Background: Because diseases that are situated anterior to the foramen magnum and the upper cervical spinal canal permit limited access, they are considered some of the most difficult intracranial lesions to surgically treat. The far-lateral transcondylar approach provides such a route. The author has reviewed the technique as well as the surgical results here. Materials and Methods: During a 16-year period 36 patients underwent surgery in which far-lateral approach were performed. This approach was utilized in patients with aneurysm, schwannoma, meningioma, and chordoma affecting the cervicomedullary junction. Medical records, including imaging studies, descriptions of microsurgical findings were reviewed. Results: Total tumor resection was achieved in 25 patients, and a subtotal resection was performed in the other 9 patients. In the 2 patients with vertebral artery-posterior inferior cerebellar artery (PICA) aneurysms, 1 underwent clipping, the other underwent trapping and occipital artery-PICA bypass procedure. Postoperative complications included CSF leakage in 4 and temporary lower cranial nerve dysfunction in 10 patients. There was no significant postoperative complication in the remainder of the patients. Conclusions: Successful surgical management depends on precise understanding of their unique microsurgical anatomy. Sufficient exposure, minimal brain retraction, and preservation of the lower cranial nerves are necessary for a safe surgery.
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