scholarly journals Far Lateral Transcondylar Approach for Anterior Foramen Magnum Lesions

2020 ◽  
Vol 24 (2) ◽  
pp. 149-155
Author(s):  
WAQAS MEHDI ◽  
AZAM NIAZ ◽  
MUHAMMAD IRFAN ◽  
SHAHZAIB TASDIQUE ◽  
SAMRA MAJEED
Keyword(s):  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Initial Assessment ◽  
Cervical Cord ◽  
Total Excision ◽  
Cardiorespiratory Arrest ◽  
Transcondylar Approach ◽  
Upper Cervical ◽  
Far Lateral ◽  
Malignant Lesions

Objective:  To study the efficacy and safety of far-lateral transcondylar approach for anterior foramen magnum lesions with early experience at our Institute. Material and Methods:  We treated six patients, with lesion anterior to the foramen magnum and posterior to the brainstem and cervical cord in a period of 2 years, March 2017 to March 2018.Initial assessment was made by history and examination followed by CT scan and contrast MRI. All were treated using far-lateral transcondylar approach. Result:  Among six patients, there were two were male and four were female. Three of these patients had a meningioma while two patients had neurofibromas and one clival chordoma. Total excision was achieved in five neoplastic cases, while subtotal excision was done in one case. There were no fresh postoperative deficits in any of the other patients. One patient had an unexplained sudden cardiorespiratory arrest 18h after the surgery and succumbed. One patient had cerebrospinal fluid (CSF) discharge from the wound, which was satisfactorily managed by lumber CSF drainage. Conclusion:  This approach provides an excellent approach to lesions located anterior to foramen magnum posterior to the brainstem and upper cervical cord. Gross total excision of these benign and malignant lesions is safely possible through this approach. Keywords:  Craniovertebral Junction, Far-Lateral Transcondylar Approach, Anterior Foramen Magnum, Brain Stem, Chordoma.

Extreme lateral transcondylar approach for resection of ventrally based meningioma of the craniovertebral junction and upper cervical spine

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1
Author(s):  
James K. Liu
Keyword(s):  
Cervical Spine ◽  
Cervical Spinal Cord ◽  
Close Association ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Upper Cervical Spine ◽  
Transcondylar Approach ◽  
Intradural Tumor ◽  
Upper Cervical ◽  
Microsurgical Resection

Ventrally based meningiomas at the craniovertebral junction can be challenging tumors to remove because of their deep location anterior to the lower brainstem and upper cervical spinal cord, and close association with complex neurovascular structures. The extreme lateral transcondylar approach provides excellent access and exposure to anterior and anterolateral intradural tumors involving the region of the craniovertebral junction, including the lower third of the clivus, the foramen magnum, and the upper cervical spine. This approach allows safe access for removal of these difficult tumors without any neural retraction. In this operative video manuscript, the author demonstrates an illustrative step-by-step technique for microsurgical resection of a ventrally based meningioma extending from the foramen magnum to C-2 using the extreme lateral transcondylar approach. The operative technique and surgical nuances, including the surgical approach, intradural tumor removal, and cranial base reconstruction, are illustrated in this video atlas. The video can be found here: http://youtu.be/4uvPpEtEShU.

scholarly journals The far-lateral approach: destruction of the condyle does not necessarily result in clinically evident craniovertebral junction instability

2016 ◽  
Vol 125 (1) ◽  
pp. 196-201 ◽  
Author(s):  
Ehab Shiban ◽  
Elisabeth Török ◽  
Maria Wostrack ◽  
Bernhard Meyer ◽  
Jens Lehmberg
Keyword(s):  
Extent Of Resection ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Occipitocervical Fusion ◽  
Anterior Portion ◽  
Far Lateral Approach ◽  
Clinical Instability ◽  
Craniocervical Instability ◽  
Far Lateral

