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The Far Lateral Approach

Surgical Correlation

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The Far Lateral Approach Performed in a Cadaverous Specimen. A, The far lateral approach performed in a cadaverous specimen. After opening of the dura mater, we can find the cerebellar suboccipital face, vertebral artery and its extra and intradural segments, hypoglossus nerve, hypoglossal canal, C1 dorsal root, the spinal root of accessory nerve, sigmoid sinus and posterior condylar emissary vein. B, The final result of the far lateral approach in a surgical picture. Note the relevant enlargement of the magnum foramen space obtained after drilling of the posterior two thirds of the occipital condyle. Note the vertebral artery and its extradural (V3) and intradural (V4) segments. Observe the dorsal roots of C1 and C2, the spinal root of accessory nerve and the cerebellar suboccipital face. At the lateral edge, we can find the sigmoid sinus and the dura mater reflected over it. This maneuver has been done in order to give pathway to cerebellum–pontine angle and cerebellum–medullary cisterns as lateral as it is possible. (Images courtesy of E de Oliveira)

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