Far lateral approach: Is condylar resection required?

Background: We report our experience with the far lateral approach (FLA) and its modifications in the surgical resection of tumors of craniocervical junction (CCJ).

Materials And Methodology: We retrospectively reviewed data of 36 patients with CCJ lesions who underwent surgical excision. Data are presented as frequency/percentages. Tumor locations were classified by anatomical relation around the CCJ (on axial plane). For anterior and laterally placed tumors, we preferred the FLA and its modification. A postoperative complication was defined as a new neurological deficit without subsequent recovery. The perioperative mortality was defined as death within 30 days of surgery.

Results: The mean age of the study population was 48.8 years (5-64 years) with 15 women. Simpson's Scale Grade 2 resection was achieved in 18 out of 19 patients with meningiomas. Overall, transient complications were observed in eight patients (22%); none of the patients developed postoperative cerebrospinal fluid fistula. The permanent morbidity rate was 5.6%. One patient died on the 6th postoperative day. The mean follow-up period was 4.1 years (range, 3 months-12 years). Tumor recurrence was observed in two patients who were advised radiotherapy. Twenty patients (96%) were independent for activities of daily living.

Conclusion: The FLA is a versatile approach and is useful for a variety of lesions located ventrolateral to the brainstem and upper cervical cord. It allows adequate exposure with minimal retraction. Most of the foramen magnum meningiomas can be excised either without or with only partial resection of the condyle. The transjugular process approach to the jugular foramen (JF) is effective for JF tumors without the necessity of facial nerve transposition.