{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T11:05:49Z","timestamp":1782471949272,"version":"3.54.5"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Asian J Neurosurg"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n               Introduction\u2003Lesions in the cerebellomedullary angle, anterolateral aspect of lower brainstem, and anterior foramen magnum can be accessed through far lateral approach and extreme lateral infrajugular transcondylar exposure. Detailed anatomical knowledge of this region is of paramount importance to avoid untoward complications.<\/jats:p><jats:p>\n               Objectives\u2003Comprehensive anatomy of this microsurgical corridor is sparse. Our aim was to define the anatomy of this region with relevance to the surgical approach, which would enable the surgeon to navigate this region with ease during surgery.<\/jats:p><jats:p>\n               Materials and Methods\u2003Cadaveric dissection was performed with focus on the various anatomical structures, which are of relevance to the operating surgeon. The same was correlated with the computerized scan and magnetic resonance imaging brain findings and intraoperative findings. The observations are presented.<\/jats:p><jats:p>\n               Discussion\u2003Through the far lateral approach, the vagoaccessory triangle (VAT) and three subtriangles within it are exposed. Lateral boundary of the VAT is formed by the spinal accessory nerve, which follows a superolateral trajectory toward the jugular foramen. Medial boundary is formed by the medulla oblongata. Superior boundary is formed by the vagus nerve, which courses horizontally toward the jugular foramen. Rootlets of the hypoglossal nerve divide the VAT into infra-hypoglossal, supra-hypoglossal, and hypoglossal\u2013hypoglossal subtriangles. The floor is formed by the inferior clivus, anterior foramen magnum, occipital condyle, and jugular tubercle. The roof is formed by the dura covering the lower part of the posterior fossa, biventral lobule, and tonsil of the cerebellum. The VAT contains three cisterns compartmentalized by three membranes, three nerves, and a fourth segment of vertebral artery (V4) with its three branches, in three subtriangles. Cisterns are the premedullary, lateral cerebellomedullary, and posterior cerebellomedullary. Membranes are the medial pontomedullary membrane, lateral pontomedullary membrane, and denticulate ligament. Nerves are the rootlets of hypoglossal, cranial accessory, and first cervical nerve. Posterior inferior cerebellar artery, anterior spinal artery, and posterior spinal artery are the three branches of V4.<\/jats:p><jats:p>\n               Conclusion\u2003Detailed knowledge of each anatomical structure and its relationship would enable the surgeon to operate safely within the corridors naturally present in this region.<\/jats:p>","DOI":"10.1055\/s-0044-1801283","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T18:54:26Z","timestamp":1737658466000},"page":"253-259","source":"Crossref","is-referenced-by-count":3,"title":["The Vagoaccessory Triangle (VAT): The Arena of ELITE"],"prefix":"10.1055","volume":"20","author":[{"given":"Nishanta M.","family":"Liyadipita","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Teaching Hospital, Badulla, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinivasan S.","family":"Uddanapalli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sri Balaji Hospitals, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakmal K.","family":"Hewage","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Teaching Hospital, Badulla, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Perera M.","family":"Galappaththi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Teaching Hospital, Badulla, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananda Lal C. Dewa","family":"Pakshage","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Teaching Hospital, Kandy, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"559","DOI":"10.3171\/jns.1986.64.4.0559","article-title":"Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions","volume":"64","author":"R C Heros","year":"1986","journal-title":"J Neurosurg"},{"key":"ref2","doi-asserted-by":"crossref","volume-title":"Cranial base surgery of hypoglossal schwannomas","author":"Y Nonaka","DOI":"10.1007\/978-94-007-7037-9_30"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.3171\/2010.8.JNS10759","article-title":"Anatomical triangles defining surgical routes to posterior inferior cerebellar artery aneurysms","volume":"114","author":"A Rodr\u00edguez-Hern\u00e1ndez","year":"2011","journal-title":"J Neurosurg"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"e463","DOI":"10.1016\/j.wneu.2019.02.073","article-title":"Anatomical analysis of the vagoaccessory triangles and triangles within","volume":"126","author":"A T Meybodi","year":"2019","journal-title":"World Neurosurg"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1177\/159101990401000402","article-title":"The so-called anterior meningeal artery: an anatomic study for treatment