Endoscope-assisted anterolateral approach to a recurrent cervical spinal chordoma



The anterolateral approach (ALA) enables to access the craniovertebral junction (CVJ), lower and middle clivus, jugular foramen, and cervical spine from a lateral perspective. It is particularly indicated when dealing with extradural bone tumors. Other rare indications are represented by spondylotic myeloradiculopathy and vascular diseases.


We describe here the steps to safely perform an anterolateral approach along with a brief description of its indications and limits.


ALA represents a valid option to treat cervical spine and CVJ bone tumors such as chordomas. Its knowledge can improve the process of approach selection when dealing with such complex cases.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6


  1. 1.

    Bruneau M, Cornelius JF, George B (2006) Antero-lateral approach to the V3 segment of the vertebral artery. Neurosurgery 58:29–35

  2. 2.

    Bruneau M, Cornelius JF, George B (2005) Anterolateral approach to the V2 segment of the vertebral artery. Neurosurgery 57:262–267

  3. 3.

    Chibbaro S, Mirone G, Bresson D, George B (2009) Cervical spine lateral approach for myeloradiculopathy: technique and pitfalls. Surg Neurol 72:318–324

  4. 4.

    Kratimenos GP, Crockard HA (1993) The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours. Br J Neurosurg 7:129–140

  5. 5.

    Rahme RJ, Arnaout OM, Sanusi OR, Kesavabhotla K, Chandler JP (2018) Endoscopic approach to clival chordomas: the northwestern experience. World Neurosurg 110:231–238

  6. 6.

    Salunke P, Karthigeyan M, Rekhapalli R, Gupta K (2019) Tailored posterior-only approach for C2 vertebral body lesions: our surgical experience in 10 patients. World Neurosurg 1878–8750

  7. 7.

    Tykocki T, Poniatowski ŁA, Czyz M, Wynne-Jones G (2018) Oblique corpectomy in the cervical spine. Spinal Cord 56:426–435

Download references

Author information

Correspondence to L. Giammattei.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Patient consent

The patient/next of kin/guardian has consented to the submission of this “How I do it” to the journal.

Additional information

Key points

• ALA is part of the neurosurgical armamentarium when dealing with complex lesions such as CVJ and cervical spine chordomas

• It is indicated especially for extradural tumors involving the anterolateral cervical spine and CVJ

• It represents a valid alternative to traditional posterolateral approaches and EEEA

• Strictly midline lesion above C2 (extra or intradural) can be approached also by EEEA

• Intradural lesions of the lower clivus/C2 are better addressed by a posterolateral approach

• Careful evaluation of preoperative anatomy, especially VA position, is mandatory

• The XIth should be early identified in order to be preserved, freed, and retracted within the surrounding fat tissue

• The sympathetic chain must be recognized and kept away from the surgical field

• Dissection of the VA should be done without violating the periosteal sheet to avoid copious bleeding

• The introduction of angled optics enables to increase safety in resection of the contralateral part of the tumor and extension into dark corners

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Tumor - Other

Electronic supplementary material

A short video presenting the endoscope-assisted resection of a recurrent chordoma of the cervical spine through anterolateral approach is added. (AVI 142669 kb)


A short video presenting the endoscope-assisted resection of a recurrent chordoma of the cervical spine through anterolateral approach is added. (AVI 142669 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Giammattei, L., di Russo, P., Penet, N. et al. Endoscope-assisted anterolateral approach to a recurrent cervical spinal chordoma. Acta Neurochir (2020) doi:10.1007/s00701-019-04194-8

Download citation


  • Anterolateral approach
  • Craniovertebral junction
  • Chordoma
  • Vertebral artery