Abstract

Introduction: Brainstem tumors are among the most difficult to treat for most neurosurgeons.

Material and Method: We performed a retrospective study for all patients operated through far lateral (n=65/92) or extreme lateral infra-jugular transchondylar (ELITE) (n=27/92) approaches in the period between January 2003 through May 2014 in Rady Children’s Hospital, San Diego, USA. Most patients were followed for an average of 5 years. The data were then analyzed and interpreted using SPSS version 20.

Result: The average age at presentation was 10 years ±8 months. Male and Female ratio was approximately 1:1. Wide range of pathologies were operated using far lateral or ELITE approaches including astrocytoms with different grades, arachnoid cysts, AT/RT, lymphomas, ependymomas, neurofibromas, epidermoid cysts, hemangiomas, meningiomas, medulloblastomas, mets, osteosarcoma, cholesteatoma, Rhabdomysarcoma, aneurysms and vertebral artery dissection. Gross total surgical resection was achieved in 63% (n=58/92), 4 patients (4.3%) had cyst fenestration for the arachnoid cysts, 1 bypass and 1 clipping for the vascular malformations. Postoperative new neurological deficits were encountered in 22 patients (23.9%) and in most of the patients it was transient and resolved during follow up. Seventy- three patients (79.4%) improved or cured, 14 deteriorated (15.2%), 1 had recurrence (1.1%) and 4 died (4.3%). DISCUSSION: Far lateral approach or extreme lateral approach was early described and utilized for several foramen magnum tumors and vascular malformations lateral and anterolateral to the brain stem since the 1980s. This approach enables complete removal of pathologies lateral and ventrolateral to the brainstem.

Conclusion: Far lateral approach or Extreme Lateral Transchondylar approach provides safe trajectory wide range of benign, malignant as well as vascular malformations. The complications related to this approach are the same if not less than those described for other approaches to lesions in this area with the added benefits of complete respectability and less postoperative cranial nerve palsies. This ensures less recurrence rates after surgical resection, favorable outcome and long-term survival for most of the patients. This approach can be effective for children as well as adults harboring difficult posterior fossa pathologies with less postoperative mortalities and morbidities.

Keywords: Far lateral approach; Extreme lateral transchondylar approach; Long-term outcome