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The Far Lateral Approach to the Craniovertebral Junction: An Update

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New Trends in Craniovertebral Junction Surgery

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 125))

Abstract

Introduction: Since 1972, when Hammon first described the far lateral approach (FLA) for treatment of vertebral artery aneurysms, it has undergone numerous modifications, including drilling of the occipital condyle, removal of the laminas of upper cervical vertebrae and so on. Also, the range of indications has increased exponentially.

Objective: In this paper we discuss state-of-the-art advances in the FLA, such as promising minimally invasive variants where an endoscope is used, and many others.

Methods: We reviewed all articles touching upon the FLA in the modern era (from the year 2000 onward) and selected those that presented a significant contribution to the development of the relevant approach. The database used was PubMed.

Results and Conclusion: We found several new caveats not mentioned in other reviews or book chapters. The FLA is an ever-changing field of battle where the common and ultimate goals are to minimize the risk of injuring the major vessel in the region—the vertebral artery—and to provide such an angle of attack upon the tumours in the anterior and anterolateral foramen magnum that it is feasible to ensure gross total resection. This paper is an update on the knowledge about this approach, which we feel is necessary.

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References

  1. Babu RP, Sekhar LN, Wright DC. Extreme lateral transcondylar approach: technical improvements and lessons learned. J Neurosurg. 1994;81(1):49–59.

    Article  CAS  PubMed  Google Scholar 

  2. Hammon WM, Kempe LG. The posterior fossa approach to aneurysms of the vertebral and basilar arteries. J Neurosurg. 1972;37(3):339–47.

    Article  CAS  PubMed  Google Scholar 

  3. Heros RC. Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg. 1986;64(4):559–62.

    Article  CAS  PubMed  Google Scholar 

  4. Bian LG, Sun QF, Tirakotai W, Zhao WG, Bertalanffy H, Shen JK. Surgical management of PICA aneurysm and incidental facial nerve schwannoma: case report. Skull Base. 2007;17(2):145–50.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Flores BC, Boudreaux BP, Klinger DR, Mickey BE, Barnett SL. The far-lateral approach for foramen magnum meningiomas. Neurosurg Focus. 2013;35(6):E12.

    Article  PubMed  Google Scholar 

  6. Krishnan P, Behari S, Banerji D, Mehrotra N, Chhabra DK, Jain VK. Surgical approach to C1–C2 nerve sheath tumors. Neurol India. 2004;52(3):319–24.

    PubMed  Google Scholar 

  7. Liu JK, Couldwell WT. Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction. Report of two cases. Neurosurg Focus. 2005;19(2):E9.

    PubMed  Google Scholar 

  8. van Overbeeke JJ, Cornips E. General principles of cranial base surgery. In: Sekhar LN, Fessler RG, editors. Atlas of neurosurgical techniques—brain. 2nd ed. New York: Thieme; 2015. p. 199–208.

    Google Scholar 

  9. Tirakotai W, Benes L, Kappus C, Sure U, Farhoud A, Bien S, Bertalanffy H. Surgical management of dural arteriovenous fistulas with transosseous arterial feeders involving the jugular bulb. Neurosurg Rev. 2007;30(1):40–8.

    Article  CAS  PubMed  Google Scholar 

  10. Ueda R, Yoshida K, Kawase T. Intradural C-1 ventral root schwannomas treated by surgical resection via the lateral suboccipital transcondylar approach—three case reports. Neurol Med Chir (Tokyo). 2006;46(6):298–301.

    Article  Google Scholar 

  11. Kawashima M, Tanriover N, Rhoton AL, et al. Comparison of the far lateral and extreme lateral variants of the atlanto-occipital transarticular approach to anterior extradural lesions of the craniovertebral junction. Neurosurgery. 2003;53(3):662–75.

    Article  PubMed  Google Scholar 

  12. Russo VM, Graziano F, Quiroga M, Russo A, Albanese E, Ulm AJ. Minimally invasive supracondylar transtubercular (MIST) approach to the lower clivus. World Neurosurg. 2012;77(5–6):704–12.

    Article  PubMed  Google Scholar 

  13. Wanibuchi M, Fukushima T, Zenga F, Friedman AH. Simple identification of the third segment of the extracranial vertebral artery by extreme lateral inferior transcondylar–transtubercular exposure (ELITE). Acta Neurochir. 2009;151(11):1499–503.

    Article  PubMed  Google Scholar 

  14. Bambakidis N, Megerian C, Spetzler R. The far-lateral approach and its variations. In: Bambakidis NC, Dickman CA, Spetzler RF, Sonntag VKH, editors. Surgery of the craniovertebral junction. New York: Thieme; 2012. p. 350–61.

