical Spine -- 8.9.2 Morbidity and Complications -- References -- Part III: Surgical Approaches -- 9: Surgical Approaches to CCJ (Endoscopic Transnasal-Transoral-Transcervical and Robotic Transoral Approach) -- 9.1 Introduction -- 9.2 Anterior Approaches -- 9.2.1 Radiological Planning of Anterior Approaches to Craniovertebral Junction [5] -- 9.2.1.1 Angles of Attack -- 9.2.1.2 Endonasal -- 9.2.1.3 Transoral -- 9.2.1.4 Transcervical -- 9.3 Transnasal Approach -- 9.3.1 Standard Transnasal/Transsphenoidal Approach -- 9.3.1.1 Operative Positioning -- 9.3.1.2 Surgical Principles -- 9.3.1.3 Postoperative Care -- 9.4 Transoral Approaches -- 9.4.1 Median Labiomandibular Glossotomy Approach -- 9.4.1.1 Operative Positioning -- 9.4.1.2 Surgical Principles -- 9.4.2 Endoscopic Transoral Approach -- 9.4.2.1 Surgical Principles -- 9.4.2.2 Removal of C1 Arch and Odontoidectomy (Endoscopic-Assisted Procedures) -- 9.4.2.3 Extradural and Tumor Removal -- 9.4.2.4 Postoperative Care -- 9.4.3 Endoscopic Combined Transnasal- Transoral Approach -- 9.4.3.1 Advantages and Disadvantages of Different Approaches -- 9.4.4 Transoral Robotic Approach -- 9.4.4.1 Surgical Principles -- 9.5 Transcervical Approaches -- 9.5.1 Standard Transcervical Approaches -- 9.5.2 Transcervical Endoscopic Approach -- References -- 10: Anterior and Lateral Approaches to Cervical Spine -- 10.1 Anterior Approach to the Cervical Spine -- 10.1.1 Preliminary Steps -- 10.1.2 Upper Cervical Spine (Scheme 10.2 -- Figs. 10.1, 10.2) -- 10.1.2.1 First Surgical Step: Incision of the Skin -- 10.1.2.2 Second Surgical Step: Dissection of the Subplatysmal Flap -- Anatomical Key Points (Figs. 10.9, 10.10, and 10.11 -- Scheme 10.4) -- Pearls.
Potential Complications -- 10.1.2.3 Third Surgical Step: Dissection of the SLDCF Anteriorly to the SCM -- Anatomical Key Points (Figs. 10.14a, 10.15, and 10.16 -- Scheme 10.5) -- Pearls -- Potential Complications -- 10.1.2.4 Fourth Surgical Step: Dissection of the MLDCF between the Carotid Sheath and the Visceral Column -- Anatomical Key Points -- Pearls -- Potential Complications -- 10.1.2.5 Fifth Surgical Step: Dissection of Prevertebral Structures and Exposure of the Vertebral Plane (Scheme 10.6) -- Anatomical Key Points -- Pearls -- Potential Complications -- 10.1.3 Midcervical Spine (C3-C6) (Scheme 10.7) and Fig. 10.3 -- 10.1.3.1 First Surgical Step: Incision of the Skin -- 10.1.3.2 Second Surgical Step: Dissection of the Subplatysmal Flap -- Anatomical Key Points -- Pearls -- Potential Complications -- 10.1.3.3 Third Surgical Step: Dissection of the SLDCF Anteriorly to the SCM -- Anatomical Key Points (Scheme 10.10) -- Pearls -- Potential Complications -- 10.1.3.4 Fourth Surgical Step: Dissection of the MLDCF between the Carotid Sheath and the Visceral Column -- Anatomical Key Points (Figs. 10.44 and 10.45) -- Pearls -- Potential Complications -- 10.1.3.5 Fifth Surgical Step: Dissection of Prevertebral Structures and Exposure of the Vertebral Plane -- Anatomical Key Points (Figs. 10.46 and 10.47) -- Pearls -- Potential Complications -- 10.1.4 Cervical Mini-invasive Approach -- 10.1.4.1 First Surgical Step: Incision of the Skin (Figs. 10.48 and 10.49) -- 10.1.4.2 Second Surgical Step: Dissection of the Subplatysmal Flap -- Anatomical Key Points -- Pearls -- Potential Complications -- 10.1.4.3 Third Surgical Step: Dissection of the SLDCF Anteriorly to the SCM -- Anatomical Key Points -- Pearls -- Potential Complications -- 10.1.4.4 Fourth Surgical Step: Dissection of the MLDCF between the Carotid Sheath and the Visceral Column.
