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Emiliano Passacantilli, Antonio Santoro, Angelo Pichierri, Roberto Delfini and Giampaolo Cantore

descriptions, advantages, and drawbacks. 2, 7, 8, 10, 13, 16, 18, 19, 24, 26, 30, 32, 34, 35, 37, 39, 41, 42, 45, 48 Classification of these approaches is difficult, but the most appropriate scheme was proposed by George and colleagues 13 in 1988, who classified lateral approaches to the CCJ based on two different routes: the posterolateral approach and the anterolateral approach, two means of exposing and controlling the V 3 segment of the VA and reaching lesions located anterior and lateral to the CCJ. Beginning in the early 1980s, a labyrinth of terminology has been

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Erdinc Civelek, Talat Kiris, Kemal Hepgul, Ali Canbolat, Gokhan Ersoy and Tufan Cansever

spondylotic myelopathy. 3 It is agreed that adequate nerve root decompression is critical for successful treatment of cervical radiculopathy. 1 , 2 , 4 , 6 , 7 , 11 , 16 , 20 , 26 , 33 Anterolateral or anteromedial uncosectomy and uncoforaminotomy provide relief of the compromised nerve roots and VAs. In a short history of the anterolateral approach to the cervical spine, Edouard Chassaignac, an anatomist, should be remembered. In 1861, Chassaignac concluded that the prominent anterior tubercle of the transverse process of C-6 is a landmark for surgical treatment of the

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Daniel K. Fahim, Sang Don Kim, Dosang Cho, Sangkook Lee and Daniel H. Kim

despite its substantial impact on patient outcome and quality of life. An unsightly and painful abdominal flank bulge can occur after anterolateral approaches to the thoracolumbar spine ( Fig. 1 ). Postoperatively, patients report abdominal muscle laxity and flank bulge, which results in asymmetrical cosmetic deformity and dissatisfaction with physical appearance. For many patients, this flank bulge can be painful and tender to the touch. F ig . 1. Photographs showing postoperative abdominal flank bulge. Abdominal flank bulge is largely underrecognized, and

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Kyriakos Papadimitriou, Anubhav G. Amin, Ryan M. Kretzer, Christopher Chaput, P. Justin Tortolani, Jean-Paul Wolinsky, Ziya L. Gokaslan and Ali A. Baaj

T he anterolateral approach to the thoracic spine is well described for the treatment of ventral pathologies, including herniated discs, 2 , 13 tumor, 9 infection, 12 and trauma. 10 Even if a thoracic surgeon is assisting with exposure, the spine surgeon must be familiar with the regional anatomy of the anterolateral thoracic spine. Knowledge of the anatomical relationships of the various structures diminishes the risk of iatrogenic neurovascular and visceral injuries. 4 These structures include the rib head, intervertebral disc, pedicle, foramina and

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Paul L. Grundy, Timothy J. Germon and Steven S. Gill

that is not physiological 11 and has been shown to accelerate spondylotic changes at adjacent vertebral levels. 1, 6 The transpedicular approaches were devised with the aim of directly decompressing the nerve root, preserving stability and mobility of the motion segment, and possibly reducing the rate of recurrence. The microsurgical procedures that we report are variations on the anterolateral approaches described by Verbiest, 23 Hakuba, 7 and Jho 11 as well as a variation on the standard posterior foraminotomy; 3, 9, 18, 24 however, they differ from these

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Sascha Marx and Henry W. S. Schroeder

ventricle. Technical note and review of the literature . J Neurosurg . 1998 ; 89 ( 6 ): 1062 – 1068 . 2 Wilson DA , Fusco DJ , Wait SD , Nakaji P . Endoscopic resection of colloid cysts: use of a dual-instrument technique and an anterolateral approach . World Neurosurg . 2013 ; 80 ( 5 ): 576 – 583 . 3 Boogaarts HD , Decq P , Grotenhuis JA , Long-term results of the neuroendoscopic management of colloid cysts of the third ventricle: a series of 90 cases . Neurosurgery . 2011 ; 68 ( 1 ): 179 – 187 . 4 Sethi A , Cavalcante D , Ormond DR

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Cédric Barrey, Ghislaine Saint-Pierre, Didier Frappaz, Marc Hermier and Carmine Mottolese

✓The authors describe a precise surgical technique in which a large intraspinal and extraspinal, multivertebral, cervical chordoma was completely removed in one stage using the lateral approach.

