Journal of Neurological Surgery Part B: Skull Base最新文献

{"title":"The Combined TL-RS Approach: Advantages and Disadvantages of Working 360 Degrees around the Sigmoid Sinus.","authors":"Maarten Kleijwegt,&nbsp;Radboud Koot,&nbsp;Andel van der Mey,&nbsp;Erik Hensen,&nbsp;Martijn Malessy","doi":"10.1055/a-1793-7925","DOIUrl":"https://doi.org/10.1055/a-1793-7925","url":null,"abstract":"<p><p><b>Objective</b>  To highlight the advantages and disadvantages of the combined translabyrinthine (TL) and classic retrosigmoid (RS) approaches. <b>Design</b>  Retrospective chart review. <b>Setting</b>  National tertiary referral center for skull base pathology. <b>Participants</b>  Twenty-two patients with very large cerebellopontine angle tumors were resected using the combined TL-RS approach. <b>Main Outcome Measures</b>  Preoperative patient characteristics including age, sex, and hearing loss. Tumor characteristics, pathology, and size. Intraoperative outcome: tumor removal. Postoperative outcomes included facial nerve function, residual tumor growth, and neurological deficits. <b>Results</b>  Thirteen patients had schwannoma, eight had meningioma, and one had both. The mean age was 47 years, mean tumor size was 39 × 32 × 35 mm (anterior-posterior, medial-lateral, craniocaudal), and mean follow-up period was 80 months. Tumor control was achieved in 13 patients (59%), and 9 (41%) had residual tumor growth that required additional treatment. Seventeen patients (77%) had postoperative House-Brackmann (H-B) facial nerve function grades I to II, one had H-B grade III, one H-B grade V, and three H-B grade VI. <b>Conclusion</b>  Combining TL and RS approaches may be helpful in safely removing large meningiomas and schwannomas in selected cases. This valuable technique should be considered when sufficient exposure cannot be achieved with the TL or RS approach alone.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 3","pages":"288-295"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/05/f0/10-1055-a-1793-7925.PMC10171928.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9822330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pituitary Adenomas as a Barometer for Health Care Access.","authors":"Nathan John Wallace,&nbsp;William Jackson Palmer,&nbsp;Anand K Devaiah","doi":"10.1055/a-1808-1445","DOIUrl":"https://doi.org/10.1055/a-1808-1445","url":null,"abstract":"<p><p><b>Introduction</b>  Expanding access to care has been shown to impact patient care and disease epidemiology for different disease states, but has not been studied in pituitary adenoma. We hypothesize that increasing access to care-which includes diagnostics-through the Affordable Care Act (ACA) and Medicaid expansion has increased identification of pituitary adenomas. <b>Methods</b>  The National Cancer Institute's Surveillance, Epidemiology, and End Results database was utilized to identify patients with pituitary adenomas from 2007-to 2016 yielding 39,120 cases. Demographic, histologic, and insurance data were extracted. After stratification based on their insurance status, they were plotted to examine trends in insurance status after introduction of the ACA and Medicaid expansion. Magnetic resonance imaging (MRI) data was gathered from the Organization for Economic Co-operation and Development. A linear regression model was developed to describe the relationship between pituitary adenoma discovery and the number of MRI exams. <b>Results</b>  Pituitary adenoma diagnoses (37.6%) and MRI examinations per 1,000 in the U.S. (32.3%) increased concurrently from 2007 to 2016. Linear regression analysis revealed a statistically significant relationship ( <i>p</i>  = 0.0004). Those patients without insurance diagnosed with pituitary adenomas decreased 36.8% after Medicaid expansion ( <i>p</i>  = 0.023). With respect to Medicaid utilization, significant increases of 28.5% ( <i>p</i>  = 0.014) and 30.3% ( <i>p</i>  = 0.00096) were noted after both the ACA enactment and Medicaid expansion, respectively. <b>Conclusion</b>  The ACA has expanded health care access which has increased the ability to identify patients with pituitary adenomas. The present study also provides evidence that access to care is important for less prevalent diseases such as pituitary adenomas.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 3","pages":"248-254"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10171934/pdf/10-1055-a-1808-1445.