Technical Description of the Mini Far-Lateral Approach: A Refined, Stability-Preserving Corridor to the Petroclival...

The far-lateral approach remains essential for accessing ventral and ventrolateral lesions of the craniovertebral junction. However, traditional exposures may involve extensive condylar drilling and muscle dissection, which can compromise craniocervical junction stability. This study aimed to define and quantitatively evaluate a stability-preserving mini far-lateral corridor that provides adequate surgical exposure while minimizing bony and soft-tissue disruption.

A systematic literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines to characterize technical advancements of the far-lateral approach. Additional cadaveric dissections were performed on 6 fresh-frozen adult specimens using a Z-shaped incision, single-plane craniocaudal muscle dissection, limited suboccipital craniectomy, and one-third occipital condyle drilling. Neuronavigation-based morphometric measurements were used to quantify petroclival exposure. A comparative statistical analysis was conducted against the classical (Spektor, 2000) and minimally invasive (Zhang, 2011) series.

The mean petroclival exposure area was 376.86 ± 45.54 mm2, larger than the values reported by Spektor et al (338.00 ± 86.00 mm2; t(17) = 7.22; P = 1.49 × 10-6) and Zhang et al (208.50 ± 28.40 mm2; t(16) = 20.31; P = 7.61 × 10-13). The approach offered a direct posterolateral trajectory to the bulbomedullary junction and lower cranial nerves while maintaining occipitocervical integrity.

The mini far-lateral approach provides comparable petroclival exposure, compared with both the classical and keyhole variants, by combining surgical effectiveness with the preservation of stability. These results support its adoption as the standard method for ventral and ventrolateral craniovertebral lesions, with wider condylectomy or fusion reserved for specific trajectory-driven indications.