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J Neurol Surg B Skull Base 2014; 75(04): 236-242
DOI: 10.1055/s-0034-1371363
Original Article
Georg Thieme Verlag KG Stuttgart · New York

A Minimal Access Far-Lateral Approach to Foramen Magnum Lesions

James T. Kryzanski
1   Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, United States
,
Jon H. Robertson
2   Department of Neurosurgery, University of Tennessee College of Medicine, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, United States
,
Carl B. Heilman
1   Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, United States
› Author Affiliations
Further Information

Publication History

14 January 2013

05 December 2013

Publication Date:
04 April 2014 (online)

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Abstract

Objectives The far-lateral approach is widely used to treat pathology of the ventral foramen magnum. Numerous methods of exposure have been described, most of which utilize long skin incisions and myocutaneous flaps. Here we present our experience with gaining exposure through a small paramedian incision using a muscle-splitting technique.

Design A cadaveric anatomical study was first performed to verify the feasibility of the approach. We then describe our experience with using the approach in 13 patients. A retrospective chart review was performed and data regarding pathology, imaging, and complications were collected.

Results The cadaveric study confirmed that a small paramedian muscle-splitting approach allows sufficient exposure to approach many foramen magnum lesions. Our case series included 10 patients with meningioma, one brainstem glioblastoma, one posterior inferior cerebellar artery aneurysm, and one odontoid pannus. The exposure was adequate in all cases. For the meningioma patients, six had gross total resections and four had subtotal resection because of tumor adherence to neurovascular structures. Two patients experienced postoperative cardiovascular complications. There were no new neurologic deficits, cerebrospinal fluid leaks, or wound complications.

Conclusions A small paramedian incision may be used to gain exposure and perform successful far-lateral approaches. The small exposure is likely to reduce the risk of local complications such as cerebrospinal fluid fistula and pseudomeningocele when compared with larger exposures.

Keywords

far-lateral - foramen magnum - meningioma - surgical approach - complications
 

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