Posterolateral Routes to the Skull Base, Craniocervical Junction, and Jugular Foramen-The Far Lateral Transcondylar Approach and Combined Transpetrosal Transcervical Approaches.

Abstract

The far lateral approach provides wide surgical access to the lower third of the clivus, pontomedullary junction, and anterolateral foramen magnum and rarely requires craniovertebral fusion. The most common indications for this approach are posterior inferior cerebellar artery and vertebral arteryaneurysms, brainstem cavernous malformations, and tumors anterior to the lower pons and medulla, including meningiomas of the anterior foramen magnum, schwannomas of the lower cranial nerves, and intramedullary tumors at the craniocervical junction. We provide a stepwise description of how we perform the far lateral approach, as well as how to combine the far lateral approach with other skull base approaches, including the subtemporal transtentorial approach, for lesions involving the upper clivus; the posterior transpetrosal approach, for lesions involving the cerebellopontine angle and/or petroclival region; and/or lateral cervical approaches, for lesions involving the jugular foramen or carotid sheath regions.