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Far-Lateral and Transcondylar Approach

Surgical Correlation

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A, A suboccipital scalp flap is commonly selected for the far-lateral exposure. The medial limb extends downward in the midline so that a wide upper cervical laminectomy can be completed if needed. The lateral limb extends below the C1 transverse process, which can be palpated between the mastoid tip and the angle of the jaw to access the vertebral artery as it ascends through the C1 transverse process. In this dissection, the muscles are reflected separately to show their anatomy; however, at an operation, the muscles superficial to the suboccipital triangle can be reflected from the suboccipital area in a single layer with the scalp flap, leaving a cuff of suboccipital muscle and fascia attached along the superior nuchal line to aid in closure. B, The scalp flap has been reflected to expose the sternocleidomastoid and trapezius, the edges of which form the margins of the posterior triangle of the neck. The splenius and semispinalis capitis are in the floor of the triangle. C, The sternocleidomastoid has been detached from the lateral part of the superior nuchal line and reflected laterally to expose the splenius capitis, which is attached just below the line. The asterion, located at the junction of the lambdoid, occipitomastoid, and parietomastoid sutures, most commonly overlies the lower half of the junction of the transverse and sigmoid sinuses. D, The splenius capitis has been reflected to expose the longissimus capitis and deep cervical fascia. The occipital artery may pass superficial or deep to the longissimus capitis. (Images courtesy of AL Rhoton, Jr.)

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