Transcondylar approach for resection of lateral medullary cavernous malformation.

Abstract

Resection of a medullary cavernous malformation requires aggressive exposure, but there is controversy on how much occipital condyle can be safely removed during the transcondylar approach. We describe and demonstrate the use of the transcondylar approach to a medullary cavernous malformation, with emphasis on adequate surgical exposure while preserving the atlanto-occipital joint. Despite conservative handling of the occipital condyle, craniocervical stability may vary in patients after transcondylar surgery. A "dynamic" computer tomography, with views of the atlanto-occipital joint at each end-rotational extreme, may be the best postoperative assessment tool to evaluate the stability of the craniocervical junction.