The Three-Dimensional Endoscopic Far-Lateral Approach: Many Dimensions to the Craniocervical Junction with a Far-From-Average Operation

Neurenteric cysts are rare and benign lesions that consist of ectopic alimentary tissue residing in the central nervous system. They tend to occur most frequently in an intraspinal rather than intracranial location. Intracranial neurenteric cysts are a rare occurrence in the pediatric population. These lesions typically present as unilateral cystic structures in the lower cerebellopontine angle and craniocervical junction. To the authors' knowledge, there have been no reported cases of bilateral localization of intracranial neurenteric cysts. In this report, they present an unusual case of a 10-year-old girl who was found to have bilateral intracranial neurenteric cysts at the pontomedullary junction. The patient was successfully treated with staged, bilateral far-lateral transcondylar resection of the cysts. The authors also provide a brief overview of the literature describing intracranial neurenteric cysts in children.

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Resection of an anterior spinal cord AVM through a far-lateral approach

Neurosurgical FOCUS ◽

10.3171/2012.v2.focus12161 ◽

2012 ◽

Vol 33 (Suppl1) ◽

pp. 1

Author(s):

L. Madison Michael ◽

Jeffrey M. Sorenson

Keyword(s):

Spinal Cord ◽

Subarachnoid Hemorrhage ◽

Arteriovenous Malformation ◽

Altered Mental Status ◽

Craniocervical Junction ◽

Lateral Approach ◽

Developmentally Delayed ◽

Stereoscopic Video ◽

Far Lateral Approach ◽

Far Lateral

A small arteriovenous malformation near the craniocervical junction with contributions from the anterior spinal artery was discovered in a young developmentally-delayed woman after she presented with altered mental status and evidence of subarachnoid hemorrhage. The malformation could not be completely treated with endovascular therapy, so it was resected through a far-lateral approach. This stereoscopic video demonstrates how to gain the exposure needed to address a lesion in this area. The video can be found here: http://youtu.be/ByjPGm_eXLc.

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Schwannoma of the craniocervical junction: surgical approach of two cases

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2003000400021 ◽

2003 ◽

Vol 61 (3A) ◽

pp. 639-641 ◽

Cited By ~ 3

Author(s):

Manoel Baldoino Leal Filho ◽

Guilherme Borges ◽

Arnaldo Ferreira ◽

Daniel França ◽

Patricia Mello

Keyword(s):

Surgical Technique ◽

Surgical Approach ◽

Craniocervical Junction ◽

Lateral Approach ◽

Special Focus ◽

Sitting Position ◽

Far Lateral Approach ◽

Far Lateral

We report two cases of craniocervical junction schwannomas with a special focus on the surgical approach. The patients underwent a far-lateral approach in the sitting position that facilitated the lesion removal. This report is meant to improve the understanding of this surgical technique as well as improve awareness of its usefulness for similar cases.

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Resection of a Recurrent Cervicomedullary Junction Fibromyxoid Sarcoma through a Far Lateral Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1701688 ◽

2020 ◽

Author(s):

Vincent Nguyen ◽

William Mangham ◽

Jaafar Basma ◽

Nickalus Khan ◽

Jeffrey Sorenson ◽

...

Keyword(s):

