Direct Lateral Approach to Pathology at the Craniocervical Junction: A Technical Note

2011 ◽  
Vol 70 (suppl_2) ◽  
pp. ons202-ons208 ◽  
Author(s):  
Kalil G. Abdullah ◽  
Richard S. Schlenk ◽  
Ajit Krishnaney ◽  
Michael P. Steinmetz ◽  
Edward C. Benzel ◽  
...  
Keyword(s):  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Technical Note ◽  
Upper Cervical Spine ◽  
Endoscopic Endonasal ◽  
Far Lateral Approach ◽  
Upper Cervical ◽  
Direct Lateral Approach ◽  
Far Lateral

ABSTRACT BACKGROUND: Approaches to the foramen magnum and upper cervical spine traditionally include the posterior midline, far lateral, and endoscopic endonasal approaches. The far lateral approach is a well-established technique for the removal of pathology ventrolateral to the brainstem and the craniocervical junction, but it may be too extensive for lesions limited to areas far from the midline. OBJECTIVE: To present an alternative to the commonly used approaches to the foramen magnum and upper cervical. METHODS: We used an approach directly overlying ventral or lateral pathology. RESULTS: Two cases are presented in which the direct lateral approach followed by an occipitocervical fusion was successfully performed. CONCLUSION: This approach can be considered for patients in whom a ventral decompression is necessary but an endoscopic endonasal approach is undesirable or when a ventral, lateral, and ventrolateral resection of tumor, pannus, or infection is required.

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

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.

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.

scholarly journals A Staged Strategy for Craniocervical Junction Chordoma with Combination of Endoscopic Endonasal Approach and Far Lateral Approach with Endoscopic Assistance: Case Report

2018 ◽  
Vol 79 (S 04) ◽  
pp. S371-S377 ◽  
Author(s):  
Shunya Hanakita ◽  
Moujahed Labidi ◽  
Kentaro Watanabe ◽  
Sebastien Froelich
Keyword(s):  
Treatment Strategy ◽  
Treatment Plan ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Far Lateral Approach ◽  
Endoscopic Assistance ◽  
Far Lateral

Objective While the endoscopic endonasal approach (EEA) has gained widespread acceptance for the resection of clivus chordomas, conventional transcranial approaches still have a crucial role in craniocervical junction (CCJ) chordoma surgery. In repeat surgery, a carefully planned treatment strategy is needed. We present a surgical treatment plan combining an EEA and a far-lateral craniotomy with endoscopic assistance (EA) in the salvage surgery of a recurrent CCJ chordoma. Case Presentation A 37-year-old woman who had undergone partial resection of a chordoma extending from the mid-clivus to the CCJ. Technique A two-stage surgical intervention was planned. First, we opted for an EEA with the intention of removing only the extradural and medial compartments of the lesion. The rationale was to avoid intradural dissection of possibly adherent tissues from the previous procedures and to minimize the cerebrospinal fluid leak risk. One month after the first endonasal stage, a far lateral craniotomy was performed. After removal of the lateral mass and pedicle of C1, a large surgical corridor to the tumor was obtained. Tumor loculations disseminated in and around the CCJ and located in the areas blind to microscopic examination were then successfully resected with EA. An occipito-cervical fusion was then performed during the same procedure. Conclusion In addition to the exact location and morphology of the tumor, history of previous surgery was an important factor in devising a treatment strategy in this case of clivus chordoma. EA was also found to be instrumental in improving the reach of the far lateral approach.

Posterolateral Approaches to the Craniovertebral Junction

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A135-A140 ◽  
Author(s):  
Youssef R. Karam ◽  
Arnold H. Menezes ◽  
Vincent C. Traynelis
Keyword(s):  
Effective Means ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Posterolateral Approach ◽  
Upper Cervical Spine ◽  
Dural Closure ◽  
Far Lateral Approach ◽  
Upper Cervical ◽  
The Stability

Abstract OBJECTIVE The indications and operative technique for a number of posterolateral approaches to the craniovertebral junction (CVJ) are reviewed. METHODS The literature addressing posterolateral approaches to the CVJ is reviewed, and illustrative cases are presented. RESULTS The far lateral approach and its variants, including the transcondylar, supracondylar, and paracondylar approaches, are an effective means of addressing intradural anterior and anterolateral CVJ lesions. These approaches provide exposure of the lower third of the clivus, the foramen magnum, and the upper cervical spine; do not cross contaminated regions; and enable a watertight dural closure to be performed. They are associated with minimal morbidity and usually do not significantly decrease the stability of the CVJ. CONCLUSION All surgeons treating lesions of the CVJ should be familiar with the posterolateral approach and its modifications.