OBJECT Far-lateral or extreme-lateral approaches to the skull base allow access to the lateral and anterior portion of the lower posterior fossa and foramen magnum. These approaches include a certain extent of resection of the condyle, which potentially results in craniocervical junction instability. However, it is debated what extent of condyle resection is safe and at what extent of condyle resection an occipitocervical fusion should be recommended. The authors reviewed cases of condyle resection/destruction with regard to necessity of occipitocervical fusion. METHODS The authors conducted a retrospective analysis of all patients in whom a far- or extreme-lateral approach including condyle resection of various extents was performed between January 2007 and December 2014. RESULTS Twenty-one consecutive patients who had undergone a unilateral far- or extreme-lateral approach including condyle resection were identified. There were 10 male and 11 female patients with a median age of 61 years (range 22–83 years). The extent of condyle resection was 25% or less in 15 cases, 50% in 1 case, and greater than 75% in 5 cases. None of the patients who underwent condyle resection of 50% or less was placed in a collar postoperatively or developed neck pain. Two of the patients with condyle resection of greater than 75% were placed in a semirigid collar for a period of 3 months postoperatively and remained free of pain after this period. At last follow-up none of the cases showed any clear sign of radiological or clinical instability. CONCLUSIONS The unilateral resection or destruction of the condyle does not necessarily result in craniocervical instability. No evident instability was encountered even in the 5 patients who underwent removal of more than 75% of the condyle. The far- or extreme-lateral approach may be safer than generally accepted with regard to craniocervical instability as generally considered and may not compel fusion in all cases with condylar resection of more than 75%.

Foramen Magnum and Upper Cervical Cord Tumors

1983 ◽  
Vol &NA; (176) ◽  
pp. 171???177
Author(s):  
HIDEO HIRANO ◽  
HIROTOSHI SUZUKI ◽  
TAKEHIKO SAKAKIBARA ◽  
KIKUO INOUE ◽  
TETSUO MURAMATSU
Keyword(s):  
Foramen Magnum ◽  
Cervical Cord ◽  
Upper Cervical

Far Lateral Transcondylar Approach for Lesions of the Foramen Magnum

2003 ◽  
Vol 9 (2) ◽  
pp. 93-105 ◽  
Author(s):  
Evandro de Oliveira ◽  
Hung Tzu Wen ◽  
Helder Tedeschi ◽  
Albert L. Rhoton, ◽  
Fabricio Carrijo Rodrigues ◽  
...  
Keyword(s):  
Foramen Magnum ◽  
Transcondylar Approach ◽  
Far Lateral

Microsurgical Excision of a Retro-odontoid Disc Hernia via a Far-lateral Approach: Successful Treatment of a Rare Cause of Myelopathy: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 54 (4) ◽  
pp. 1015-1018 ◽  
Author(s):  
Akira Matsuno ◽  
Michi Nakashima ◽  
Mineko Murakami ◽  
Tadashi Nagashima
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Lateral Approach ◽  
The Body ◽  
Cervical Cord ◽  
Resonance Imaging ◽  
Far Lateral Approach ◽  
Far Lateral

Abstract OBJECTIVE AND IMPORTANCE Among mass lesions causing myelopathy at the craniovertebral junction, retro-odontoid intervertebral disc hernias are very rare, with only four such cases reported in the literature. CLINICAL PRESENTATION A 77-year-old woman with this rare condition complained of motor and sensory disturbances in her extremities. Magnetic resonance imaging scans demonstrated an extradural mass lesion at the craniovertebral junction, compressing the lower medulla oblongata and the upper cervical cord posteriorly. INTERVENTION The lesion, which was partly mucinous cartilaginous and partly fatty and fibrous, was meticulously removed via a left far-lateral approach. The lesion was not neoplastic but was determined to be composed of fibrocartilaginous tissue, consistent with disc material. Postoperatively, the patient's sensory disturbances and motor weakness improved, and magnetic resonance imaging scans demonstrated marked shrinkage of the lesion. CONCLUSION Sagittal, T1-weighted, magnetic resonance imaging scans demonstrated a low-intensity band between the odontoid process and the body of the axis, which suggested a persistent cartilaginous band. Although upward migration of a herniated disc from the lower cervical spine and degeneration of retro-odontoid ligaments might be possible causes, a persistent cartilaginous band extending between the odontoid process and the body of the axis was considered to be the more likely origin of the retro-odontoid intervertebral disc hernia. Because the far-lateral surgical approach does not require retraction of the cervical cord and provides safe access to the lesion at the craniovertebral junction, it is a suitable surgical method for this condition.

