• Sae Min Kwon, Min Kyun Na, Kyu-Sun Choi, Ji Hoon Bang, Hyoung Soo Byoun, Hoonsub Han, and Yong Seok Nam.
• Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu.
• World Neurosurg. 2021 Feb 1; 146: e979-e984.

ObjectiveThe necessity of partial occipital condyle (OC) resection for lesions in the ventral craniocervical junction is debatable. This study's purpose was to compare the surgical exposure of the classic far-lateral approach (FLA) and transcondylar FLA.MethodsThe classic FLA and transcondylar FLA were performed in 12 human cadaveric heads (24 sides). The surgical corridor of 3 levels (a: vagus nerve, b: from the midpoint of proximal ends of the vagus and hypoglossal nerves to the midpoint of the distal ends of each nerve, c: hypoglossal nerve) and the maneuverability (the area between neurovascular structures that limits instrumental maneuvers) were measured after each approach.ResultsThe surgical corridors were significantly greater in transcondylar FLA than in classic FLA (a: 14.4 ± 3.4 mm vs. 17.1 ± 4.4 mm, P < 0.001; b: 8.6 ± 2.9 mm vs. 11.2 ± 4.1 mm, P < 0.001; c: 5.5 ± 2.2 mm vs. 7.7 ± 2.8 mm, P < 0.001). Transcondylar FLA also provided greater maneuverability than classic FLA (73.2 ± 23.9 mm2 vs. 94.9 ± 32.2 mm2, P < 0.001). The increased length of the surgical corridor was greatest in a (a: 2.7 ± 2.3 mm, b: 2.6 ± 2.0 mm, c: 2.2 ± 1.4 mm). However, the rate of increase was greatest in c (a: 18.9 ± 16.4%, b: 30.4 ± 26.2%, c: 44.8 ± 27.2%). The area of increased maneuverability was 21.7 ± 20.3 mm2 (31.1 ± 27.8%) after partial OC resection.ConclusionsTranscondylar FLA can significantly increase surgical exposure compared with the classic FLA, although also increasing surgical complications. Therefore, the surgical approach should be individualized according to each lesion and patient. The results of our study may assist in surgical decision-making regarding the need for OC resection.Copyright © 2020 Elsevier Inc. All rights reserved.

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