Approaches to Skull Base
I Anterior Cranial Base
  Anterior craniofacial resection
Basal subfrontal approach
II Middle Cranial Base

Central Compartment  

  Trans septal sphenoid
Transpalatal
Extended maxillotomy
Midfacial split		  

Lateral Compartment  

  Infratemporal fossa approach l case 1 l case 2
Transparotid
Subtemporal preauricular infratemporal fossa approach
Trans facial approaches

  Facial translocation approach l case 1 l case 2
Extended osteoplastic maxillotomy approach
Extended transfacial subcranial approach l case 1 l case 2
III Posterior cranial base

Transtemporal approaches
  Translabyrinthine approach
Transotic approach
Transcochlear approach l Case 1 l Case 2

Extreme lateral/transcondylar approach

 
Skull Base Surgery

Extreme Lateral/Transcondylar Approach

Case-1

An 18 year old female presented with quadriplegia and loss of bladder control. MRI showed a meningioma at the lower clivus extending into the foramen magnum pressing on the brain stem. Both vertebral arteries were buried in the mass. Tumour was removed through an extreme lateral/transcondylar approach. Postoperatively patient regained bladder control and was able to walk and write after intensive physiotherapy.

 

 

MRI shows the meningioma compressing the brain stem. Tumour was seen surrounding both vertebral arteries.

 

   MRI shows the meningioma compressing the brain stem. Tumour was seen surrounding both vertebral arteries.
 

In extreme lateral approach , there is a retrosigmoid craniectomy extended to open up foramen magnum and mobilization of vertebral artery after opening the foramen transversorium and laminectomy of C1 vertebra.

 

   Operation photograph of extreme lateral approach.
 

MRI shows complete tumour removal.