Far lateral approach for intradural tumors at the craniocervical junction

ABSTRACT

Ventrally placed tumors at the cranio-cervical junctions is a challenging neurosurgical task. The most important factor that influences the surgical outcome in foramen magnum lesions is comprehensive and three-dimensional understanding of the specific anatomy of the region. This study describes in details the far lateral approach for intradural tumors in the craniocervical region, with special emphasis on the management of the vertebral artery and on the anatomic variations encountered in this region. Patients The study included 28 patients with different tumor pathologies in the lateral foramen magnum. All were operated using the far lateral approach to access the lateral angle of the foramen magnum after mobilizing the vertebral artery. The study included 15 cases of ventrally placed meningiomas at the foramen magnum, 7 patients with intra-axial brainstem gliomas, and 6 patients with lower cranial nerve schwanoma. Total excision was achieved in 15 patients, whereas subtotal resection was achieved in thirteen cases. The study included three cases of CSF leakage; one of which needed a secondary dural repair with contimous lumbar drainage. One patient suffered intradural vertebral artery injury in a recurrent meningioma which led to serious morbidity postoperative. Far lateral approach can provide a good working angle to the anterior of the brainstem without extra drilling of the occipital condyle, the aim of surgery at the foramen magnum should be directed at brainstem decompression rather than unsafe total excision of the tumor