{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T13:24:43Z","timestamp":1790083483373,"version":"4.0.1"},"reference-count":84,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:p>The far-lateral approach (FLA) has become a mainstay for skull base surgeries involving the anterior foramen magnum and lower clivus. The authors present a surgical technique using the FLA for the management of lesions of the anterior\/ anterolateral foramen magnum and lower clivus. The authors consider this modification a \u201clazy\u201d FLA. The vertebral artery (VA) is both a critical anatomical structure and a barrier that limits access to this region. The most important nuance of this FLA technique is the management of this critical vessel. When the lazy FLA is used, the VA is reflected laterally, encased in its periosteal sheath and wrapped in the dura, greatly minimizing the risk for vertebral injury while preserving a wide working space. To accomplish this step, drilling is performed lateral to the point where the VA pierces the dura. The dura is incised medial to the VA entry point by using a slightly curved longitudinal cut. Drilling of the condyle and the C-1 lateral mass is performed in a manner that preserves craniocervical stability. The lazy FLA is a true FLA that is based on manipulation of the VA and lateral bone removal to obtain excellent exposure ventral to the spinal cord and medulla, yet it is among the most conservative FLA techniques for management of the VA and provides a safer window for bone work and lesion management. Among 44 patients for whom this technique was used to resect 42 neoplasms and clip 2 posterior inferior cerebral artery aneurysms, there was no surgical mortality and no injury to the VA.<\/jats:p>","DOI":"10.3171\/2015.2.focus14784","type":"journal-article","created":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T13:05:25Z","timestamp":1427893525000},"page":"E14","source":"Crossref","is-referenced-by-count":32,"title":["\u201cLazy\u201d far-lateral approach to the anterior foramen magnum and lower clivus"],"prefix":"10.3171","volume":"38","author":[{"given":"Samuel","family":"Moscovici","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Umansky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergey","family":"Spektor","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus14784","series-title":"Acta Neurochir (Wien)","first-page":"546","article-title":"The effect of condylectomy on extreme lateral transcondylar approach to the anterior foramen magnum","volume":"139","author":"A\u00e7ikba\u015f","year":"1997"},{"key":"b2-focus14784","series-title":"J Neurosurg","first-page":"1","article-title":"The transcondylar approach to extradural nonneoplastic lesions of the craniovertebral junction","volume":"84","author":"al-Mefty","year":"1996"},{"key":"b3-focus14784","series-title":"Neurosurgery","first-page":"804","article-title":"Endarterectomy of the intradural vertebral artery via the far lateral approach","volume":"33","author":"Anson","year":"1993"},{"issue":"1 Suppl","key":"b4-focus14784","series-title":"J Neurosurg","first-page":"71","article-title":"Ventral foramen magnum meninigiomas","volume":"92","author":"Arnautovi\u0107","year":"2000"},{"key":"b5-focus14784","series-title":"J Neurosurg","first-page":"49","article-title":"Extreme lateral transcondylar approach: technical improvements and lessons learned","volume":"81","author":"Babu","year":"1994"},{"key":"b6-focus14784","series-title":"Neurosurgery","first-page":"1177","article-title":"Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach","volume":"59","author":"Bassiouni","year":"2006"},{"key":"b7-focus14784","series-title":"Oper Tech Neurosurg","first-page":"11","article-title":"Surgery of intradural tumors at the foramen magnum level","volume":"5","author":"Bertalanffy","year":"2002"},{"key":"b8-focus14784","series-title":"Neurosurgery","first-page":"815","article-title":"The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction","volume":"29","author":"Bertalanffy","year":"1991"},{"key":"b9-focus14784","series-title":"Clin Neurosurg","first-page":"467","article-title":"Foramen magnum meningiomas","volume":"44","author":"David","year":"1997"},{"key":"b10-focus14784","series-title":"J Neurosurg","first-page":"544","article-title":"Cranial base approaches to posterior circulation