Anterolateral approach to the craniocervical junction.

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Cervical Spine Surgery

Background:

• Lesions at the craniocervical junction (CCJ) pose surgical challenges due to complex anatomy.
• Anterolateral lesions require specialized approaches for safe and effective resection.
• The presternomastoid retrojugular route offers potential advantages for CCJ access.

Purpose of the Study:

• To evaluate the surgical outcomes of the anterolateral approach for CCJ lesions.
• To assess the efficacy and safety of this technique in resecting tumors with extradural components.

Main Methods:

• A presternomastoid retrojugular anterolateral approach was used in 14 patients.
• The technique involved exposing the vertebral artery (VA) at C-1 and extending the dissection as needed.
• Tumor resection completeness and complications were documented during follow-up (4 months to 6.2 years).

Main Results:

• Complete tumor resection was achieved in 11 patients; subtotal resection in two.
• A vein graft bypass for vertebral artery coiling remained patent for 2 years.
• Transient seventh cranial nerve deficits occurred in two patients with glomus tumors.

Conclusions:

• The anterolateral approach offers sufficient access to anterolateral CCJ lesions with significant extradural components.
• This technique provides excellent control of the vertebral artery, internal carotid artery, jugular complex, and lower cranial nerves.
• The approach is versatile, allowing combination with other techniques and extension to the jugular foramen or lower cervical spine.