CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2021; 82(S 01): S37-S38
DOI: 10.1055/s-0040-1701689
Skull Base: Operative Videos

Far Lateral Approach for Resection of Transverse Ligament Cyst

Lattimore Madison Michael II
1   Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
,
1   Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
,
Jaafar Basma
1   Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
,
William Mangham
1   Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
,
Nickalus Khan
1   Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
,
Jeffrey Sorenson
1   Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
› Author Affiliations
 

Abstract

Objectives This study was aimed to describe a far lateral approach for microsurgical resection of a transverse ligament cyst, with emphasis on the microsurgical anatomy and technique.

Design A far lateral craniotomy is performed in the lateral decubitus position. After opening the dura laterally, dural sutures are placed for retraction. A stitch placed through the dentate ligament is advantageous to rotate the spinal cord to allow access to the ventral cyst. The cyst is marsupirlized and mass effect on the spinal cord is relieved. Photographs of the region are borrowed from Dr Rhoton's laboratory to illustrate the microsurgical anatomy.

Participants The first author performed the surgery and edited the video. Chart review and literature review were performed by the other authors.

Outcome Measures Outcome was assessed with postoperative neurological function.

Results The patient was discharged home after an uneventful hospital course. At short-term follow-up, the patient had a significant improvement in postoperative strength.

Conclusion The far lateral approach provides an adequate corridor to the ventrolateral brainstem in combination with utilization of the dentate ligament to reach ventral cysts compressing the spinal cord. An adequate understanding of the relevant microsurgical anatomy is a key to safe surgery in this region.

The link to the video can be found at: https://youtu.be/5MGVPO2Q2pI.


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Zoom Image
Fig. 1 These images show a ventral C2 synovial cyst with significant spinal cord compression in the setting of ankylosing spondylitis.
Zoom Image
Fig. 2 A far lateral approach provides an optimal corridor to the ventrolateral craniocervical junction for resection of this large cyst.

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Quality:

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Conflict of Interest

None declared.

Address for correspondence

Lattimore Madison Michael II, MD
Department of Neurosurgery, University of Tennessee
847 Monroe Avenue, Suite 427, Memphis, TN 38163
United States   

Publication History

Received: 02 April 2019

Accepted: 29 September 2019

Article published online:
13 March 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Zoom Image
Fig. 1 These images show a ventral C2 synovial cyst with significant spinal cord compression in the setting of ankylosing spondylitis.
Zoom Image
Fig. 2 A far lateral approach provides an optimal corridor to the ventrolateral craniocervical junction for resection of this large cyst.