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 Far Lateral Transcondylar Transtubercular Approach for Microsurgical Resection of Foramen Magnum Meningioma: Operative Video and Technical Nuances

2020 ◽  
Author(s):  
James K. Liu ◽  
Vincent N. Dodson ◽  
Ali T. Meybodi
Keyword(s):  
Vertebral Artery ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Endoscopic Endonasal ◽  
Surgical Access ◽  
Far Lateral Approach ◽  
Far Lateral

AbstractSurgical access to the ventral foramen magnum remains a technical challenge. With large lesions in this region compressing the brainstem and distorting the regional neurovascular relationships, formulating a surgical plan and its appropriate execution have crucial importance in achieving favorable outcomes. While the endoscopic endonasal approaches have gained increasing attention to access the clivus and the ventral brainstem, foramen magnum meningiomas are still preferred to be removed via an approach that obviates a trajectory through the nasopharyngeal mucosa. Therefore, the far lateral approach remains one of the most practical approaches for these challenging lesions. This operative video demonstrates the use of the far lateral transcondylar transtubercular approach to remove a large meningioma in the ventral foramen magnum in a 63-year-old male with progressive cervical myelopathy, presenting as spastic quadriparesis without any cranial nerve abnormality. Using a right-sided far lateral transcondylar transtubercular approach, the meningioma was exposed within the cerebellomedullary gutter engulfing the vertebral artery and distorting the course of the adjacent cranial nerves. Using the different corridors identified between the vertebral artery, spinal accessory, vagus, and hypoglossal nerves, multiple angles of attacks to the tumor were established and utilized to resect the lesion. A gross total resection was achieved and the patient was neurologically intact without any neurological deficits. This video demonstrates the importance of understanding the intricacies of neurovascular anatomy of the cervicomedullary region (i.e., the various triangles formed between these structures), and the effective use of these corridors to safely and efficiently remove a challenging ventral foramen magnum meningioma with neurovascular involvement, while preserving cranial nerve function. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video.The link to the video can be found at: https://youtu.be/s1dFhuaRSt8.

scholarly journals P.140 A new international nomenclature of far and extreme lateral approaches to the craniocervical junction

2018 ◽  
Vol 45 (s2) ◽  
pp. S53-S53
Author(s):  
Ns Alshafai ◽  
T Klepinowski
Keyword(s):  
Literature Search ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Significant Discrepancy ◽  
Search Terms ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Anterolateral Aspect ◽  
Number Of Authors

Background: Far and extreme lateral approaches have become a mainstay treatment for lesions located at the anterolateral aspect of foramen magnum and its vicinity. However, there is a significant discrepancy between authors on what these approaches truly are, which leads to producing papers naming different techniques the same and same techniques differently. Methods: We performed literature search employing PubMed-MEDLINE and Scopus databases. The search terms referred to the nomenclature of far lateral approach (FLA), extreme lateral approach (ELA), and their variants. Finally, important papers on the topic from article references were also included, if deemed contributory. Results: In total, 37 articles were collected. Surprisingly, we found that not a single paper has addressed the confusing nomenclature directly yet. Nine truly separate variants of FLA and ELA were found. We implemented them intraoperatively depending on both patient and lesion characteristics. The essence about each is summarized. Conclusions: In the CNSF meeting, we will shortly discuss causes behind confusion and debate each FLA and ELA variants according to a number of authors and their unique yet sometimes confusing understanding of the approaches. Ultimately, a logical proposal for the unification is provided to stir up discussion

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