modalities","volume":"10","author":"S Shimizu","year":"2004","journal-title":"Interv Neuroradiol"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1007\/s00276-023-03126-7","article-title":"Surgical anatomy of hypoglossal canal for various skull base surgeries","volume":"45","author":"S G Kalthur","year":"2023","journal-title":"Surg Radiol Anat"},{"issue":"11","key":"ref7","first-page":"e31257","article-title":"Immersive surgical anatomy of the far-lateral approach","volume":"14","author":"A Payman","year":"2022","journal-title":"Cureus"},{"issue":"08","key":"ref8","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1007\/s00701-005-0555-x","article-title":"A morphometric analysis of the foramen magnum region as it relates to the transcondylar approach","volume":"147","author":"N Muthukumar","year":"2005","journal-title":"Acta Neurochir (Wien)"},{"key":"ref9","first-page":"34","volume-title":"The skull","author":"C A Cunningham","year":"2021","edition":"42nd ed."},{"issue":"02","key":"ref10","first-page":"181","article-title":"Anatomical variations of the foramen magnum, occipital condyle and jugular tubercle","volume":"21","author":"E Avci","year":"2011","journal-title":"Turk Neurosurg"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1177\/1971400919840843","article-title":"Clinical importance of the posterior meningeal artery: a review of the literature","volume":"32","author":"G Wang","year":"2019","journal-title":"Neuroradiol J"},{"key":"ref13","first-page":"11","volume-title":"Meningeal anatomy","author":"A Sekar","year":"2010"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1227\/00006123-198807000-00012","article-title":"Microsurgical anatomy of the posterior fossa cisterns","volume":"23","author":"H Matsuno","year":"1988","journal-title":"Neurosurgery"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"454","DOI":"10.3171\/2010.9.JNS10883","article-title":"The intracranial denticulate ligament: anatomical study with neurosurgical significance","volume":"114","author":"R S Tubbs","year":"2011","journal-title":"J Neurosurg"},{"key":"ref16","first-page":"37","article-title":"The surgical treatment of spasmodic torticollis","volume":"2","author":"K G McKenzie","year":"1954","journal-title":"Clin Neurosurg"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"650","DOI":"10.3109\/02688697.2014.899318","article-title":"The nerve of McKenzie: anatomic study with application to intradural rhizotomy for spasmodic torticollis","volume":"28","author":"R S Tubbs","year":"2014","journal-title":"Br J Neurosurg"},{"key":"ref18","first-page":"193","volume-title":"Posterior inferior cerebellar artery aneurysms","author":"M T Lawton","year":"2011","edition":"Vol. 20"},{"issue":"02","key":"ref19","first-page":"109","article-title":"Intracranial course and relations of the hypoglossal nerve. An anatomic study","volume":"20","author":"A Bhuller","year":"1998","journal-title":"Surg Radiol Anat"},{"key":"ref20","first-page":"27","volume-title":"Cranial arterial anatomy","author":"J V Byrne","year":"2017","edition":"Vol. 2"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1002\/ar.23823","article-title":"The accessory nerve: a comprehensive review of its anatomy, development, variations, landmarks and clinical considerations","volume":"302","author":"J Johal","year":"2019","journal-title":"Anat Rec (Hoboken)"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.wneu.2019.12.024","article-title":"A review of the history, anatomy, and development of the C1spinal nerve","volume":"135","author":"S Gutierrez","year":"2020","journal-title":"World Neurosurg"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"228","DOI":"10.3171\/2008.12.SPINE08289","article-title":"Microsurgical anatomy of the posterior spinal artery via a far-lateral transcondylar approach","volume":"10","author":"H Se\u00e7kin","year":"2009","journal-title":"J Neurosurg Spine"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4103\/0974-8237.65476","article-title":"Classification system of foramen magnum meningiomas","volume":"1","author":"M Bruneau","year":"2010","journal-title":"J Craniovertebr Junction Spine"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"74","DOI":"10.5455\/aim.2016.24.74-77","article-title":"Foramen magnum meningioma: a case report and review of literature","volume":"24","author":"P Jurinovic","year":"2016","journal-title":"Acta Inform Med"}],"container-title":["Asian Journal of Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0044-1801283.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:49:40Z","timestamp":1756360180000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0044-1801283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,23]]},"references-count":24,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2025,6,4]]},"published-print":{"date-parts":[[2025,6]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0044-1801283","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1793-5482","2248-9614"],"issn-type":[{"value":"1793-5482","type":"print"},{"value":"2248-9614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,23]]}}}