gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

A modified “far-lateral” approach for safe resection of retroodontoid dural cysts

Ein modifizierter “far-lateral” approach zur sicheren operativen Entfernung retroodontoid gelegener duraler Zysten

Meeting Abstract

Search Medline for

  • corresponding author G. Lütjens - Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover
  • C. Bärlocher - Klinik Stephanshorn, Klinik für Neurochirurgie, St. Gallen
  • J. K. Krauss - Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 084

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Lütjens et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Cystic mass lesions of the ventral craniocervical junction are rare lesions that may cause cervical myelopathy. There is controversy on their optimal treatment and a variety of different surgical approaches were used in the past. We introduce a modified “far-lateral” approach for save treatment and to prevent postoperative instability.

Methods: The modified “far-lateral” approach consists of a C1 hemilaminectomy combined with drilling of the most medial aspect of the right condyle to approach the ventral extraaxial cystic lesion.

Results: The modified “far-lateral” approach was used in a 74-year-old woman complaining about dizziness, cervico-occipital pain and paresthesias in both arms. The neurological examination revealed slight loss of strength of the right side. MR imaging showed an 8x9x8 mm extraaxial cystic lesion at C0/C1 ventral to the spinal cord. The lesion was approached without any compromise of the upper spinal cord and other neural and vascular structures and was resected at ease. The postoperative course was uneventful. One year postoperatively, MR imaging was unremarkable. The neurological examination was normal. There was no instability.

Conclusions: The modified “far-lateral” approach for treatment of retroodontoid cysts offers several advantages compared to other options. It is less invasive than the transoral approach, while it does not result in postoperative instability which is the case in more extensive dorsolateral approaches. It offers optimal control of neurovascular structures. With regard to the aging population in Western countries retroodontoid cysts should be expected to be more frequent in the future and they should be included in the differential diagnosis of the upper cervical myelopathy. They can be removed safely by a limited approach.