gms | German Medical Science

Objective: The extensive approaches to the anterior and middle cranial base underwent to changes over the years thank to the deep-microsurgical and endoscopic key-hole techniques. The familiar with endoscopic and endoscope assisted techniques helped to improve the so-called work-corridors technique. The “far lateral” approach described by B. George is a milestone in the approaches to the foramen magnum region, but the development of this approach has gradually brought to consider redundant the vertebral artery transposition and the condyle drilling. The improvement of the experience and the use of deep microsurgery, in the majority of the cases lead to consider these steps time consuming and riskfull. The authors report their experience in the treatment of lesions of foramen magnum region with this “less invasive far-lateral approach” (LIFLA).

Methods: In the last two years 2 patients suffering from meningiomas involving anterior and antero-lateral parts of foramen magnum, 3 patients with vascular pathologies (i.e. 2 PICA aneurisms and 1 AVM) and 1 patient with ecchondrosis of the clivus have been operated on with the so-called “less-invasive-far lateral-approach”; it resulted to be enough to obtain a good working space.

Results: 3 patients with mass lesions received gross total removal; in one case was necessary a V-P shunt for hydrocephalus after three months. In all the cases the clinical and the imaging results were good. In the other three patients the vascular lesions were treated. Two cases had a good recovery, while one patient died for air embolism.

Conclusions: In the treatment of foramen magnum lesions the “far lateral” approach affords significant advantages. The extension of bone removal and vertebral artery manipulation may be reduced in some cases without limitation of operative space.