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9480231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment for Severe Primary Midbrain and Upper Pons Hemorrhages Using a Subtemporal Tentorial Approach.","authors":"Jie Wu,&nbsp;Xiao Wu,&nbsp;Yong Zhang,&nbsp;Wei Du,&nbsp;Ke Wei,&nbsp;Guo Jie Yao","doi":"10.1055/s-0042-1745737","DOIUrl":"https://doi.org/10.1055/s-0042-1745737","url":null,"abstract":"<p><p><b>Objectives</b>  It is unclear whether surgical hematoma evacuation should be performed in cases of primary brainstem hemorrhages (PBH). Here, we analyzed 15 cases with severe primary midbrain and upper pons hemorrhages to assess the associations between the subtemporal tentorial approach and patient functional outcomes and mortality. <b>Design</b>  A total of 15 patients diagnosed with severe primary midbrain and upper pons hemorrhages who had previously received the subtemporal tentorial approach at our facility from January 2018 and March 2019 were analyzed. All surviving cases received a follow-up at 6 months after surgery. The Glasgow Coma Scale and Glasgow Outcome Scale (GOS) scores were analyzed 1 and 6 months after surgery, respectively. Demographic data, lesion characteristics, and follow-up data were retrospectively collected. <b>Results</b>  All patients successfully underwent surgical evacuation for hematomas using the subtemporal tentorial approach. The overall survival rate for these cases was 66.7% (10/15). At the last follow-up, 26.7% of patients (4/15) exhibited healthy function (GOS score: 4), 20.0% (3/15) showed disability (GOS score: 3) and 20.0% (3/15) were in a vegetative state (GOS score: 2). <b>Conclusions</b>  Based on the results uncovered in this study, the subtemporal tentorial approach was found to be both safe and feasible and may be beneficial for the treatment of severe primary midbrain and upper pons hemorrhages, but a more comprehensive and comparative study is required to further confirm these results.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 3","pages":"281-287"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5c/44/10-1055-s-0042-1745737.PMC10171936.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9523173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of Patient Refusal of Postoperative Radiation Therapy in Sinonasal Squamous Cell Carcinoma.","authors":"Rijul S Kshirsagar,&nbsp;Jacob G Eide,&nbsp;Aman Prasad,&nbsp;Ryan M Carey,&nbsp;Karthik Rajasekaran,&nbsp;Jason A Brant,&nbsp;Jason G Newman,&nbsp;James N Palmer,&nbsp;Nithin D Adappa","doi":"10.1055/a-1780-4157","DOIUrl":"https://doi.org/10.1055/a-1780-4157","url":null,"abstract":"<p><p><b>Objectives</b>  Although adjuvant radiotherapy may be indicated in patients with sinonasal squamous cell carcinoma (SNSCC) following primary surgery, some patients choose to forgo recommended postoperative radiation therapy (PORT). This study aimed to elucidate factors associated with patient refusal of recommended PORT in SNSCC and examine overall survival. <b>Methods</b>  Retrospective analysis of patients with SNSCC treated with primary surgery from the National Cancer Database diagnosed between 2004 and 2016. A multivariable logistic regression model was created to determine the association between clinical or demographic covariates and likelihood of PORT refusal. Unadjusted Kaplan-Meier estimates, log-rank tests, and a multivariable Cox proportional hazard model were used to assess overall survival. <b>Results</b>  A total of 2,231 patients were included in the final analysis, of which 1,456 (65.3%) were males and 73 (3.3%) refused recommended PORT. Patients older than 74 years old were more likely to refuse PORT than those younger than 54 (odds ratio [OR] 3.43, 95% confidence interval [CI]: 1.84-6.62). Median survival among the entire cohort, those who received recommended PORT, and those who refused PORT was 83.0 months (95% CI: 74.6-97.1), 83.0 months (95% CI: 74.9-98.2), and 63.6 months (95% CI: 37.3-101.4), respectively. Refusal of PORT was not associated with overall survival (hazard ratio: 0.99, 95% CI: 0.69-1.42). <b>Conclusions</b>  PORT refusal in patients with SNSCC is rare and was found to be associated with several patient factors. The decision to forgo PORT is not independently associated with overall survival in this cohort. Further study is required to determine the clinical implications of these findings as the treatment decisions are complex.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 3","pages":"232-239"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10171933/pdf/10-1055-a-1780-4157.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9954615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications in Endoscopic Endonasal Pituitary Adenoma Surgery: An Institution Experience in 310 Patients.","authors":"Mohamad Namvar,&nbsp;Arad Iranmehr,&nbsp;Mohamad Reza Fathi,&nbsp;Seyed Mousa Sadrhosseini,&nbsp;Azin Tabari,&nbsp;Noushin Shirzad,&nbsp;Mehdi Zeinalizadeh","doi":"10.1055/a-1838-5897","DOIUrl":"https://doi.org/10.1055/a-1838-5897","url":null,"abstract":"<p><p><b>Objective</b>  Endoscopic endonasal approaches (EEAs) have shown excellent results for majority of hypophyseal tumors. The aim of this study was to evaluate and report the complications of EEA in patients with pituitary adenoma (PA) who underwent surgery between 2013 and 2018. <b>Methods</b>  We performed a retrospective review of 310 consecutive patients/325 procedures with PA treated with an EEA from May 2013 to January 2018. Minor complications including transient diabetes insipidus (DI) or new anterior pituitary hormone insufficiency in one axis and major complications including CSF leakage, hematoma needing reoperation, vascular damage, brain infection, new pan-hypopituitarism permanent DI, new visual impairment, neurological deficits, and mortality were recorded. <b>Results</b>  We encountered 58 complications in 310 patients (18.7%) and 325 procedures (17.7%). Minor complications were 43 (13.9 and 13.2%) in 310 patients and in 325 procedures, respectively; whereas, major complications were 28 (9 and 8.6%, respectively). Total complications were associated with diameter group 2 (>30 mm), diaphragm sella violation, suprasellar extension, parasellar involvement, nonfunctional secretory type, and intraoperative arachnoid tearing. <b>Conclusion</b>  EEA can be considered as a safe surgical treatment which has acceptable complications in the management of PAs.