aneurysms","volume":"87","author":"Day","year":"1997"},{"key":"b11-focus14784","series-title":"Oper Tech Neurosurg","first-page":"50","article-title":"The V3 segment of the vertebral artery: surgery around the craniocervical junction","volume":"5","author":"George","year":"2002"},{"key":"b12-focus14784","series-title":"Surg Neurol","first-page":"484","article-title":"Lateral approach to the anterior portion of the foramen magnum. Application to surgical removal of 14 benign tumors: technical note","volume":"29","author":"George","year":"1988"},{"key":"b13-focus14784","series-title":"Skull Base Surg","first-page":"9","article-title":"Anterolateral and posterolateral approaches to the foramen magnum: technical description and experience from 97 cases","volume":"5","author":"George","year":"1995"},{"key":"b14-focus14784","series-title":"J Neurosurg","first-page":"917","article-title":"Neurinomas of the first two cervical nerve roots: a series of 42 cases","volume":"82","author":"George","year":"1995"},{"key":"b15-focus14784","series-title":"Surg Neurol","first-page":"371","article-title":"Meningioma of the foramen magnum: a series of 40 cases","volume":"47","author":"George","year":"1997"},{"key":"b16-focus14784","series-title":"Surg Neurol","first-page":"563","article-title":"The supracondylar approach to the jugular tubercle and hypoglossal canal","volume":"50","author":"Gilsbach","year":"1998"},{"key":"b17-focus14784","series-title":"Neurosurgery","first-page":"102","article-title":"Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: a report on an experience with 17 cases","volume":"49","author":"Goel","year":"2001"},{"key":"b18-focus14784","series-title":"Surgery of Cranial Base Tumors","first-page":"671","article-title":"Transcondyle approach for foramen magnum meningioms","author":"Hakuba","year":"1993"},{"key":"b19-focus14784","series-title":"J Neurosurg","first-page":"559","article-title":"Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions","volume":"64","author":"Heros","year":"1986"},{"key":"b20-focus14784","series-title":"Neurosurgery","first-page":"748","article-title":"A transcondylar approach to the arteriovenous malformation at the ventral cervicomedullary junction: report of three cases","volume":"34","author":"Hosoda","year":"1994"},{"key":"b21-focus14784","series-title":"Neurosurgery","first-page":"149","article-title":"The jugular foramen: microsurgical anatomy and operative approaches","volume":"41","author":"Katsuta","year":"1997"},{"key":"b22-focus14784","series-title":"Br J Neurosurg","first-page":"129","article-title":"The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours","volume":"7","author":"Kratimenos","year":"1993"},{"key":"b23-focus14784","series-title":"Acta Neurochir (Wien)","first-page":"132","article-title":"The suboccipital transcondylar approach to the clivus and craniocervical junction for ventrally placed pathology at and above the foramen magnum","volume":"125","author":"Lang","year":"1993"},{"issue":"4 Suppl","key":"b24-focus14784","series-title":"Neurosurgery","first-page":"367","article-title":"Far-lateral approach to the craniocervical junction","volume":"57","author":"Lanzino","year":"2005"},{"issue":"2","key":"b25-focus14784","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction. Report of two cases","volume":"19","author":"Liu","year":"2005"},{"issue":"2 Suppl","key":"b26-focus14784","series-title":"Neurosurgery","first-page":"324","article-title":"Lateral approach to anterolateral tumors at the foramen magnum: factors determining surgical procedure","volume":"56","author":"Margalit","year":"2005"},{"key":"b27-focus14784","series-title":"J Neurosurg","first-page":"302","article-title":"Far-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle","volume":"96","author":"Nanda","year":"2002"},{"issue":"3 Suppl","key":"b28-focus14784","series-title":"Neurosurgery","first-page":"S195","article-title":"The far-lateral approach and its transcondylar, supracondylar, and paracondylar extensions","volume":"47","author":"Rhoton","year":"2000"},{"key":"b29-focus14784","series-title":"Neurosurg Clin N Am","first-page":"349","article-title":"Meningiomas of the cerebellopontine angle and foramen magnum","volume":"5","author":"Rhoton","year":"1994"},{"key":"b30-focus14784","series-title":"Surg Neurol","first-page":"8","article-title":"Posterior fossa meningiomas: surgical experience