Anatomical Key Points (Fig. 10.55).
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Intro -- Acknowledgment -- Contents -- Contributors -- Part I: Anatomy -- 1: Anatomy of Craniocervical Junction -- 1.1 Osseous Anatomy -- 1.1.1 Occipital Bone -- 1.1.2 Atlas (Fig. 1.1) -- 1.1.3 Axis (Fig. 1.2) -- 1.2 Articular and Ligamentous Anatomy -- 1.2.1 Transverse Ligament -- 1.2.2 Alar Ligament -- 1.2.3 Transverse Occipital Ligament -- 1.2.4 Accessory Atlantoaxial Ligament -- 1.2.5 Lateral Atlanto-Occipital Ligament -- 1.2.6 Barkow Ligament -- 1.2.7 Apical Ligament -- 1.2.8 Tectorial Membrane -- 1.2.9 Posterior Atlanto-Occipital Membrane -- 1.2.10 Anterior Atlanto-Occipital Membrane -- 1.2.11 Nuchal Ligament -- 1.3 Muscular Anatomy -- 1.4 The Arterial System -- 1.4.1 V1 Segment -- 1.4.2 V2 Segment -- 1.4.3 V3 Segment -- 1.4.4 Anatomical Variation -- 1.5 The Venous System -- 1.6 Neural Tissue -- References -- 2: Anatomy of the Subaxial Cervical Spine -- 2.1 Bony Anatomy -- 2.1.1 C3-C6 -- 2.1.2 C7: Vertebra Prominens -- 2.2 Joints and Ligamentous Anatomy -- 2.2.1 Anterior Longitudinal Ligament -- 2.2.2 Posterior Longitudinal Ligament -- 2.2.3 Ligamentum Flavum -- 2.2.4 Interspinous Ligaments -- 2.2.5 Ligamentum Nuchae -- 2.3 Muscular Anatomy -- 2.4 The Arterial System -- 2.5 The Venous System -- 2.6 The Cervical Spinal Nerves -- References -- 3: Anatomy of the Neck -- 3.1 Topographic Anatomy -- 3.2 Muscles of the Neck -- 3.2.1 Platysma -- 3.2.2 Sternocleidomastoid Muscle -- 3.2.3 Suprahyoid Muscles (Fig. 3.3) -- 3.2.4 Infrahyoid Muscles ("Strap Muscles") (Fig. 3.3) -- 3.2.5 Omohyoid (Fig. 3.4) -- 3.3 Vascular Supply: Arteries and Veins (Fig. 3.5) -- 3.3.1 Arteries -- 3.3.2 Important Anatomical Variation of the Arteries of the Neck -- 3.3.2.1 Lusory Artery -- 3.3.2.2 Veins (Fig. 3.7) -- 3.4 Nerves -- 3.4.1 Vagus -- 3.4.2 Superior Laryngeal Nerve.

