J Neurol Surg B Skull Base 2023; 84(04): 413-420
DOI: 10.1055/s-0042-1755600
Original Article

A Contemporary Clinico-Anatomical Guide to Craniovertebral Junction Surgery

1   North Shore University Hospital, Manhasset, New York, United States
Basil Gruter
2   Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
Giyarpuram Prashant
3   Department of Neurosurgery, North Shore University Hospital, Manhasset, New York, United States
Joshua Haegler
4   Department of Neurosurgery, Kantonsspital Aarau AG, Aarau, Aargau, Switzerland
Mark Eisenberg
3   Department of Neurosurgery, North Shore University Hospital, Manhasset, New York, United States
Aaron A. Cohen-Gadol
5   Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, United States
Amir R. Dehdashti
1   North Shore University Hospital, Manhasset, New York, United States
› Institutsangaben


Background Surgical treatment of ventral and ventrolateral lesions of the craniocervical junction are among the most challenging neurosurgical pathologies to treat. Three surgical techniques, the far lateral approach (and its variations), the anterolateral approach, and the endoscopic far medial approach can be used to approach and resect lesions in this area.

Objective The aim of the study is to examine the surgical anatomy of three skull base approaches to the craniocervical junction and review surgical cases to better understand the indications and possible complications for each of these approaches.

Methods Cadaveric dissections with standard microsurgical and endoscopic instruments were performed for each of the three surgical approaches, and key steps and surgically relevant anatomy were documented. Six patients with appropriate pre-, post-, and intraoperative imaging and video documentation are presented and discussed accordingly.

Results Based on our institutional experience, all three approaches can be utilized to safely and effectively approach a wide variety of neoplastic and vascular pathology. Unique anatomical characteristics, lesion morphology and size, and tumor biology should all be considered when determining the optimal approach.

Conclusion Preoperative assessment of surgical corridors with 3D illustrations helps to define the best surgical corridor. 360 degree knowledge of the anatomy of craniovertebral junction allows safe surgical approach and treatment of ventral and ventrolateral located lesions using one of the three approaches.


Eingereicht: 01. April 2022

Angenommen: 20. Juni 2022

Artikel online veröffentlicht:
28. September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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