Step-by-Step Dissection of the Extreme Lateral Transodontoid Approach to the Anterior Craniovertebral Junction: Surgical Anatomy and Technical Nuances

Authors

Irakliy Abramov, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Mohamed A. Labib, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
David Altshuler, Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Lena Mary Houlihan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Nicolas I. Gonzalez-Romo, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Evan Luther, Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Michael E. Ivan, Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Jacques J. Morcos, Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Mark C. Preul, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@barrowneuro.org.

Document Type

Article

Abstract

BACKGROUND: Multicompartmental lesions of the anterior craniovertebral junction require aggressive management. However, the lesions can be difficult to reach, and the surgical procedure is difficult to understand. The aim of this study was to create a procedural, stepwise microsurgical educational resource for junior trainees to learn the surgical anatomy of the extreme lateral transodontoid approach (ELTOA). METHODS: Ten formalin-fixed, latex-injected cadaveric heads were dissected under an operative microscope. Dissections were performed under the supervision of a skull base fellowship-trained neurosurgeon who has advanced skull base experience. Key steps of the procedure were documented with a professional camera and a high-definition video system. A relevant clinical case example was reviewed to highlight the principles of the selected approach and its application. The clinical case example also describes a rare complication: a pseudoaneurysm of the vertebral artery. RESULTS: Key steps of the ELTOA include patient positioning, skin incision, superficial and deep muscle dissection, vertebral artery dissection and transposition, craniotomy, clivus drilling, odontoidectomy, and final extradural and intradural exposure. CONCLUSIONS: The ELTOA is a challenging approach, but it allows for significant access to the anterior craniovertebral junction, which increases the likelihood of gross total lesion resection. Given the complexity of the approach, substantial training in the dissection laboratory is required to develop the necessary anatomic knowledge and to minimize approach-related morbidity.

Publication Date

11-3-2023

Publication Title

World neurosurgery

E-ISSN

1878-8769

PubMed ID

37925146

Digital Object Identifier (DOI)

10.1016/j.wneu.2023.10.132

Recommended Citation

Abramov, Irakliy; Labib, Mohamed A.; Altshuler, David; Houlihan, Lena Mary; Gonzalez-Romo, Nicolas I.; Luther, Evan; Ivan, Michael E.; Lawton, Michael T.; Morcos, Jacques J.; and Preul, Mark C., "Step-by-Step Dissection of the Extreme Lateral Transodontoid Approach to the Anterior Craniovertebral Junction: Surgical Anatomy and Technical Nuances" (2023). Neurosurgery. 1951.
https://scholar.barrowneuro.org/neurosurgery/1951