Minimally Invasive Far Lateral Approach to the Ventrolateral Skull Base: A Single-Center Experience

The far lateral craniotomy is a foundational approach for ventrolateral skull base lesions. We present our experience with a minimally invasive curvilinear retroauricular incision as a variation to the traditional midline "hockey-stick" incision for far lateral craniotomies.

In this retrospective cohort study, we identified patients who underwent a far lateral craniotomy through a curvilinear retroauricular approach at our quaternary referral hospital between January 2012 and January 2025. The primary outcome measures were complications, postoperative deficits, and recurrences.

Fifty-four patients underwent 56 far lateral craniotomies (mean age 53.3 ± 15.4 years; 61.1% female). Indications included tumors (80.4%) and vascular lesions (19.6%). Common presenting symptoms included headache (53.6%), cranial nerve (CN) palsy (28.6% [primarily CN VIII 43.8%, CN X 31.3%, CN VI 31.3%]), ataxia (19.6%), weakness (10.7%), and sensory disturbance (8.9%). Gross total resection was achieved in 82.6% of tumor cases. Occipital condyle drilling (<50%), laminectomy, and vertebral artery mobilization were performed in 71.4%, 67.9%, and 32.1% of cases, respectively. Fat grafts and lumbar drains were used frequently (96.4% and 67.9%, respectively). Complications [including most commonly hematoma (7.1%) and sinus thrombosis (3.6%)] occurred in 16.1% of patients. The mean follow-up was 16.1 ± 22.5 months; 39 patients (81.3%) had resolved or improved symptoms, whereas 14.8% of patients experienced new postoperative deficits, including CN palsies (13%) and ataxia (1.9%).

The minimally invasive retroauricular curvilinear variation of the approach is a safe and effective alternative to the traditional opening for selected patients with ventrolateral skull base lesions not requiring destabilizing surgery, with favorable rates of gross total resection and a low rate of complications in this series.