Far Lateral Transcondylar Approach for Anterior Foramen Magnum Lesions

  • WAQAS MEHDI
  • AZAM NIAZ
  • MUHAMMAD IRFAN
  • SHAHZAIB TASDIQUE
  • SAMRA MAJEED

Abstract

Objective:  To study the efficacy and safety of far-lateral transcondylar approach for anterior foramen magnum lesions with early experience at our Institute.

Material and Methods:  We treated six patients, with lesion anterior to the foramen magnum and posterior to the brainstem and cervical cord in a period of 2 years, March 2017 to March 2018.Initial assessment was made by history and examination followed by CT scan and contrast MRI. All were treated using far-lateral transcondylar approach.

Result:  Among six patients, there were two were male and four were female. Three of these patients had a meningioma while two patients had neurofibromas and one clival chordoma. Total excision was achieved in five neoplastic cases, while subtotal excision was done in one case. There were no fresh postoperative deficits in any of the other patients. One patient had an unexplained sudden cardiorespiratory arrest 18h after the surgery and succumbed. One patient had cerebrospinal fluid (CSF) discharge from the wound, which was satisfactorily managed by lumber CSF drainage.

Conclusion:  This approach provides an excellent approach to lesions located anterior to foramen magnum posterior to the brainstem and upper cervical cord. Gross total excision of these benign and malignant lesions is safely possible through this approach.

Keywords:  Craniovertebral Junction, Far-Lateral Transcondylar Approach, Anterior Foramen Magnum, Brain Stem, Chordoma.

References

1. Babu RP, Sekhar LN, Wright DC. Extreme lateral transcondylar approach: technical improvements and lessons learned. Journal of Neurosurgery, 1994; 81 (1): 49-59.
2. Boulton MR, Cusimano MD. Foramen magnum meningiomas: concepts, classifications, and nuances. Neurosurgical Focus, 2003; 14 (6): 1-8.
3. Bragg TM, Duckworth EA. Contralateral far-lateral approach for clipping of a ruptured vertebral artery–posterior inferior cerebellar artery aneurysm. Neurosurgical Focus, 2008; 25 (6): E9.
4. Husain AKA-MO. M: Ventral foramen magnum meninigiomas. J Neurosurg. 2000; 92 (1): 71-80.
5. Kumar CR, Satyanarayana S, Rao BRM, Palur RS. Extreme lateral approach to ventral and ventrolaterally situated lesions of the lower brainstem and upper cervical cord. Skull Base, 2001; 11 (04): 265-76.
6. Lanzino G, Paolini S, Spetzler RF. Far-lateral approach to the craniocervical junction. Operative Neurosurgery, 2005; 57 (suppl_4): ONS-367-ONS-71.
7. Liu JK, Couldwell WT. Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction: report of two cases. Neurosurgical Focus, 2005; 19 (2): 1-7.
8. Liu JK, Rao G, Schmidt MH, Couldwell WT. Far lateral transcondylar transtubercular approach to lesions of the ventral foramen magnum and craniovertebral junction. Contemporary Neurosurgery, 2007; 29 (10): 1-7.
9. Rhoton Jr A. Far lateral and transcondylar approaches. Neurosurgery, 2007; 61 (S4): 211-28.
10. Sharma B, Gupta S, Khosla V, Mathuriya S, Khandelwal N, Pathak A, et al. Midline and far lateral approaches to foramen magnum lesions. Neurology India, 1999; 47 (4): 268.
11. Wen HT, Rhoton AL, Katsuta T, de Oliveira E. Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach. Journal of neurosurgery, 1997; 87 (4): 555-85.
Published
2020-07-14
Section
Original Article