in 161 cases","volume":"56","author":"Roberti","year":"2001"},{"issue":"2 Suppl","key":"b31-focus14784","series-title":"J Neurosurg","first-page":"206","article-title":"Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients","volume":"90","author":"Salas","year":"1999"},{"key":"b32-focus14784","series-title":"Neurosurgery","first-page":"1086","article-title":"Surgical results for meningiomas of the craniocervical junction","volume":"39","author":"Samii","year":"1996"},{"key":"b33-focus14784","series-title":"Neurosurgery","first-page":"472","article-title":"Cranial base approaches to intracranial aneurysms in the sub-arachnoid space","volume":"35","author":"Sekhar","year":"1994"},{"key":"b34-focus14784","series-title":"J Neurooncol","first-page":"249","article-title":"Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls","volume":"29","author":"Sekhar","year":"1996"},{"key":"b35-focus14784","series-title":"Neurosurgery","first-page":"197","article-title":"An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum","volume":"27","author":"Sen","year":"1990"},{"key":"b36-focus14784","series-title":"J Neurosurg","first-page":"824","article-title":"Quantitative description of the far-lateral transcondylar transtubercular approach to the foramen magnum and clivus","volume":"92","author":"Spektor","year":"2000"},{"key":"b37-focus14784","series-title":"BNI Q","first-page":"35","article-title":"The far lateral approach to the inferior clivus and the upper cervical region. Technical note","volume":"6","author":"Spetzler","year":"1990"},{"key":"b38-focus14784","series-title":"Surg Neurol","first-page":"180","article-title":"Lateral approaches to the petroclival region","volume":"41","author":"Tedeschi","year":"1994"},{"issue":"1 Suppl","key":"b39-focus14784","series-title":"J Neurosurg","first-page":"91","article-title":"Stability of the craniovertebral junction after unilateral occipital condyle resection: a biomechanical study","volume":"90","author":"Vishteh","year":"1999"},{"key":"b40-focus14784","series-title":"Neurosurgery","first-page":"934","article-title":"Quantitative analysis of the transcondylar approach to the foramen magnum","volume":"49","author":"Wanebo","year":"2001"},{"key":"b41-focus14784","series-title":"J Neurosurg","first-page":"555","article-title":"Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach","volume":"87","author":"Wen","year":"1997"},{"key":"b42-focus14784","series-title":"Meningiomas of the Basal Posterior Cranial Fossa","first-page":"3","article-title":"Advances and technical standards in neurosurgery","author":"Yasargil","year":"1980"},{"key":"b1-focus14784","series-title":"Acta Neurochir (Wien)","first-page":"546","article-title":"The effect of condylectomy on extreme lateral transcondylar approach to the anterior foramen magnum","volume":"139","author":"A\u00e7ikba\u015f","year":"1997"},{"key":"b2-focus14784","series-title":"J Neurosurg","first-page":"1","article-title":"The transcondylar approach to extradural nonneoplastic lesions of the craniovertebral junction","volume":"84","author":"al-Mefty","year":"1996"},{"key":"b3-focus14784","series-title":"Neurosurgery","first-page":"804","article-title":"Endarterectomy of the intradural vertebral artery via the far lateral approach","volume":"33","author":"Anson","year":"1993"},{"issue":"1 Suppl","key":"b4-focus14784","series-title":"J Neurosurg","first-page":"71","article-title":"Ventral foramen magnum meninigiomas","volume":"92","author":"Arnautovi\u0107","year":"2000"},{"key":"b5-focus14784","series-title":"J Neurosurg","first-page":"49","article-title":"Extreme lateral transcondylar approach: technical improvements and lessons learned","volume":"81","author":"Babu","year":"1994"},{"key":"b6-focus14784","series-title":"Neurosurgery","first-page":"1177","article-title":"Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach","volume":"59","author":"Bassiouni","year":"2006"},{"key":"b7-focus14784","series-title":"Oper Tech Neurosurg","first-page":"11","article-title":"Surgery of intradural tumors at the foramen magnum level","volume":"5","author":"Bertalanffy","year":"2002"},{"key":"b8-focus14784","series-title":"Neurosurgery","first-page":"815","article-title":"The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction","volume":"29","author":"Bertalanffy","year":"1991"},{"key":"b9-focus14784","series-title":"Clin