    Google Scholar 

  15. Wu B, Chen L-Y, Huang G-F, Liu W-D. Disposal of occipital condyle in far lateral approach for ventrolateral foramen magnum meningiomas. World Neurosurg. 2016;93:29–37.

    Article  PubMed  Google Scholar 

  16. Chaddad Neto F, Doria-Netto HL, de Campos Filho JM, Reghin Neto M, Rothon AL Jr, de Oliveira E. The far-lateral craniotomy: tips and tricks. Arq Neuropsiquiatr. 2014;72(9):699–705.

    Article  PubMed  Google Scholar 

  17. Nanda A, Vincent DA, Vannemreddy PS, Baskaya MK, Chanda A. Far-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle. J Neurosurg. 2002;96(2):302–9.

    Article  PubMed  Google Scholar 

  18. Matsushima T, Kawashima M, Masuoka J, Mineta T, Inoue T. Transcondylar fossa (supracondylar transjugular tubercle) approach: anatomic basis for the approach, surgical procedures, and surgical experience. Skull Base. 2010;20(2):83–91.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sughrue M, Parsa A. Far-lateral suboccipital approach. In: Jandial R, McCormick P, Black P, editors. Core techniques in operative neurosurgery. Philadelphia: Saunders; 2011. p. 104–10.

    Chapter  Google Scholar 

  20. Bruneau M, George B. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature. Neurosurg Rev. 2008;31(1):19–33.

    Article  PubMed  Google Scholar 

  21. Gordon D, Sen C. Far lateral approach. Fundam Oper Tech Neurosurg; 2011.

    Google Scholar 

  22. Avci E, Kocaogullar Y, Fosseti D. Vertebral artery landmarks for the far-lateral transcondylar approach: an anatomical study. Turk Neurosurg. 2000;10:112–7.

    Google Scholar 

  23. Spektor S, Anderson GJ, McMenomey SO, Horgan MA, Kellogg JX, Delashaw JB. Quantitative description of the far-lateral transcondylar transtubercular approach to the foramen magnum and clivus. J Neurosurg. 2000;92(5):824–31.

    Article  CAS  PubMed  Google Scholar 

  24. Benet A, Prevedello DM, Carrau RL, Rincon-Torroella J, Fernandez-Miranda JC, Prats-Galino A, Kassam AB. Comparative analysis of the transcranial “far lateral” and endoscopic endonasal “far medial” approaches: surgical anatomy and clinical illustration. World Neurosurg. 2014;81(2):385–96.

    Article  PubMed  Google Scholar 

  25. Park HH, Lee K-S, Hong C-K. Vertebral artery transposition via an extreme-lateral approach for anterior foramen magnum meningioma or craniocervical junction tumors. World Neurosurg. 2016;88:154–65.

    Article  PubMed  Google Scholar 

  26. Moscovici S, Umansky F, Spektor S. “Lazy” far-lateral approach to the anterior foramen magnum and lower clivus. Neurosurg Focus. 2015;38(4):E14.

    Article  PubMed  Google Scholar 

  27. Landi A, Dugoni DE, Delfini R. Postero-lateral approach to the cranio-vertebral junction: how, when and why. J Spine. 2016;5:303. https://doi.org/10.4172/2165-7939.1000303.

    Article  Google Scholar 

  28. Margalit NS, Lesser JB, Singer M, Sen C. Lateral approach to anterolateral tumors at the foramen magnum: factors determining surgical procedure. Neurosurgery. 2005;56(4 Suppl):324–36.

    PubMed  Google Scholar 

  29. Sen C, Shrivastava R, Anwar S, Triana A. Lateral transcondylar approach for tumors at the anterior aspect of the craniovertebral junction. Neurosurgery. 2010;66(Supplement):A104–12.

    Article  Google Scholar 

  30. Wanebo JE, Chicoine MR. Quantitative analysis of the transcondylar approach to the foramen magnum. Neurosurgery. 2001;49(4):934–43.

    CAS  PubMed  Google Scholar 

  31. Avci E, Dagtekin A, Hakan Ozturk A, et al. Anatomical variations of the foramen magnum, occipital condyle and jugular tubercle. Turk Neurosurg. 2011;21(2):181–90.

    PubMed  Google Scholar 

  32. Naderi S, Korman E, Çitak G, Güvençer M, Arman C, Şenoǧlu M, Tetik S, Arda MN. Morphometric analysis of human occipital condyle. Clin Neurol Neurosurg. 2005;107(3):191–9.