scholarly journals The So-Called Anterior Meningeal Artery: An Anatomic Study for Treatment Modalities

2004 ◽  
Vol 10 (4) ◽  
pp. 293-299 ◽  
Author(s):  
S. Shimizu ◽  
A.S. Garcia ◽  
N. Tanriover ◽  
K. Fujii
Keyword(s):  
Soft Tissues ◽  
Deep Layer ◽  
Odontoid Process ◽  
Posterior Longitudinal Ligament ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Treatment Modalities ◽  
Upper Cervical ◽  
Vertebral Bodies ◽  
Meningeal Artery

The so called anterior meningeal artery (AMA) is a branch of the vertebral artery (VA), which had been interpreted as a supplying vessel of the dura in the foramen magnum and upper cervical level. In this study, we examined the anatomy of this artery and relationships to its surrounding structures for treatment modalities. With the aid of magnification, five adult cadaveric head and neck complex and five cervical spines were examined after perfusion of the vessels with colored silicone. The AMA arose from the VA between the C2 and C3 level, and passed medially through the intrervertebral foramen anterior to the dural sheath of the third cervical nerve root. It ran upwards dorsal to the deep layer of the posterior longitudinal ligament (PLL) with anterior internal vertebral venous plexus. Rostrally, it formed an arcade above the apex of the odontoid process with its contralateral mate. The AMA gave off several tiny branches to the deep layer of the PLL, ligaments and soft tissues above the apex of the odontoid process, and vertebral bodies of the axis. At the level of the foramen magnum, it ended in several small twigs to the dura. Anastomoses between the AMA system and adjacent vessels were observed. One was directed through the hypoglossal canal to the ascending pharyngeal artery and the other was with the V3 segment of the VA. The origin and course of the two AMA, and anastomoses were symmetric. Although the AMA feeds the ventral dura of the foramen magnum, the perfusion area is larger than its name suggests, including the bony and ligamentous structures in the craniovertebral junction. Anatomical knowledge of the AMA, including its anastomoses and layer relationships to the surrounding structures, may help to perform treatment modalities in this region rationally.

scholarly journals Foramen Magnum Meningioma: Microsurgical Endoscopic-Controlled Resection via a Lateral Suboccipital Retrocondylar Approach with Preservation of Posterior Arch of Atlas Integrity

2019 ◽  
Vol 80 (S 04) ◽  
pp. S352-S354
Author(s):  
Hischam Bassiouni
Keyword(s):  
Vertebral Artery ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Radical Resection ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Cervical Cord ◽  
Posterior Arch ◽  
Suboccipital Craniotomy ◽  
Upper Cervical

Abstract Objective Surgical treatment of foramen magnum (FM) meningiomas is challenging due to proximity of the tumor to critical neurovascular structures, namely, the lower brainstem/upper cervical cord, vertebral artery, PICA, and lower cranial nerves. Controversies in microsurgical resection of meningiomas in this location include the necessity for condyle drilling and the need for vertebral artery mobilization. However, a laminectomy or hemilaminectomy of the C1 posterior arch is usually routinely performed. We herein present microsurgical, endoscopic-controlled resection of a FM meningioma via a posterolateral retrocondylar suboccipital craniotomy with preservation of the integrity of the posterior arch of the atlas. Setting Our patient, a 57-year-old patient, suffered from right-sided hemiparesis due to a right-sided ventrolateral FM meningioma compromising the medulla oblongata and upper cervical cord. The tumor at the craniocervical junction was resected through a posterolateral suboccipital retrocondylar craniotomy. Results Radical resection of the FM meningioma was accomplished via a lateral suboccipital retrocondylar craniotomy with preservation of posterior arch of atlas integrity. The postoperative course was uneventful with full preservation of neurological function. Preoperative hemiparesis subsided completely after surgery. Conclusion Anterior-laterally located FM meningiomas can be safely and completely resected via a suboccipital retrocondylar craniotomy. A laminectomy or hemilaminectomy of the posterior arch of C1 is not routinely required for complete and safe resection of these tumors at the craniocervical junction. Neuroendoscopy is beneficial for control of complete tumor resection.The link to the video can be found at: https://youtu.be/DBk6qoJ6OzQ.

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