Lateral Approach to the Craniovertebral Junction

The removal of craniovertebral lesions localized in front of the spinal cord is demanding owing to its overlying anatomical structures. A transoral approach with removal of parts of the C1 and C2 vertebra may be accompanied with a postoperative instability and the need for further stabilization. A modified “far-lateral” approach with partial removal on lateral parts of the C1 and C2 lamina allows a very good exposure of the ventral and ventrolateral parts of the spinal canal without producing an instability. This retrospective study analyzes 9 patients with lesions in the ventral spinal canal and summarizes the advantages and complications of the lateral approach to the craniovertebral junction. Surgical resection was done in most of the cases for meningioma or neurinoma. In all cases the tumor was completely removed by this approach. No postoperative instability persisted. Major complications like paraplegia did not occur. One patient developed a partial atrophy of the trapezius muscle. One patient showed a transient palsy of the facialis nerve. This far-lateral approach offers the advantage of a direct visualization of the lateral and ventral aspect of the upper cervical spine without the need of an additional stabilization.