3.4.3 Inferior Laryngeal Nerve or Recurrent Laryngeal Nerve -- 3.4.4 Nonrecurrent Inferior Laryngeal Nerve -- 3.4.5 Spinal Accessory Nerve (Fig. 3.17) -- 3.4.6 Hypoglossum (Fig. 3.18) -- 3.4.7 Glossopharyngeal Nerve -- 3.4.8 Cervical Plexus -- 3.4.9 The Cervical Phrenic Nerve -- 3.4.10 Cervical Sympathetic Trunk -- 3.5 Fascias of the Neck -- 3.5.1 Superficial Cervical Fascia -- 3.5.2 Deep Cervical Fascia -- 3.5.3 Superficial Layer of Deep Cervical Fascia -- 3.5.4 Middle Layer of Deep Cervical Fascia -- 3.5.4.1 Muscular Layer -- 3.5.4.2 Visceral Layer -- 3.5.4.3 Buccopharyngeal Fascia -- 3.5.5 Deep Layer of Deep Cervical Fascia -- References -- Part II: Planning -- 4: Interventional Radiology: Presurgical Selective Angiographic Embolization (SAE) in Hypervascular Cervical Spine Tumours -- 4.1 Introduction: Anatomy -- 4.1.1 Cervical Vascularization -- 4.1.2 Anatomy of the Anterior Spinal Artery (ASA) at Cervical Level -- 4.1.3 Anatomy of the Cervical Posterior Spinal Arteries -- 4.1.4 Radicular Arteries or Lateral Spinal Arteries at Cervical Level -- 4.2 Diagnostic Angiography of Spinal Cord: Technique -- 4.2.1 Technical Considerations on Super-­Selective Catheterization -- 4.2.2 Embolic Agents and Techniques -- 4.2.2.1 Micro-particles -- Injection of Micro-particles: Technique -- Flow Control Technique -- 4.2.2.2 Acrylic Glue (Glubran 2®) -- Glubran2® Injection Technique -- 4.2.2.3 Coils -- Presurgical Occlusion of Vertebral Arteries: Technical Notes -- 4.3 Exemplificative Cases -- Selected References -- 5: Anesthesiological Management and Patient Positioning -- References -- 6: Cervical Spine Instrumentation -- 6.1 Anterior Instrumentation -- 6.1.1 Anterior Cervical Discectomy and Fusion (ACDF) -- 6.1.2 Cervical Interbody: Cages and Grafting -- 6.1.3 Anterior Cervical Corpectomy and Fusion (ACCF).

6.1.4 Reconstruction of the Anterior Column -- 6.1.4.1 Graft Selection for Anterior Interbody Fusion: Autograft Versus Allograft? -- 6.1.5 Supplemental Posterior Fixation for Multilevel ACCF -- 6.1.6 Anterior Cervical Plating -- 6.1.7 Motion Sparing Techniques: Cervical Disc Prosthesis -- 6.2 Posterior Instrumentation -- 6.2.1 Occipital Plate -- 6.2.2 Segmental Screw Fixation -- 6.2.2.1 C1 Lateral Mass Screws (Goel, Harms, and Melcher) -- 6.2.2.2 C2 Pedicle Screws (Judet) -- 6.2.2.3 C2 Translaminar Screw Fixation (Wright) -- 6.2.2.4 Subaxial Lateral Mass Screws (Magerl) -- 6.2.2.5 C7 Transpedicular Screw -- 6.2.3 Laminoplasty -- 6.2.3.1 Kurokawa Modification -- 6.2.3.2 Tomita Modification -- 6.3 Focus on C1-C2 Fusion Techniques -- 6.3.1 Posterior C1-C2 Wiring (Gallie technique -- Brooks and Jenkins technique) -- 6.3.2 Posterior C1-C2 Transarticular Screws (Magerl and Seeman) -- 6.3.3 Posterior C1-C2 Fusion Using Rod and Polyaxial Screw Construct (Harms Technique) -- References -- 7: Tracheotomy Surgical Technique -- 7.1 Surgical Technique -- 7.1.1 Landmarks on the Skin -- 7.1.2 1st Surgical Step: Incision of the Skin -- 7.1.2.1 Anatomical Key Points (Fig. 7.2) -- 7.1.2.2 Pearls and Potential Complications -- 7.1.3 2nd Surgical Step: Incision of SLDCF and Identification of Median Line -- 7.1.3.1 Anatomical Key Points -- 7.1.3.2 Pearls and Potential Complications -- 7.1.4 3rd Surgical Step: Incision of MLDCF and Identification of Thyroid Gland and Trachea -- 7.1.5 4th Surgical Step: Incision of the Trachea -- 7.1.5.1 Pearls and Possible Complications -- 8: Surgical Planning in Cervical Spine Oncologic Patients -- 8.1 Epidemiology -- 8.2 Clinical Findings and Imaging -- 8.3 Biopsy -- 8.4 Oncological Staging -- 8.4.1 Benign Tumors -- 8.4.2 Malignant Tumors -- 8.5 Margins and Surgical Planning -- 8.6 Terminology.

