Posterior Midline Approach C0–C2: How to Expose Meticulously with Less Bleeding

Craniovertebral junction is a delicate region; any damage to vertebral artery (VA) or medullo-spinal cord junction may result in a life-threatening situation. We should have a meticulous dissection method with proper understanding of anatomy to obtain a wide and dry surgical field. The author would like to emphasize three significant points: 1. Too much use of an electrical scalpel is one of the risk factors to meet unpleasant bleeding from VA or dilated epidural venous plexus. Subperiosteal dissection is the key. 2. Understanding of anatomical characteristics around epidural venous plexus will help you to know how to manage epidural venous plexus between C1 and C2. 3. Direct suction to the bleeding from venous plexus may tear the plexus wall more. Suction via saline soaked cotton pad is quite useful to arrest bleeding.