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CC BY-NC-ND 4.0 · Asian J Neurosurg 2018; 13(03): 651-655
DOI: 10.4103/ajns.AJNS_273_16
Original Article

Far-lateral transcondylar approach to anterior foramen magnum lesions - Our experience

S Pai
Department of Neurosurgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka
,
G Raghuram
1   Department of Neurosurgery, Columbia Asia Referral Hospital, Bengaluru, Karnataka
,
G Keshav
Department of Neurosurgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka
,
Elvis Rodrigues
Department of Neurosurgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka
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Background: Initial surgical management of the anterior foramen magnum lesions through the posterior approaches was fraught with unacceptable morbidity, mortality, and incomplete removal. The far-lateral approach provides excellent exposure and access to these lesions resulting in complete excision of these lesions with reduced frequency of unwanted complications. Materials and Methods: Eight patients with lesions anterior to the brainstem and upper cervical cord were surgically treated using the far-lateral transcondylar approach. Two of these patients had a meningioma while three patients had “white epidermoid.” One patient had a vertebral artery (VA) aneurysm while another was a rare case of lower brainstem compression by the VA and the last was a clival chordoma. The technical aspects of this surgical procedure are briefly illustrated in this article. Results: Total excision was achieved in five neoplastic cases while subtotal excision was done in one case. The VA aneurysm was satisfactorily clipped while in the brainstem compression patient, microvascular decompression was done. The VA aneurysm patient developed postoperative lower cranial nerve palsies. There were no fresh postoperative deficits in any of the other patients. One patient had an unexplained sudden cardiorespiratory arrest 18 h after the surgery and succumbed. One patient had cerebrospinal fluid (CSF) otorrhea which was satisfactorily managed by intrathecal CSF drainage. Conclusion: The far-lateral transcondylar approach provides excellent approach to lesions located anterior to the brainstem and upper cervical cord. Total excision of these benign lesions is safely possible through this approach.

Key-words:

Craniovertebral junction - far-lateral transcondylar approach - foramen magnum - ventral brain stem - white epidermoid


Publication History

Article published online:
14 September 2022

© 2018. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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