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Extreme Lateral Approach to the Craniovertebral Junction: An Update

  • Nabeel S. Alshafai
  • Tomasz Klepinowski
Chapter
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 125)

Abstract

Introduction:The term ‘extreme lateral approach’ (ELA) was first introduced by Sen and Sekhar relatively recently (in 1990). Its definition varies and remains controversial, but it generally entails more aggressive bony removal than the far lateral approach (FLA).

Goal: In this paper we review the relevant literature and weigh up the advantages and disadvantages of this approach. We propose methods to manage the complications resulting from the more invasive character of the ELA. Some modern trends regarding how to definitely distinguish the ELA from the FLA are also presented.

Methods: Using the PubMed database, literature was collected on the relevant topics and subsequently reviewed. All up-to-date tips and tricks were carefully gathered, and current morbidity and mortality rates were obtained, as well as further perspectives.

Results and Conclusion: The morbidity associated with the ELA remains higher than that associated with the FLA, but the mortality nowadays is comparable. The ELA undoubtedly is a challenging procedure requiring deep insight into the relevant anatomy and its normal variants.

Keywords

Extreme lateral approach Meningiomas ELITE Vertebral artery transposition Craniovertebral junction 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Nabeel S. Alshafai
    • 1
  • Tomasz Klepinowski
    • 1
    • 2
  1. 1.Alshafai Neurosurgical Academy (ANA)TorontoCanada
  2. 2.Department of NeurosurgeryCollegium Medicum Jagiellonian UniversityKrakówPoland

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