ABSTRACT
Selecting the most appropriate surgical approach to the craniovertebral junction (CVJ)
is based on minimizing the associated morbidity and maximizing the operative exposure
in relation to the size, pathology, and specific location of the lesion. With the
evolving repertoire of modern neurosurgical techniques, direct access to the CVJ can
be attained along all 360 degrees of the occipital-spinal axis.
Anterior-superior approaches to the CVJ, which include the transoral approach, are
best suited for extradural, midline lesions of the clivus and upper cervical vertebrae. Anterior lesions that
have a paramedian location or extend inferiorly from the CVJ may be exposed by either
a retropharyngeal or mandibular swing approach. The lateral approaches to the CVJ
include the lateral transcervical, transpetrosal, and infratemporal fossa approaches.
These approaches are particularly well suited for ventrally situated intradural lesions. Finally, posterior approaches are preferred for midline posterior or posterolaterally
situated intradural lesions. The far lateral approach provides direct access to the
lower ventral brainstem and the anterior foramen magnum while minimizing the need
for retraction. The following article is a synopsis of the most common surgical approaches.
KEYWORDS
Craniovertebral junction - surgery - transoral - far lateral - suboccipital - complications
