Endoscope-assisted anterolateral approach to a recurrent cervical spinal chordoma

Abstract

Background

The anterolateral approach (ALA) enables to access the craniovertebral junction (CVJ), lower and middle clivus, jugular foramen, and cervical spine from a lateral perspective. It is particularly indicated when dealing with extradural bone tumors. Other rare indications are represented by spondylotic myeloradiculopathy and vascular diseases.

Method

We describe here the steps to safely perform an anterolateral approach along with a brief description of its indications and limits.

Conclusion

ALA represents a valid option to treat cervical spine and CVJ bone tumors such as chordomas. Its knowledge can improve the process of approach selection when dealing with such complex cases.

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Authors

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Correspondence to L. Giammattei.

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The authors declare that they have no conflict of interest.

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Additional information

Key points

• ALA is part of the neurosurgical armamentarium when dealing with complex lesions such as CVJ and cervical spine chordomas

• It is indicated especially for extradural tumors involving the anterolateral cervical spine and CVJ

• It represents a valid alternative to traditional posterolateral approaches and EEEA

• Strictly midline lesion above C2 (extra or intradural) can be approached also by EEEA

• Intradural lesions of the lower clivus/C2 are better addressed by a posterolateral approach

• Careful evaluation of preoperative anatomy, especially VA position, is mandatory

• The XIth should be early identified in order to be preserved, freed, and retracted within the surrounding fat tissue

• The sympathetic chain must be recognized and kept away from the surgical field

• Dissection of the VA should be done without violating the periosteal sheet to avoid copious bleeding

• The introduction of angled optics enables to increase safety in resection of the contralateral part of the tumor and extension into dark corners

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This article is part of the Topical Collection on Tumor - Other

Electronic supplementary material

A short video presenting the endoscope-assisted resection of a recurrent chordoma of the cervical spine through anterolateral approach is added. (AVI 142669 kb)

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Giammattei, L., di Russo, P., Penet, N. et al. Endoscope-assisted anterolateral approach to a recurrent cervical spinal chordoma. Acta Neurochir 162, 443–447 (2020). https://doi.org/10.1007/s00701-019-04194-8

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Keywords

  • Anterolateral approach
  • Craniovertebral junction
  • Chordoma
  • Vertebral artery