• Valentina Tardivo, Moujahed Labidi, Thibault Passeri, Anne Laure Bernat, Francesco Zenga, Eduard Voormolen, Nicolas Penet, and Sebastien Froelich.
• Department of Neurosurgery, Lariboisière Hospital, Paris VII-Diderot University, Paris, France; Department of Surgical Sciences, University of Torino, Torino, Italy. Electronic address: tardivo.valentina@gmail.com.
• World Neurosurg. 2020 Feb 1; 134: e771-e782.

BackgroundSurgical management of extensive skull base tumors, such as chordoma and chondrosarcoma, remains very challenging. The need for gross total removal to improve survival must be weighed against the risk of injury to neurovascular structures and the loss of stability at the craniovertebral junction. In cases of tumors that are already compromising craniovertebral junction stability, the occipital condyle can be exploited as a deep keyhole to reach the clivus, petrous apex, and sphenoid sinus.MethodsWe performed an anatomic study on 7 cadaveric specimens to describe the main landmarks and boundaries of the corridor. We also provide a clinical case to demonstrate the feasibility of the approach.ResultsIn all specimens, using the space provided by the condyle, it was possible to drill the petrous bone up to the posterior wall of the sphenoid sinus following the direction of the inferior petrosal sinus. To successfully complete the approach, after the hypoglossal canal was exposed, endoscopic assistance was needed to overcome the narrowing of the visual field provided by the microscope.ConclusionsIn cases of invasive skull base tumor involving the craniovertebral junction and affecting its stability, the occipital condyle can be exploited as a deep keyhole to the homolateral and contralateral petrous apex, clivus, and sphenoid sinus.Copyright © 2019 Elsevier Inc. All rights reserved.

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