Extreme Lateral Approach to Ventral and Ventrolaterally Situated Lesions of the Lower Brainstem and Upper Cervical Cord

ABSTRACT

Lesions situated ventrally and ventrolaterally to the lower brainstem and upper cervical spinal cord test the skills of neurosurgeons. We present our experience with eight such patients who underwent the extreme lateral craniocervical approach. The pathologies encountered include three distal vertebral aneurysms, one prepontine epidermoid, one anterior foramen magnum meningioma, and three high cervical dumbbell neurofibromas. All lesions were treated effectively. Postoperatively, the patients improved significantly. Complications included transient lower cranial nerve paresis in three patients, meningitis in one patient, and a pseudomeningocele in two patients. All complications improved with therapy. We conclude that the extreme lateral approach offers excellent visualization and access with minimal neural retraction for treating these difficult lesions.

KEYWORD

Extreme lateral approach - clivus - cervical spine - dumbbell tumor - vertebral artery aneurysm - operative technique - skull base

REFERENCES

• 1 Babu R P, Sekhar L N, Wright D C. Extreme lateral transcondylar approach. Technical improvements and lessons learned.  J Neurosurg . 1994;  81 49-59
• 2 Wen H T, Rhoton A L, Katsuta T. Microsurgical anatomy of the transcondylar, supracondylar and paracondylar extensions of the far-lateral approach.  J Neurosurg . 1997;  87 555-585
• 3 Day J D, Fukushima T, Gianotta S L. Cranial base approaches to posterior circulation aneurysms.  J Neurosurg . 1997;  87 544-554
• 4 Sen C N, Sekhar L N. An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum.  Neurosurgery . 1990;  27 197-204
• 5 George B, Dematons C, Cophignon J. Lateral approach to the anterior portion of the foramen magnum. Application to surgical removal of 14 benign tumors: technical note.  Surg Neurol . 1988;  29 484-490
• 6 El-Mahdy W, Kane P J, Powell M P, Crackard H A. Spinal intradural tumors: part I-extramedullary.  Br J Neurosurg . 1999;  13 550-557
• 7 Banerji D, Behari S, Jain V K, Pandey T, Chabra D K. Extreme lateral transcondylar approach to the skull base.  Neurol India . 1999;  47 22-31
• 8 Salas E, Sekhar L N, Ziyal I M, Caputy A J, Wright D C. Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients.  J Neurosurg (Spine 2) . 1999;  90 206-219
• 9 Samii M, Cheatham M L, Becker D P. Lateral approach to the craniocervical junction. In: Samii M, Cheatham ML, Becker DP Atlas of cranial base surgery. Philadelphia: WB Saunders Co 1995: 54-61
• 10 Bertalanffy H, Seeger W. The dorsolateral, suboccipital, trancondylar approach to the lower clivus and anterior portion of the craniocervical junction.  Neurosurgery . 1991;  29 815-821
• 11 Dowd G C, Zeiller S, Awasthi D. Far lateral transcondylar approach: dimensional anatomy.  Neurosurgery . 1999;  45 95-100
• 12 McCormick P C. Surgical management of dumbbell tumors of the cervical spine.  Neurosurgery . 1996;  38 294-300