The patient in this case was a 29-year-old woman who presented with signs of radicular pain in the left C-3 area. Computed tomography and magnetic resonance imaging demonstrated a large intra- and extraspinal multivertebral tumor from C-2 to C-5, a finding that suggested a cervical chordoma. The tumor was completely removed in one stage using the lateral approach while controlling the vertebral artery (VA), and a partial corporectomy of C2–5 was also performed. Results from a postoperative histopathological examination confirmed that the tumor was a typical chordoma. The patient’s postoperative course was uneventful.

Cervical chordomas are typically excised using a posterior–anterior surgical approach with partial resection of the tumor. The lateral approach was appropriate in this patient for complete resection in one stage, because it enabled the surgeons to control the VA and access both extraspinal and intraspinal components of the chordoma.

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Ernesto Coscarella, A. Giancarlo Vishteh, Robert F. Spetzler, Eduardo Seoane and Joseph M. Zabramski

✓ The microsurgical anatomy of the temporal and zygomatic branches of the facial nerve are presented along with related local vasculature (frontal and parietal branches of the superficial temporal artery [STA]) as encountered when using subfascial and submuscular temporal muscle dissection techniques for anterolateral craniotomies.

Twenty sides were studied in 10 cadaveric specimens that had been previously injected with latex. The rami of the temporal and zygomatic branches of the facial nerve and branches of the STA were dissected out through pterional and orbitozygomatic approaches by using a submuscular or subfascial temporal muscle dissection technique.

The three rami of the temporal branch of the facial nerve (the auricularis, frontalis, and orbicularis) were found to run within the galeal plane of the scalp. The zygomatic branch of the facial nerve was found to course deeper than the most caudal extension of the galea, known as the superficial musculoaponeurotic layer. The frontal branch of the STA served as an important landmark for the subfascial or submuscular dissections because excessive reflection of the scalp flap inferior to the level of this vessel would inadvertently injure the frontalis branch of the facial nerve.

Subfascial and submuscular dissections of the temporal muscle offer an alternative to the interfascial technique during anterolateral craniotomies. Scalp and temporal dissection performed with careful attention to anatomical landmarks (frontal branch of the STA and the suprafascial fat pad) provides a safe and expeditious alternative to the traditional interfascial technique.

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Krzysztof Zapalowicz, Piotr Skora, Ryszard Myslinski, Feliks Karnicki and Andrzej Radek

anterolateral approach, offering minimal risk of cement extrusion into the spinal canal. Treatment The procedure was performed under fluoroscopic control. The patient was placed supine and sedated. At the C-7 level a skin stab incision was made on the anterior edge of the right sternocleidomastoid muscle. Through an anterolateral approach a KyphX Osteo Introducer cannula (Kyphon, Inc.) was inserted into the VB at a depth of 2–3 mm. Moderate bleeding through the cannula was observed. A biopsy was not performed to avoid possible hemorrhage. The kyphoplasty balloon was

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Ryo Kanematsu, Junya Hanakita, Toshiyuki Takahashi, Yosuke Tomita and Manabu Minami

a more kyphotic spinal alignment or beaked-type OPLL. The logical and ideal procedure to relieve spinal cord compression in thoracic myelopathy caused by OPLL on the concave side of the spinal cord is OPLL removal via the anterolateral approach. 2–6 , 8 , 19 , 34 When using the transthoracic anterolateral approach, microsurgical techniques are mandatory to prevent spinal cord damage during the decompression procedure. 5 , 6 Microsurgical resection of ossified lesions via this transthoracic anterolateral approach may be effective and safe, but is technically