Microsurgical Resection of Craniocervical Junction Meningioma via A Far-Lateral (Paracondylar) Approach

Craniocervical junction meningiomas compress the ventral medulla and may encase the vertebral artery, making resection challenging. This operative video demonstrates a far-lateral paracondylar approach with C1 laminectomy and dentate-ligament division for broad exposure and safe resection. A far-lateral paracondylar approach (<25% condyle drilling) was performed with C1 laminectomy and extradural mobilization of the V3 segment of the vertebral artery; intradural C1-C2 dentate-ligament division enabled controlled medialization of the spinal cord for circumferential contralateral dissection. Surgical exposure spanned the CN VII-VIII complex superiorly, the paravertebral V3-V4 corridor laterally, the lateral and dorsal aspects of C2 inferiorly, and an intradural corridor between the spinal cord and the ipsilateral vertebral artery extending toward the contralateral vertebral artery and hypoglossal nerve. Gross-total resection was achieved without occipitocervical stabilization, with preservation of the posterior inferior cerebellar artery (PICA), anterior spinal arteries, and lower cranial nerves; single-layer myocutaneous closure limited pseudomeningocele formation. This approach, combining minimal condylar drilling, C1 laminectomy, and dentate-ligament division, affords expansive exposure of foramen magnum meningiomas extending to C2, enabling maximal tumor resection while preserving critical neurovascular structures and maintaining craniocervical stability.