A Minimal Access Far-Lateral Approach to Foramen Magnum Pathology

Introduction: The far-lateral transcondylar approach is widely used to treat pathology of the ventral foramen magnum. Numerous methods of exposure have been described, most of which use long skin incisions and myocutaneous flaps. Here we present our experience with gaining exposure through a small paramedian incision using a muscle-splitting technique.

Methods: We performed a retrospective chart review and identified 13 patients who had surgery using this approach. Data regarding pathology, imaging, and complications were collected.

Results: There were 10 patients with meningioma, 1 with brainstem glioblastoma, 1 with posterior inferior cerebellar artery (PICA) aneurysm, and 1 with odontoid pannus. The exposure was adequate in all cases. For the meningioma patients, six had gross total resections and four had subtotal resection because of tumor adherence to neurovascular structures. Two patients experienced postoperative cardiac complications. There were no cerebrospinal fluid leaks or wound complications.

Conclusions: A small paramedian incision may be used to gain exposure and perform successful far-lateral approaches. The small exposure is likely to reduce the risk of postoperative cerebrospinal fluid leak and pseudomeningocele formation compared with larger exposures.