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surgeon to view the craniovertebral junction (CVJ) from a lateral perspective, has been introduced by Al-Mefty, et al., as an alternative approach. In this report, the authors describe the surgical technique of the extreme lateral—transatlas approach and their clinical experiences. Methods. The authors first examined the surgical approach to the dens from a lateral perspective in five cadaveric heads. They found that removal of the lateral mass of the atlas provided adequate exposure for resection of the dens. Following this cadaveric study, the extreme lateral—transatlas

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Uğur Türe and M. Necmettin Pamir

human cadaveric specimens and was modified by deleting the resection of the occipital condyle. In this report we describe the surgical technique of the extreme lateral—transatlas approach and our clinical experiences ( Fig. 1 ). Fig. 1. Superior view of the C1–2 complex. The dark area between the two white arrows indicates the resection of the atlas. aa = anterior arch of C-1; at = anterior tubercle of C-1; da = dens of axis; pa = posterior arch of C-1; pt = posterior tubercle of C-1; saf = superior articular facet of C-1; tf = transverse foramen of C-1; tp

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Pranay Soni, Jeremy G. Loss, Callan M. Gillespie, Robb W. Colbrunn, Richard Schlenk, Michael P. Steinmetz, Pablo F. Recinos, Edward C. Benzel, and Varun R. Kshettry

and transverse ligament requires posterior fixation and fusion. Endoscopic endonasal approaches also require a skilled multidisciplinary team, which may not be readily available at all spine centers. The direct lateral approach (also known as the far lateral transatlas, extreme lateral transatlas, or anterolateral approach) involves C1 hemilaminectomy and partial or complete lateral mass resection and has been proposed as one alternative. 11 , 12 Although some ventral atlantoaxial pathologies are the result of chronic instability and require fusion for definitive

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Pranay Soni, Jeremy G. Loss, Callan M. Gillespie, Robb W. Colbrunn, Richard Schlenk, Michael P. Steinmetz, Pablo F. Recinos, Edward C. Benzel, and Varun R. Kshettry

and transverse ligament requires posterior fixation and fusion. Endoscopic endonasal approaches also require a skilled multidisciplinary team, which may not be readily available at all spine centers. The direct lateral approach (also known as the far lateral transatlas, extreme lateral transatlas, or anterolateral approach) involves C1 hemilaminectomy and partial or complete lateral mass resection and has been proposed as one alternative. 11 , 12 Although some ventral atlantoaxial pathologies are the result of chronic instability and require fusion for definitive

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Neurosurgical Forum: Letters to the Editor To The Editor Simona Buonamassa , M.D. Giuseppe Mariniello , M.D., Ph.D. Naples, Italy 139 140 We read with interest the article by Drs. Türe and Pamir (Türe U, Pamir MN: Extreme lateral—transatlas approach for resection of the dens of the axis. J Neurosurg (Spine 1) 96: 73–82, January, 2002) concerning a modified extreme-lateral approach to the craniovertebral junction (CVJ). The authors are to be commended for the remarkable anatomical

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Michael Karsy, Neal Moores, Faizi Siddiqi, Douglas L. Brockmeyer, and Robert J. Bollo

V arious surgical approaches for odontoid resection and decompression of the foramen magnum have been described in the adult literature, including the open transoral approach, 35 endoscopic combined transoral and transnasal approach, 17 extreme lateral transatlas approach, 36 and robot-assisted transoral approach. 16 However, limited data are available regarding the optimal surgical approach in children. Although microscopic transoral approaches, 15 as well as endoscopic endonasal and transcervical approaches, 11 , 18 , 20 , 26 , 31 have been

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Eleftherios Archavlis, Lucas Serrano, Eike Schwandt, Amr Nimer, Moisés Felipe Molina-Fuentes, Tamim Rahim, Maximilian Ackermann, Angelika Gutenberg, Sven Rainer Kantelhardt, and Alf Giese

: Atlantoaxial stabilization with posterior transarticular screw fixation: technical description and report of 22 cases . Neurosurgery 32 : 948 – 955 , 1993 10.1227/00006123-199306000-00011 31 Subach BR , Morone MA , Haid RW Jr , McLaughlin MR , Rodts GR , Comey CH : Management of acute odontoid fractures with single-screw anterior fixation . Neurosurgery 45 : 812 – 820 , 1999 10.1097/00006123-199910000-00015 10515475 32 Türe U , Pamir MN : Extreme lateral-transatlas approach for resection of the dens of the axis . J Neurosurg 96 : 1