Background: The far-lateral approach, frequently employed by skull base surgeons, targets lesions in the ventrolateral region of the craniovertebral junction (CVJ). Although various incisions can be utilized, the linear incision is notably less invasive and more efficient. Despite its advantages, the literature lacks a comprehensive description of the technical steps involved in this approach.
Methods: We discuss the pertinent surgical anatomy and provide a step-by-step intraoperative description of performing the linear incision far-lateral approach, accompanied by clear intraoperative photographs.
Conclusion: The linear incision for the far-lateral approach reduces the extent of soft tissue dissection while having a negligible impact on surgical exposure. Key factors for ensuring the procedure safe and effective include: (1) a comprehensive understanding of the surgical anatomy in the suboccipital region and accurate identification of the midline from this specific position and incision; and (2) employing the "interfascial-subperiosteal-interdural dissection" technique to manage the soft tissues around the CVJ, thereby minimizing the risk of vertebral artery injury.
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http://dx.doi.org/10.1007/s00701-024-06386-3 | DOI Listing |
We present a novel technique to approach far lateral lumbar pathologies using a bitubular, biportal endoscopic system and a paramedian approach. Background: Conventional approaches for lumbar far lateral discectomy range from open approaches to newer minimally invasive approaches such as tubular discectomy and single portal endoscopic discectomy. We present a case of a patient suffering with a left L3-4 and left L4-5 extraforaminal disc herniation who was treated successfully with a left sided bitubular, biportal endoscopic 2 level far lateral discectomy.
View Article and Find Full Text PDFWorld Neurosurg
December 2024
Department of Neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fu Jian, China. Electronic address:
Objective: This study aims to elucidate the anatomical principles governing the surrounding venous structures (VS) of the horizontal part of the third segment of the vertebral artery (V3h) and develop a safe and bloodless surgical technique for exposing V3h.
Methods: This study used ten formalin-infused cadaveric head specimens. The dissections were performed stepwise to simulate the far lateral approach process, exposing the V3h with a novel technique.
J Neurosurg Pediatr
December 2024
1Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston.
Objective: Tumors in the ventral craniocervical junction (CCJ) pose unique challenges, particularly in children. The potential constraints with endoscopic approaches to tumors extending inferiorly and laterally and the risk of CSF leakage can be exacerbated in the pediatric population. Here, the authors present their experience with the extreme lateral transodontoid (ELTO) approach in children with large ventral CCJ tumors as an alternative or complement to anterior approaches.
View Article and Find Full Text PDFNeurol India
November 2024
Department of Neurosurgery, Kauvery Institute of Brain and Spine, Kauvery Hospital, Chennai, Tamil Nadu, India.
Background: Schwannomas of C1 are rare tumors. Because of the wide variation in their anatomy, and presentation and their rarity, there is no proper understanding of their pathological anatomy nor their optimal management.
Methods: A retrospective study of the C1 schwannomas operated by the author between 2000 and 2020 and a PubMed-based search of English literature were done to analyze data on the location and extent of the lesions, surgical approaches used, and operative outcomes.
J Clin Med
December 2024
Department of Neurosurgery "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania.
: Superior cerebellar artery (SCA) aneurysms are exceedingly rare, posing unique diagnostic and management challenges due to their complex anatomical location within the posterior circulation. The proximity of the SCA to vital structures, such as the brainstem and cerebellum, along with the significant role of poorly controlled hypertension in aneurysm formation, further complicates treatment. This case aims to highlight the surgical approach and management strategies employed in treating a rare SCA aneurysm in a patient with longstanding hypertension.
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