Far-lateral Approach to the Craniocervical Junction

2005 ◽  
Vol 57 (suppl_4) ◽  
pp. ONS-367-ONS-371 ◽  
Author(s):  
Giuseppe Lanzino ◽  
Sergio Paolini ◽  
Robert F. Spetzler
Keyword(s):  
Craniocervical Junction ◽  
Lateral Approach ◽  
Occipital Condyle ◽  
Lateral Part ◽  
Posterior Arch ◽  
Bone Removal ◽  
Far Lateral Approach ◽  
Cranial Base Surgery ◽  
Far Lateral ◽  
Angle Of View

Abstract THE FAR-LATERAL APPROACH is an extension of the standard suboccipital approach, designed to maximize exposure of the lateroventral craniocervical junction. Following a basic principle of cranial base surgery, the angle of view is increased by bone removal. Bone removal involves the most lateral part of the inferior occipital squama and the posterior arch of C1. Drilling of various portions of the occipital condyle further increases the exposure. Transposition of the vertebral artery is seldom required. The far-lateral approach allows a tangential, unobstructed view of the lateroventral cervicomedullary area and can be applied effectively to manage with a heterogeneous spectrum of pathological lesions involving this area. The technical aspects of the procedure are briefly illustrated in this report.

scholarly journals Foramen Magnum Meningioma: Far Lateral Approach

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.

Far-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle

2002 ◽  
Vol 96 (2) ◽  
pp. 302-309 ◽  
Author(s):  
Anil Nanda ◽  
David A. Vincent ◽  
Prasad S. S. V. Vannemreddy ◽  
Mustafa K. Baskaya ◽  
Amitabha Chanda
Keyword(s):  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Additional Patient ◽  
Occipital Condyle ◽  
Rheumatoid Disease ◽  
Content Type ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Fine Print

Object. The goal of this study was to determine whether drilling out the occipital condyle facilitates surgery via the far-lateral approach by comparing data from 10 clinical cases with that from studies of eight cadaver heads. Methods. During the last 6 years at Louisiana State University Health Sciences Center—Shreveport, 10 patients underwent surgery via the far-lateral approach to the foramen magnum. Six of these patients harbored anterior foramen magnum meningiomas, one patient a dermoid cyst, two patients vertebral artery (VA) aneurysms, and an additional patient suffered from rheumatoid disease of the craniocervical junction. The surgical approach consisted of retromastoid craniectomy and C-1 laminectomy. The seven tumors and the pannus of rheumatoid disease were completely excised, and the two aneurysms were clipped without drilling the occipital condyle. In one patient a chronic subdural hematoma was found 3 months after surgery, but no patient displayed any complication associated with surgery. It is significant that in no patient was a cerebrospinal fluid leak present. All patients experienced improved neurological function postoperatively. To compare surgical visibility, eight cadaveric specimens (16 sides) were studied, including delineation of the VA and its segments around the craniocervical junction. Increase in visibility as a function of fractional removal of the occipital condyle was quantified by measuring the degrees of visibility gained by removing one third and one half of the occipital condyle. Removal of one third of the occipital condyle produced a mean increase of 15.9° visibility, and removal of one half produced a mean increase of 19.9°. Conclusions. On the basis of their findings the authors conclude that removal of the occipital condyle is not necessary for the safe and complete resection of anterior intradural foramen magnum tumors.

scholarly journals Muscular-stage Dissection during Far Lateral Approach and Its Transcondylar Extension

2018 ◽  
Vol 79 (S 04) ◽  
pp. S356-S361 ◽  
Author(s):  
Sakyo Hirai ◽  
Yoshiki Obata ◽  
Taketoshi Maehara ◽  
Masaru Aoyagi ◽  
Akihito Sato
Keyword(s):  
Vertebral Artery ◽  
Transverse Process ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Oblique Muscle ◽  
Occipital Condyle ◽  
Artery Dissection ◽  
Posterior Arch ◽  
Far Lateral Approach ◽  
Far Lateral

Background The far lateral approach includes exposure of the C1 transverse process, vertebral artery, posterior arch of the atlas, and occipital condyle. We designed a method for systematic muscular-stage dissection and present our experience with this approach. Operative Methods We used a horseshoe scalp flap that was reflected downward and medially. The lateral muscle layers were separated layer to layer to expose the suboccipital triangle. The medial muscle layers were separated in the midline and reflected in a single layer. At this stage, the midline of the C1 process and the foramen magnum were identified. The rectus capitis posterior major muscle was reflected to expose the posterior arch of the atlas. The C1 transverse process and vertebral artery were identified by reflection of the superior oblique muscle. The occipital condyle was separated accordingly. Results We used this method of muscular dissection in 10 patients (foramen magnum meningioma, n = 5; hypoglossal schwannoma, n = 2; others, n = 3). Systematic muscular-stage dissection facilitates identification of the anatomical landmarks with no vertebral artery injury. Gross total removal was obtained in all 9 patients with complex tumors. The patient with vertebral artery dissection successfully underwent proximal clipping. Conclusion Our muscular-stage dissection could contribute to safe and effective surgery for the far lateral approach.

Staged bilateral far-lateral approach for bilateral cervicomedullary junction neurenteric cysts in a 10-year-old girl

2013 ◽  
Vol 12 (3) ◽  
pp. 274-280 ◽  
Author(s):  
Smruti K. Patel ◽  
James K. Liu
Keyword(s):  
Unusual Case ◽  
Pediatric Population ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
Rare Occurrence ◽  
Benign Lesions ◽  
Far Lateral Approach ◽  
The Central Nervous System ◽  
Far Lateral ◽  
Pontomedullary Junction

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.

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

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.

scholarly journals Schwannoma of the craniocervical junction: surgical approach of two cases

2003 ◽  
Vol 61 (3A) ◽  
pp. 639-641 ◽  
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.

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

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.

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

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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