[Comparison of the far lateral approach, transcondylar fossa approach, and transcondylar approach using a...

The far lateral approach, transcondylar fossa approach, and transcondylar approach are widely accepted as basic suboccipital lateral skull base techniques to treat various pathologies located in the lateral to anterior regions of the cervico-medullary junction. Surgical simulations were performed to evaluate the differences between these techniques using a three-dimensional dissectable skull base model with an artificial vertebral artery. The far lateral approach provided space around the intradural vertebral artery at the level of the jugular foramen. The transcondylar fossa approach allowed better visualization of the vertebral artery at the level between the jugular foramen and the hypoglossal canal. The transcondylar approach did not offer significantly better visualization of the vertebral artery compared with the transcondylar fossa approach except at the level below the hypoglossal canal. However, the transcondylar approach offered more extensive removal of the jugular tubercle than the transcondylar fossa approach because the removed occipital condyle, including the atlanto-occipital joint provided space for introduction of a surgical drill into the anterior part of this bony protuberance. Evaluation using the dissectable skull base model clearly demonstrated the differences in the surgical exposures of the intradural vertebral artery provided by these skull base approaches.