How I do it: far-lateral approach using a linear incision.

Abstract

The far-lateral approach, frequently employed by skull base surgeons, targets lesions in the ventrolateral region of the craniovertebral junction (CVJ). Although various incisions can be utilized, the linear incision is notably less invasive and more efficient. Despite its advantages, the literature lacks a comprehensive description of the technical steps involved in this approach. We discuss the pertinent surgical anatomy and provide a step-by-step intraoperative description of performing the linear incision far-lateral approach, accompanied by clear intraoperative photographs. The linear incision for the far-lateral approach reduces the extent of soft tissue dissection while having a negligible impact on surgical exposure. Key factors for ensuring the procedure safe and effective include: (1) a comprehensive understanding of the surgical anatomy in the suboccipital region and accurate identification of the midline from this specific position and incision; and (2) employing the "interfascial-subperiosteal-interdural dissection" technique to manage the soft tissues around the CVJ, thereby minimizing the risk of vertebral artery injury.