Cranial Nerves ◽

Extent Of Resection ◽

Craniocervical Junction ◽

Lateral Approach ◽

Senior Author ◽

Microsurgical Anatomy ◽

Dural Graft ◽

Far Lateral Approach ◽

Fibromyxoid Sarcoma ◽

Far Lateral

Abstract Objectives This study describes a far lateral approach for the resection of a recurrent fibromyxoid sarcoma involving the ventrolateral brainstem, with emphasis on the microsurgical anatomy and technique. Design A far lateral craniotomy is performed in the lateral decubitus position and the transverse and sigmoid sinuses exposed. After opening the dura, sutures are placed to allow gentle mobilization of the sinuses. The recurrent tumor is immediately visible. The involved dura is resected and aggressive internal debulking is performed. Subarachnoid dissection gives access to the lower cranial nerves. The tumor is dissected off the affected portions of the brainstem. A dural graft is used to reconstitute the dura. Photographs of the region are borrowed from Dr. Rhoton's laboratory to illustrate the microsurgical anatomy. Participants The senior author performed the surgery. The video was edited by Dr. V.N. chart review, and literature review were performed by Drs. W.M. and J.B. Outcome measures Outcome was assessed with the extent of resection and postoperative neurological function. Results A near gross total resection of the lesion was achieved. The patient developed a left vocal cord paresis, but her voice was improving at 3-month follow-up. Conclusion Understanding the microsurgical anatomy of the craniocervical junction and ventrolateral brainstem and meticulous microneurosurgical technique are necessary to achieve adequate resection of lesions involving the ventrolateral brainstem. The far lateral approach provides an adequate corridor to this region.The link to the video can be found at: https://youtube/uYEhgPbgrTs.

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Retrocondylar Far-Lateral Approach for Resection of a Craniocervical Junction Hemangioblastoma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1698821 ◽

2019 ◽

Vol 80 (S 04) ◽

pp. S349-S351

Author(s):

Alexander X. Tai ◽

Kathleen Knudson ◽

Walter C. Jean

Keyword(s):

Cystic Lesion ◽

Craniocervical Junction ◽

Lateral Approach ◽

Total Resection ◽

Operative Strategy ◽

Postoperative Course ◽

Suboccipital Craniectomy ◽

Far Lateral Approach ◽

Far Lateral ◽

Neurologically Intact

AbstractWe present a case in which a retrocondylar far-lateral approach was utilized to resect a hemangioblastoma at the craniocervical junction. The patient was a 33-year-old man presenting with 2 months of symptoms referable to compression at the craniocervical junction (i.e., dizziness and gait instability). Though neurologically intact on exam, his imaging demonstrated a highly vascular cystic lesion dorsolateral to the medulla on the left consistent with a hemangioblastoma. Virtual reality software was critical to visualize the patient's lesion in relationship to the vertebral artery and draining vein (Fig. 1). A far-lateral retrocondylar suboccipital craniectomy with a C1 hemilamiectomy permitted resection of this lesion. The operative strategy was to address the lesion similar to an arteriovenous malformation by detaching the lesion from its arterial feeders first, and then addressing the lesion's draining vein (Fig. 2). Postoperative imaging demonstrated a gross-total resection and the patient had an uncomplicated postoperative course. This case demonstrates not only the lateral reach of a retrocondylar far-lateral approach; but also, clearly demonstrates an effective dissection strategy when approaching a hemangioblastoma.The link to the video can be found at: https://youtu.be/M0szMOdhjfE.

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Far Lateral Approach for Disconnection of Craniocervical Junction Dural Arteriovenous Fistula Presented with Myelopathy and Hydrocephalus

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1714402 ◽

2020 ◽

Author(s):

Siu Kei Samuel Lam ◽

Sai Lok Chu ◽

Shing Chau Yuen ◽

Kwong Yui Yam

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Hybrid Approach ◽

Normal Pressure ◽

Craniocervical Junction ◽

Lateral Approach ◽

External Carotid Artery ◽

External Carotid ◽

Far Lateral Approach ◽

Far Lateral

AbstractWe report a case of craniocervical junction dural arteriovenous fistula (dAVF) presented with myelopathy and normal pressure hydrocephalus, and was treated with hybrid approach of embolization and surgical disconnection. A 68-year-old gentleman presented with 1 year history of unsteady gait and sphincter disturbance. Magnetic resonance imaging (MRI) showed abnormally enlarged and tortuous vessels over right cerebellomedullary cistern. Digital subtraction angiogram (DSA) showed Cognard's type-V dAVF at craniocervical junction. Catheter embolization was performed via external carotid artery and finally surgical disconnection was done with far lateral approach (Fig. 1). Postoperative DSA showed no more arteriovenous shunting (Fig. 2). Clinically the patient improved after a course of rehabilitation. Dural AVF at craniocervical junction is rare and its clinical presentation can be highly variable from subarachnoid hemorrhage to brainstem dysfunction. Identification of the exact fistula site is essential in surgical planning. Surgery is effective and safe to achieve complete obliteration and good clinical outcome.1 2 3 4 5 6 The link to the video can be found at: https://youtu.be/xI48stSlWpY.

