EXTREME LATERAL TRANSCONDYLAR APPROACH - TECHNICAL IMPROVEMENTS AND LESSONS LEARNED

An extreme lateral transcondylar or extreme lateral transfacetal surgi cal approach was used to treat 22 patients with complex lesions over a 22-month period. The lesions included basilar invagination with verte bral artery pathology, giant aneurysm or arteriovenous fistula of the vertebral artery, meningioma, chordoma, chondrosarcoma, and paragangli oma. The approach was used alone or in combination with a presigmoid p etrosal or subtemporal-infratemporal approach. Refinements of the oper ative technique, treatment strategies for complex lesions, and the avo idance of complications are discussed. Complications included cerebros pinal fluid leakage, meningitis, pseudomeningocele, hemiparesis or qua driparesis, lower cranial nerve deficits, and vertebral artery injury requiring repair. With treatment, major neurological deficits resolved completely in three patients and partially in two. There was no opera tive mortality, but four patients died during the follow-up period. Fo r the 18 surviving patients, the mean preoperative and postoperative K arnofsky scores were 81 and 93, respectively. For the four who died, t he mean preoperative Karnofsky score was 73 and the mean postoperative score was 63.