Quantitative evaluation of different far lateral approaches to the cranio-vertebral junction using the microscope and the endoscope: a cadaveric study using a tumor model

Abstract

In 1-cm tumors, the S-FLA and the T-FLA expose a wider skull base area than the B-FLA. In larger tumors, the exposure is similar for all three approaches. Use of the endoscope in an assistive mode may further increase the surgical exposure and maneuverability.

Modified Pure Endoscopic Approach to Pineal Region: Proof of Concept of Efficient and Inexpensive Surgical Model Based on Laboratory Dissections

“…In addition, the endoscope may allow a clearer distinction of the interface between the tumor and the surrounding eloquent structures. [6][7][8][9][10][11][12][13][14][15][16][17] In 2008 Gore et al reported the first application of a pure endoscopic supracerebellar infratentorial approach for dealing with a pineal cyst, a minimally invasive alternative to conventional microsurgical procedures that requires no exposure of the venous sinuses. 1,18,19 However, potential bleeding coming from bridging veins and/or highly vascularized lesions may be extremely hard to control with the endoscopic instrumentation.…”

Classification and microsurgical treatment of foramen magnum meningioma

“…There are a variety of extensions of FLA, including B-FLA, T-FLA, S-FLA, P-FLA, and extended FLA (E-FLA) [16,[23][24][25][26][27][28], and we think that the approach should be combined to analyze ABS and SIM classifications (Table 2).…”

“…Far lateral approach (FLA) is the extension and expansion of the standard retrosigmoid approach and is mainly used to expose the ventral side of the brainstem and cervical spinal cord maximally and the vast space from the clivus to C2 and to reveal the relationship between tumors and the medulla oblongata and cervical spinal cord from the coronal. Important structures, such as the medulla oblongata and cervical spinal cord, do not need to be retracted to expose and remove FMMs effectively [12][13][14][15][16][17][18][19]. However, its clinical application is severely limited by the complicated anatomical relationships of important neurovascular structures, the deep location of the lesions, the high risk of intraoperative injury, and slow postoperative recovery.…”