Abstract
The far lateral approach has been extensively described in the literature as an excellent surgical approach for access and resection of foramen magnum lesions.(1-3) Dissection of the superficial and intermediate muscle layers of the suboccipital region is critical for adequate exposure and to safely localize the vertebral artery.(4-8) Exoscopic assistance has hitherto been marginally explored yet may represent a useful tool for such proper dissection.(4) This illustrative operative video highlights the surgical anatomy and relevant steps to perform a combined exoscopic and microscopic far lateral retrocondylar approach for resection of a ventral foramen magnum meningioma in a 56-year-old woman who presented to the emergency department with severe myelopathy from brainstem and spinal cord compression. Magnetic resonance imaging showed a 3 x 2.3 cm contrast enhancing foramen magnum lesion that was located ventrally and displaced the upper brainstem and lower cervical spinal cord dorsally causing severe compression. A far lateral retrocondylar approach to the ventral foramen magnum was performed under exoscopic and microscopic visualization. A gross total tumor resection was achieved, and histopathology confirmed diagnosis of meningioma WHO Grade 1. The patient's presentation, rationale, key surgical steps, and outcome are discussed. The patient consented to the procedure and the publication of her image.
