The far lateral approaches to the craniovertebral junction

Access to pathologies at the craniovertebral junction can be achieved with a number of approaches; all should avoid manipulation of the neural structures. In much the same way as an orbito-zygomatic approach is used to augment fronto-temporal access and reduce brain retraction and a trans-labyrinthine approach is chosen rather than a retrosigmoid approach to a vestibular schwannoma, so bone at the foramen magnum, including condyle, can be removed to improve access to structures ventral to the brainstem and the spinal cord. Large tumors may create a corridor of access allowing a more posterior approach to be employed. Smaller tumors and pathologies that do not distort the brain may, however, require more bone removal along with mobilization of the vascular structures, particularly the vertebral artery and occasionally the jugular tubercle. The far lateral approach with partial condylectomy and vertebral artery mobilization is described as the preferred access.