8.7 Intralesional Excision -- 8.8 En Bloc Resection -- 8.9 Palliative Procedure -- 8.9.1 Surgical Techniques: En Bloc Resections in the Cervical Spine -- 8.9.2 Morbidity and Complications -- References -- Part III: Surgical Approaches -- 9: Surgical Approaches to CCJ (Endoscopic Transnasal-Transoral-Transcervical and Robotic Transoral Approach) -- 9.1 Introduction -- 9.2 Anterior Approaches -- 9.2.1 Radiological Planning of Anterior Approaches to Craniovertebral Junction [5] -- 9.2.1.1 Angles of Attack -- 9.2.1.2 Endonasal -- 9.2.1.3 Transoral -- 9.2.1.4 Transcervical -- 9.3 Transnasal Approach -- 9.3.1 Standard Transnasal/Transsphenoidal Approach -- 9.3.1.1 Operative Positioning -- 9.3.1.2 Surgical Principles -- 9.3.1.3 Postoperative Care -- 9.4 Transoral Approaches -- 9.4.1 Median Labiomandibular Glossotomy Approach -- 9.4.1.1 Operative Positioning -- 9.4.1.2 Surgical Principles -- 9.4.2 Endoscopic Transoral Approach -- 9.4.2.1 Surgical Principles -- 9.4.2.2 Removal of C1 Arch and Odontoidectomy (Endoscopic-Assisted Procedures) -- 9.4.2.3 Extradural and Tumor Removal -- 9.4.2.4 Postoperative Care -- 9.4.3 Endoscopic Combined Transnasal- Transoral Approach -- 9.4.3.1 Advantages and Disadvantages of Different Approaches -- 9.4.4 Transoral Robotic Approach -- 9.4.4.1 Surgical Principles -- 9.5 Transcervical Approaches -- 9.5.1 Standard Transcervical Approaches -- 9.5.2 Transcervical Endoscopic Approach -- References -- 10: Anterior and Lateral Approaches to Cervical Spine -- 10.1 Anterior Approach to the Cervical Spine -- 10.1.1 Preliminary Steps -- 10.1.2 Upper Cervical Spine (Scheme 10.2 -- Figs. 10.1, 10.2) -- 10.1.2.1 First Surgical Step: Incision of the Skin -- 10.1.2.2 Second Surgical Step: Dissection of the Subplatysmal Flap -- Anatomical Key Points (Figs. 10.9, 10.10, and 10.11 -- Scheme 10.4) -- Pearls.

Potential Complications -- 10.1.2.3 Third Surgical Step: Dissection of the SLDCF Anteriorly to the SCM -- Anatomical Key Points (Figs. 10.14a, 10.15, and 10.16 -- Scheme 10.5) -- Pearls -- Potential Complications -- 10.1.2.4 Fourth Surgical Step: Dissection of the MLDCF between the Carotid Sheath and the Visceral Column -- Anatomical Key Points -- Pearls -- Potential Complications -- 10.1.2.5 Fifth Surgical Step: Dissection of Prevertebral Structures and Exposure of the Vertebral Plane (Scheme 10.6) -- Anatomical Key Points -- Pearls -- Potential Complications -- 10.1.3 Midcervical Spine (C3-C6) (Scheme 10.7) and Fig. 10.3 -- 10.1.3.1 First Surgical Step: Incision of the Skin -- 10.1.3.2 Second Surgical Step: Dissection of the Subplatysmal Flap -- Anatomical Key Points -- Pearls -- Potential Complications -- 10.1.3.3 Third Surgical Step: Dissection of the SLDCF Anteriorly to the SCM -- Anatomical Key Points (Scheme 10.10) -- Pearls -- Potential Complications -- 10.1.3.4 Fourth Surgical Step: Dissection of the MLDCF between the Carotid Sheath and the Visceral Column -- Anatomical Key Points (Figs. 10.44 and 10.45) -- Pearls -- Potential Complications -- 10.1.3.5 Fifth Surgical Step: Dissection of Prevertebral Structures and Exposure of the Vertebral Plane -- Anatomical Key Points (Figs. 10.46 and 10.47) -- Pearls -- Potential Complications -- 10.1.4 Cervical Mini-invasive Approach -- 10.1.4.1 First Surgical Step: Incision of the Skin (Figs. 10.48 and 10.49) -- 10.1.4.2 Second Surgical Step: Dissection of the Subplatysmal Flap -- Anatomical Key Points -- Pearls -- Potential Complications -- 10.1.4.3 Third Surgical Step: Dissection of the SLDCF Anteriorly to the SCM -- Anatomical Key Points -- Pearls -- Potential Complications -- 10.1.4.4 Fourth Surgical Step: Dissection of the MLDCF between the Carotid Sheath and the Visceral Column.

Anatomical Key Points (Fig. 10.55).

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