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Endoscope-Assisted Resection of Extra-Axial Premedullary Neurenteric Cyst via Far Lateral-Supracondylar Approach: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab300 ◽

2021 ◽

Author(s):

Kunal V Vakharia ◽

Ryan M Naylor ◽

Jamie J Van Gompel

Keyword(s):

Posterior Inferior Cerebellar Artery ◽

Cranial Nerves ◽

Craniocervical Junction ◽

Foramen Magnum ◽

Lateral Approach ◽

Neurenteric Cyst ◽

En Bloc ◽

Icg Angiography ◽

Far Lateral Approach ◽

Far Lateral

Abstract Neurenteric cysts are rare congenital lesions that may compress the ventral brainstem.1-9 In this operative video, we illustrate the surgical treatment of an intradural extra-axial neurenteric cyst extending from the lower pons to the craniocervical junction. The patient, an asymptomatic 52-yr-old female, underwent surveillance imaging of the premedullary lesion for 14 yr without progression. However, after developing progressive strain-induced headaches, imaging revealed a significant enlargement of the lesion with brainstem compression and partial obstruction of the foramen magnum. Therefore, surgical resection was pursued. The patient consented to the procedure. The patient underwent a lateral suboccipital craniotomy and C1 laminectomy through a far lateral approach. The lesion was immediately visualized upon opening the dura. After identifying the cranial nerves, we resected the tumor while taking care to preserve the neurovascular elements of the cerebellopontine angle and foramen magnum. During the resection, we unexpectedly encountered a firm nodule that was adherent to the right posterior inferior cerebellar artery. This was meticulously dissected and removed en bloc using intraoperative indocyanine green (ICG) angiography. The cavity was inspected with 0-degree and 30-degree endoscopes to ensure complete resection of the lesion. Gross total resection was confirmed on postoperative magnetic resonance imaging. The patient was neurologically intact with no cranial nerve abnormalities and discharged home on postoperative day 3. This case demonstrates that the far lateral-supracondylar approach affords safe access to the ventral pontomedullary and craniocervical junctions and that intraoperative adjuncts, including ICG angiography and endoscopic visualization, can facilitate complete lesion resection with excellent clinical outcomes.

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Foramen Magnum Meningioma: Far Lateral Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1695701 ◽

2019 ◽

Vol 80 (S 04) ◽

pp. S363-S364

Author(s):

Ciro Vasquez ◽

Alexander Yang ◽

A. Samy Youssef

Keyword(s):

Vertebral Artery ◽

Cranial Nerves ◽

Mass Effect ◽

Craniocervical Junction ◽

Foramen Magnum ◽

Lateral Approach ◽

Neurological Deficits ◽

Occipital Condyle ◽

Far Lateral Approach ◽

Far Lateral

We present a case of a foramen magnum meningioma in a 42-year-old female who presented with headaches for 2 years, associated with decreased sensation and overall feeling of “heaviness” of the right arm. The tumor posed significant mass effect on the brainstem, and given the location of the tumor in the anterolateral region of the foramen magnum, a right far lateral approach was chosen. The approach incorporates the interfascial dissection technique to safely expose and preserve the vertebral artery in the suboccipital triangle. After drilling the posteromedial portion of the occipital condyle and opening the dura, the tumor can be entirely exposed with minimal retraction on the cerebellum. The working space offered by the far lateral approach allows careful dissection at the lateral craniocervical junction, and preservation of the V4 segment of the vertebral artery and the lower cranial nerves. Simpson's grade-2 resection was achieved with coagulation of the dural base around the vertebral artery. The postoperative course was unremarkable for any neurological deficits. At the 2-year follow-up, imaging identified no recurrence of tumor and the patient remains asymptomatic.The link to the video can be found at: https://youtu.be/IMN1O7vO5B0.

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