Posterolateral Approaches to the Craniovertebral Junction

OBJECTIVE: The indications and operative technique for a number of posterolateral approaches to the craniovertebral junction (CVJ) are reviewed. METHODS: The literature addressing posterolateral approaches to the CVJ is reviewed, and illustrative cases are presented. RESULTS: The far lateral approach and its variants, including the transcondylar, supracondylar, and paracondylar approaches, are an effective means of addressing intradural anterior and anterolateral CVJ lesions. These approaches provide exposure of the lower third of the clivus, the foramen magnum, and the upper cervical spine; do not cross contaminated regions; and enable a watertight dural closure to be performed. They are associated with minimal morbidity and usually do not significantly decrease the stability of the CVJ. CONCLUSION: All surgeons treating lesions of the CVJ should be familiar with the posterolateral approach and its modifications.