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Basilar decompression via a far lateral transcondylar approach: technical note.

Robert C Rennert1, Marcus L Stephens2, Angela W Palmer2

  • 1Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA.

Acta Neurochirurgica
|July 22, 2022
PubMed
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The far lateral transcondylar approach effectively treats basilar invagination (BI) by decompressing the brainstem. This technique, utilizing a retroauricular incision, showed 100% symptom improvement in patients with BI.

Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Spinal Surgery

Background:

  • Basilar invagination (BI) presents treatment challenges, with options including posterior decompression, distraction/fusion, and anterior decompression.
  • Occipitocervical fusion is often necessary depending on craniocervical instability.
  • The far lateral transcondylar approach for BI has been described in limited series but not widely adopted.

Purpose of the Study:

  • To evaluate the efficacy and safety of the far lateral transcondylar approach for odontoidectomy and inferior clivus resection in patients with basilar invagination.
  • To detail the surgical technique using a lateral retroauricular incision for this approach.

Main Methods:

  • Retrospective review of consecutive patients undergoing the far lateral transcondylar approach for BI.
Keywords:
Basilar invaginationFar lateralOdontoidectomyTranscondylar

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  • Surgical period: January 1, 2016, to December 31, 2021.
  • Technique illustrated with cadaveric dissections and intraoperative images.

    • Main Results:

    • Nine patients (3 male, 6 female; mean age 40.2 years) with congenital or acquired BI were included.
    • No major neurologic or wound-healing complications occurred.
    • All nine patients (100%) reported improvement in preoperative symptoms.

    Conclusions:

    • The far lateral transcondylar approach offers a direct corridor for ventral brainstem decompression in symptomatic BI.
    • A thorough understanding of craniovertebral junction anatomy is crucial for safe execution, particularly with a lateral retroauricular incision.