Far lateral transcondylar transtubercular approach

Access to the craniovertebral junction poses several challenges due its deep location and close proximity to several vital structures, such as the vertebral arteries and lower cranial nerves. The far lateral approach was designed to maximize lateral viewing exposure to the craniovertebral junction and foramen magnum while obviating the need for brain retraction and reducing the chance of damage to neighboring neurovascular structures. At its core, this approach requires a lateral suboccipital craniectomy with removal of the lateral edge of the foramen magnum and a C1 hemilaminectomy, with extensions of the approach involving further partial reduction of the occipital condyle and jugular tubercle. In this chapter, the transcondylar and transtubercular extensions of the far lateral approach will be covered in depth, with regard to the indications, technical details, operative nuances, and limitations of these approaches.