    Article  PubMed  Google Scholar 

  33. Lanzino G, Paolini S, Spetzler RF. Far-lateral approach to the craniocervical junction. Neurosurgery. 2005;57(4 Suppl):367–71.

    PubMed  Google Scholar 

  34. Wu A, Zabramski JM, Jittapiromsak P, Wallace RC, Spetzler RF, Preul MC. Quantitative analysis of variants of the far-lateral approach. Oper Neurosurg. 2010;66(6 Suppl):191–8.

    Article  Google Scholar 

  35. Kshettry VR, Healy AT, Colbrunn R, Beckler DT, Benzel EC, Recinos PF. Biomechanical evaluation of the craniovertebral junction after unilateral joint-sparing condylectomy: implications for the far lateral approach revisited. J Neurosurg. 2016;127:1–8.

    Google Scholar 

  36. Shiban E, Török E, Wostrack M, Meyer B, Lehmberg J. The far-lateral approach: destruction of the condyle does not necessarily result in clinically evident craniovertebral junction instability. J Neurosurg. 2016;125(July):196–201.

    Article  PubMed  Google Scholar 

  37. Cardoso AC, Fontes RBV, Tan LA, Rhoton AL, Roh SW, Fessler RG. Biomechanical effects of the transcondylar approach on the craniovertebral junction. Clin Anat. 2015;28(5):683–9.

    Article  PubMed  Google Scholar 

  38. Mei-hua L, Geng-sheng X, Zhi-qun J, Yi-yun L, Tao H. Supracondylar transjugular tubercle approach to intradural lesions anterior or anterolateral to the craniocervical junction without resection of the occipital condyle. Turk Neurosurg. 2013;23(2):202–7.

    PubMed  Google Scholar 

  39. Guan MW, Wang JY, Feng DX, et al. Anatomical study of endoscope-assisted far lateral keyhole approach to the ventral craniocervical region with neuronavigational guidance. Chin Med J. 2013;126(9):1707–13.

    PubMed  Google Scholar 

  40. Komotar RJ, Zacharia BE, McGovern RA, Sisti MB, Bruce JN, D’Ambrosio AL. Approaches to anterior and anterolateral foramen magnum lesions: a critical review. J Craniovertebr Junction Spine. 2010;1(2):86–99.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Crowley W, Dumont A, McKisic S, Jane J. Positioning for cranial surgery. In: Winn H, Winn H, editors. Youmans neurological surgery. 6th ed. Philadelphia: Saunders; 2011. p. 442–6.

    Chapter  Google Scholar 

  42. Huang J, Dai M, Cheng C, Wu D, Jiang C, Zhou Z, Shao J. Far-lateral approach assisted by multimodal neuronavigation and electrophysiological monitoring technique for complex clival tumor. Br J Neurosurg. 2015;29(4):597–9.

    Article  PubMed  Google Scholar 

  43. Calzada G, Isaacson B, Yoshor D, Oghalai J. Surgical approaches to the hypoglossal canal. Skull Base. 2007;17(3):187–96.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Katsuta T, Matsushima T, Wen HT, Rhoton AL. Trajectory of the hypoglossal nerve in the hypoglossal canal: significance for the transcondylar approach. Neurol Med Chir (Tokyo). 2000;40(4):206–10.

    Article  CAS  Google Scholar 

  45. Liu JK, Rao G, Schmidt MH, Couldwell WT. Far lateral transcondylar transtubercular approach to lesions of the ventral foramen magnum and craniovertebral junction. Contemp Neurosurg. 2007;29(10):1–8.

    Article  Google Scholar 

  46. Menezes AH. Surgical approaches: postoperative care and complications “posterolateral–far lateral transcondylar approach to the ventral foramen magnum and upper cervical spinal canal”. Childs Nerv Syst. 2008;24(10):1203–7.

    Article  PubMed  Google Scholar 

  47. Patel AJ, Gressot LV, Cherian J, Desai SK, Jea A. Far lateral paracondylar versus transcondylar approach in the pediatric age group: CT morphometric analysis. J Clin Neurosci. 2014;21(12):2194–200.

    Article  PubMed  Google Scholar 

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Alshafai, N.S., Klepinowski, T. (2019). The Far Lateral Approach to the Craniovertebral Junction: An Update. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_23

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  • DOI: https://doi.org/10.1007/978-3-319-62515-7_23

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  • Online ISBN: 978-3-319-62515-7

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