Article
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
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Authors
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G. Lütjens
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover
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C. Bärlocher
- Klinik Stephanshorn, Klinik für Neurochirurgie, St. Gallen
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J. K. Krauss
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover
| Published: | May 30, 2008 |
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Outline
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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.