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 3","pages":"255-265"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10171927/pdf/10-1055-a-1838-5897.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9750993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histology of the Porous Oculomotorius: Relevance to Anterior Skull Base Approaches.","authors":"Robert C Rennert,&nbsp;Vanessa Goodwill,&nbsp;Jeffrey A Steinberg,&nbsp;Takanori Fukushima,&nbsp;John D Day,&nbsp;Alexander A Khalessi,&nbsp;Michael L Levy","doi":"10.1055/a-1780-4619","DOIUrl":"https://doi.org/10.1055/a-1780-4619","url":null,"abstract":"<p><p><b>Objective</b>  Mobilization of cranial nerve III (CNIII) at its dural entry site is commonly described to avoid damage from stretching during approaches to the parasellar, infrachiasmatic, posterior clinoid, and cavernous sinus regions. The histologic relationships of CNIII as it traverses the dura, and the associated surgical implications are nonetheless poorly described. We herein assess the histology of the CNIII-dura interface as it relates to surgical mobilization of the nerve. <b>Methods</b>  A fronto-orbitozygomatic temporopolar approach was performed on six adult cadaveric specimens. The CNIII-dural entry site was resected and histologically processed. The nerve-tissue planes were assessed by a neuropathologist. <b>Results</b>  Histologic analysis demonstrated that CNIII remained separate from the dura within the oculomotor cistern (porous oculomotorius up to the oculomotor foramen). Fusion of the epineurium of CNIII and the connective tissue of the dura was seen at the level of the foramen, with no clear histologic plane identified between these structures. <b>Conclusion</b>  CNIII may be directly mobilized within the oculomotor cistern, while dissections of CNIII distal to the oculomotor foramen should maintain a thin layer of connective tissue on the nerve.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 3","pages":"210-216"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10171935/pdf/10-1055-a-1780-4619.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9822331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Negative-Pressure Face-Mounted System Reduces Aerosol Spread during Endonasal Endoscopic Surgery.","authors":"Edmond Jonathan Gandham,&nbsp;Abhijit Goyal-Honavar,&nbsp;Latif Rajesh Johnson,&nbsp;Ankush Gupta,&nbsp;Regi Thomas,&nbsp;Suresh Devasahayam,&nbsp;Krishna Prabhu,&nbsp;Ari George Chacko","doi":"10.1055/a-1774-6091","DOIUrl":"https://doi.org/10.1055/a-1774-6091","url":null,"abstract":"<p><p><b>Purpose</b>  Due to the potential risk of COVID-19 transmission during endonasal surgery, we studied methods to reduce droplet and aerosol generation during these procedures. <b>Methods</b>  Droplet spread was assessed using ultraviolet light and a camera that detected fluorescence in the operative field and surgeon's personal protective equipment. Density of aerosols sized <10 µm was measured using a photometric particle counter. We designed a face-mounted negative-pressure mask placed on the patients' face during endoscopic endonasal surgery. Sixteen patients were recruited between October 2020 and March 2021 and randomly assigned to the mask and no-mask groups. We compared droplet spread and aerosols generated in both groups, with copious irrigation and continuous suction during drilling forming the mainstay of surgical technique in all cases. <b>Results</b>  Droplet contamination due to direct spillage of fluorescein from the syringe was noted in two patients. Aerosol density rose during sphenoid drilling in both groups, with no significant difference when continuous suction and irrigation were employed (1.27 times vs. 1.07 times the baseline, <i>p</i>  = 0 <i>.248</i> ). Aerosol density rose significantly when suction and irrigation were interrupted in the no-mask group (44.9 times vs. 1.2 times, <i>p</i>  = 0 <i>.028)</i> , which was not seen when the mask was used. <b>Conclusion</b>  Aerosol generation increases during drilling in endonasal procedures and is a concern during this pandemic. The use of a rigid suction close to the drill along with copious irrigation is effective in reducing aerosol spread. The use of a negative pressure mask provides additional safety when inadvertent blockage of suction and inadequate irrigation occur.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 3","pages":"217-224"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10171932/pdf/10-1055-a-1774-6091.