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KMID : 0942820090080020170
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Journal of Korean Brain Tumor Society
2009 Volume.8 No. 2 p.170 ~ p.175
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The Far Lateral Transcondylar Approach to the Anterior Foramen Magnum and Clinical Analysis of 22 Consecutive Patients
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Moon Ju-Hyung
Hong Chang-Ki
Kim Chang-Hyun
Ahn Jung-Yong
Chang Jong-Hee
Lee Kyu-Sung
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Abstract
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Objective: Because diseases that are situated anterior to the foramen magnum, lower clivus, and the upper cervical spinal canal permit only limited access, they are considered some of the most difficult intracranial lesions to surgically treat. The far-lateral transcondylar approach provides such a route. The author has reviewed the technique as well as the surgical results here.
Methods: During a 6-year period 22 patients underwent surgery in which far-lateral approach were performed. This approach to the craniocervical junction was utilized in patients with aneurysm, schwannoma, meningioma, and chordoma affecting the cervicomedullary junction. Medical records, including imaging studies, descriptions of microsurgical findings, photographs, and video records of operative procedures, were reviewed. Mean follow up period was 4.4 years.
Results: Total tumor resection was achieved in 16 patients, and a subtotal resection of the tumor was performed in the other 4 patients. In the 2 patients with vertebral artery-posterior inferior cerebellar artery(PICA) aneurysms, 1 underwent clipping, the other underwent trapping and occipital artery-PICA bypass procedure. Postoperative complications included CSF leak in 4 and temporary low cranial nerve dysfunction in 4. There was no significant postoperative complication in the remainder of the patients, and their conditions improved after surgery.
Conclusion: Successful surgical management of anterior foramen magnum lesion depends on precise understanding of their unique microsurgical anatomy, avoidance of pitfalls, and the surgeon’s experience. Sufficient exposure, minimal brain retraction, and preservation of the lower cranial nerves are necessary for a safe surgery.
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KEYWORD
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Far-lateral approach, Anterior foramen magnum, Craniocervical junction
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