Far-Lateral Suboccipital Approach

Indications

• The suboccipital approach with C1 laminectomy provides adequate visualization of approximately 270 degrees of the circumference around the medulla. This approach does not provide safe access to the 90 degrees anterior to the medulla, however, because the visual angle needed to see this region is obscured by the occipital condyle, which must be drilled in most cases to allow access along this visual trajectory.

• The muscular bulk in the midline approach performed in a conventional suboccipital craniectomy effectively limits the surgeon’s ability to dissect safely laterally enough to visualize the extracranial vertebral artery and to drill away the posterior occipital condyle.