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Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 59--60

Far lateral approach to anterior foramen magnum meningiomas – When should condyle be drilled?

Laligam Sekhar, Qazi Zeeshan 
 Department of Neurosurgery, University of Washington, Seattle, Washington, USA

Correspondence Address:
Dr. Laligam Sekhar
Department of Neurosurgery, University of Washington, Seattle, Washington

How to cite this article:
Sekhar L, Zeeshan Q. Far lateral approach to anterior foramen magnum meningiomas – When should condyle be drilled?.Neurol India 2019;67:59-60

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Sekhar L, Zeeshan Q. Far lateral approach to anterior foramen magnum meningiomas – When should condyle be drilled?. Neurol India [serial online] 2019 [cited 2022 Jun 28 ];67:59-60
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In this issue, Srinivas et al., have presented a nice series of anterior and antero-lateral foramen magnum meningiomas operated using a far lateral approach, with tailored occipital condylectomy.[1] Since the publication of our original article on the extreme lateral transcondylar approach, this approach has undergone a number of modifications and critiques.[2],[3],[4],[5],[6] We would like to emphasize some key points as it is practiced currently.

A “complete transcondylar approach” (resection of the occipital condyle and the lateral mass of the atlas [C1]) with full mobilization of the terminal V2 and the V3 segment of the vertebral artery (VA; from the C2 foramen to the dural entrance point of the artery) is only used for chordomas involving the foramen magnum area, which also extend laterally.[5] In such cases, some type of fusion procedure, including the possible placement of a bone graft between C2-occiput and instrumentation is needed [7]In patients with foramen magnum meningiomas, a complete transcondylar approach is never needed. No resection, or a partial resection up to ½ of the bone structures is performed as needed. When a tumor is more anterior and fibrous and the vertebral arteries (one or both) are in close proximity to the tumor, some condylar resection is very helpful.[5],[8] A fusion procedure is almost never needed in such patientsThe exposure and mobilization of the ipsilateral VA is very helpful when the tumor is more anteriorly located and the intradural VA (s) are encased. Both proximal control, possibility of repair in the event of injury, and increased exposure due to the posterior mobilization of the artery are the advantages of this approach [5],[9]Whenever possible, we try to get a Simpson Grade 1 resection (with the involved dura mater). The only exceptions are when the lower cranial nerves are involved by the tumor (in which case, tumor pieces may be left behind and treated by radiosurgery) or if the tumor is invading the brain stem.[3],[10] It should be noted that recurrent tumors of this area are very difficult to remove by surgery and are also amenable to undergo radiosurgery.[11],[12]


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