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9477610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Anatomic Assessment of the Intercavernous Sinuses and Review of the Literature.","authors":"Jennifer Kosty,&nbsp;Racheal Peterson,&nbsp;Sumitra Miriyala,&nbsp;Timothy Banks,&nbsp;Sandeep Kandregula,&nbsp;Rimal Dossani,&nbsp;Bharat Guthikonda","doi":"10.1055/a-1819-0144","DOIUrl":"https://doi.org/10.1055/a-1819-0144","url":null,"abstract":"<p><p><b>Introduction</b>  As expanded endoscopic endonasal approaches are gaining popularity, a thorough understanding of the anatomy of the intercavernous sinuses is pertinent to avoid bleeding complications. There have been few studies reporting the presence and dimensions of the anterior intercavernous sinus (AIS), posterior intercavernous sinus (PIS), and inferior intercavernous sinus (IIS). We performed a cadaveric study to better understand these structures. <b>Methods</b>  Colored latex was injected into the arterial and venous trees of 17 cadaveric heads. Dissections assessed the presence and dimensions of the AIS, PIS, and IIS. In an additional three specimens, the sellar contents were subjected to histological analysis. <b>Results</b>  Of the 20 total specimens, 13 (65%) demonstrated the gross presence of all three sinuses. In six specimens (30%), only the AIS and PIS could be identified, and in one specimen, only an AIS and IIS were identified. An AIS was identified in all 20 (100%) specimens, PIS in 18 (88%), and an IIS in 14 (70%). In two specimens (10%), the AIS covered the entire face of the sella. Dimensions of the AIS averaged 1.7 × 11.7 × 2.8 mm, PIS averaged 1.5 × 10.8 × 1.7 mm, and IIS averaged 8.7 × 11.8 × 1.0 mm when present. <b>Conclusion</b>  All examined specimens demonstrated the presence of an AIS, and most had a PIS. The presence of an IIS was more variable. Preoperative awareness of these sinuses is helpful in planning transsphenoidal surgery to minimize the risk of bleeding.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 3","pages":"266-271"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10171929/pdf/10-1055-a-1819-0144.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9567189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thank You and Welcome to the New Editors of JNLS Reports.","authors":"Dennis Kraus, Michael J Link","doi":"10.1055/s-0043-1769002","DOIUrl":"10.1055/s-0043-1769002","url":null,"abstract":"","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 4","pages":"421"},"PeriodicalIF":0.9,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9805967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Far Lateral Approach.","authors":"Christopher S Graffeo,&nbsp;Avital Perry,&nbsp;Lucas P Carlstrom,&nbsp;Luciano Leonel,&nbsp;Bachtri T Nguyen,&nbsp;Jonathan M Morris,&nbsp;Colin L W Driscoll,&nbsp;Michael J Link,&nbsp;Maria Peris-Celda","doi":"10.1055/a-1760-2528","DOIUrl":"https://doi.org/10.1055/a-1760-2528","url":null,"abstract":"<p><p><b>Introduction</b>  Skull base neuroanatomy is classically taught using surgical atlases. Although these texts are critical and rich resources for learning three-dimensional (3D) relationships between key structures, we believe they could be optimized and complemented with step-by-step anatomical dissections to fully meet the learning needs of trainees. <b>Methods</b>  Six sides of three formalin-fixed latex-injected specimens were dissected under microscopic magnification. A far lateral craniotomy was performed by each of three neurosurgery resident/fellow at varying stages of training. The study objective was the completion and photodocumentation of the craniotomy to accompany a stepwise description of the exposure to provide a comprehensive, intelligible, and anatomically oriented resource for trainees at any level. Illustrative case examples were prepared to supplement approach dissections. <b>Results</b>  The far lateral approach provides a wide and versatile corridor for posterior fossa operation, with access spanning the entire cerebellopontine angle (CPA), foramen magnum, and upper cervical region. <b>Key Steps Include</b>  The study includes the following steps: positioning and skin incision, myocutaneous flap, placement of burr holes and sigmoid trough, fashioning of the craniotomy bone flap, bilateral C1 laminectomy, occipital condyle/jugular tubercle drilling, and dural opening. <b>Conclusion</b>  Although more cumbersome than the retrosigmoid approach, a far lateral craniotomy offers unparalleled access to lesions centered lower or more medially in the CPA, as well as those with significant extension into the clival or foramen magnum regions. Dissection-based neuroanatomic guides to operative approaches provide a unique and rich resource for trainees to comprehend, prepare for, practice, and perform complex cranial operations, such as the far lateral craniotomy.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 2","pages":"170-182"},"PeriodicalIF":0.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9991529/pdf/10-1055-a-1760-2528.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9084919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}