Far-lateral trans-atlas extradural resection of retro-odontoid synovial cyst: Surgical technique and review of literature

Abstract

Abstract Background and importance Synovial cysts of the cranio-cervical junction constitute an uncommon pathology in neurosurgical practice. Different surgical approaches have been described for treating those lesions including trans-oral microsurgical approaches, endoscopic endo-nasal approaches and sub-occipital trans-dural approaches. Objective The purpose of this article is to describe a case of resection of a retro-odontoid synovial cyst through a modified far-lateral trans-atlas extradural approach. A detailed surgical plan with cadaveric dissection is presented as well as literature review of surgical approaches. Methods The authors describe an 86-year-old man presenting with gradual deterioration of his gait as well as upper and lower extremities weakness. He was found to have an odontoid pannus accompanied by midline retro-odontoid cyst on MRI. An anatomical cadaveric dissection describing the modified far-lateral trans-atlas extradural approach is described and then used to completely resect the cystic lesion, decompress the brain stem and perform a fusion of the cranio-cervical junction. Result This surgical technique allows for the decompression and fusion to be performed in the same operative time, avoids the contaminated surgical fields encountered during anterior approaches and prevents CSF leakage by avoiding dura opening. Conclusion Modified Far-Lateral Transatlas Approach offers several advantages when compared with the other options and can provide an alternative to treat these patients.