• Kalil G Abdullah, Richard S Schlenk, Ajit Krishnaney, Michael P Steinmetz, Edward C Benzel, and Thomas E Mroz.
• Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.
• Neurosurgery. 2012 Jun 1;70(2 Suppl Operative):202-8.

BackgroundApproaches to the foramen magnum and upper cervical spine traditionally include the posterior midline, far lateral, and endoscopic endonasal approaches. The far lateral approach is a well-established technique for the removal of pathology ventrolateral to the brainstem and the craniocervical junction, but it may be too extensive for lesions limited to areas far from the midline.ObjectiveTo present an alternative to the commonly used approaches to the foramen magnum and upper cervical.MethodsWe used an approach directly overlying ventral or lateral pathology.ResultsTwo cases are presented in which the direct lateral approach followed by an occipitocervical fusion was successfully performed.ConclusionThis approach can be considered for patients in whom a ventral decompression is necessary but an endoscopic endonasal approach is undesirable or when a ventral, lateral, and ventrolateral resection of tumor, pannus, or infection is required.

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