Neurosurg","first-page":"467","article-title":"Foramen magnum meningiomas","volume":"44","author":"David","year":"1997"},{"key":"b10-focus14784","series-title":"J Neurosurg","first-page":"544","article-title":"Cranial base approaches to posterior circulation aneurysms","volume":"87","author":"Day","year":"1997"},{"key":"b11-focus14784","series-title":"Oper Tech Neurosurg","first-page":"50","article-title":"The V3 segment of the vertebral artery: surgery around the craniocervical junction","volume":"5","author":"George","year":"2002"},{"key":"b12-focus14784","series-title":"Surg Neurol","first-page":"484","article-title":"Lateral approach to the anterior portion of the foramen magnum. Application to surgical removal of 14 benign tumors: technical note","volume":"29","author":"George","year":"1988"},{"key":"b13-focus14784","series-title":"Skull Base Surg","first-page":"9","article-title":"Anterolateral and posterolateral approaches to the foramen magnum: technical description and experience from 97 cases","volume":"5","author":"George","year":"1995"},{"key":"b14-focus14784","series-title":"J Neurosurg","first-page":"917","article-title":"Neurinomas of the first two cervical nerve roots: a series of 42 cases","volume":"82","author":"George","year":"1995"},{"key":"b15-focus14784","series-title":"Surg Neurol","first-page":"371","article-title":"Meningioma of the foramen magnum: a series of 40 cases","volume":"47","author":"George","year":"1997"},{"key":"b16-focus14784","series-title":"Surg Neurol","first-page":"563","article-title":"The supracondylar approach to the jugular tubercle and hypoglossal canal","volume":"50","author":"Gilsbach","year":"1998"},{"key":"b17-focus14784","series-title":"Neurosurgery","first-page":"102","article-title":"Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: a report on an experience with 17 cases","volume":"49","author":"Goel","year":"2001"},{"key":"b18-focus14784","series-title":"Surgery of Cranial Base Tumors","first-page":"671","article-title":"Transcondyle approach for foramen magnum meningioms","author":"Hakuba","year":"1993"},{"key":"b19-focus14784","series-title":"J Neurosurg","first-page":"559","article-title":"Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions","volume":"64","author":"Heros","year":"1986"},{"key":"b20-focus14784","series-title":"Neurosurgery","first-page":"748","article-title":"A transcondylar approach to the arteriovenous malformation at the ventral cervicomedullary junction: report of three cases","volume":"34","author":"Hosoda","year":"1994"},{"key":"b21-focus14784","series-title":"Neurosurgery","first-page":"149","article-title":"The jugular foramen: microsurgical anatomy and operative approaches","volume":"41","author":"Katsuta","year":"1997"},{"key":"b22-focus14784","series-title":"Br J Neurosurg","first-page":"129","article-title":"The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours","volume":"7","author":"Kratimenos","year":"1993"},{"key":"b23-focus14784","series-title":"Acta Neurochir (Wien)","first-page":"132","article-title":"The suboccipital transcondylar approach to the clivus and craniocervical junction for ventrally placed pathology at and above the foramen magnum","volume":"125","author":"Lang","year":"1993"},{"issue":"4 Suppl","key":"b24-focus14784","series-title":"Neurosurgery","first-page":"367","article-title":"Far-lateral approach to the craniocervical junction","volume":"57","author":"Lanzino","year":"2005"},{"issue":"2","key":"b25-focus14784","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction. Report of two cases","volume":"19","author":"Liu","year":"2005"},{"issue":"2 Suppl","key":"b26-focus14784","series-title":"Neurosurgery","first-page":"324","article-title":"Lateral approach to anterolateral tumors at the foramen magnum: factors determining surgical procedure","volume":"56","author":"Margalit","year":"2005"},{"key":"b27-focus14784","series-title":"J Neurosurg","first-page":"302","article-title":"Far-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle","volume":"96","author":"Nanda","year":"2002"},{"issue":"3 Suppl","key":"b28-focus14784","series-title":"Neurosurgery","first-page":"S195","article-title":"The far-lateral approach and its transcondylar, supracondylar, and paracondylar extensions","volume":"47","author":"Rhoton","year":"2000"},{"key":"b29-focus14784","series-title":"Neurosurg Clin N Am","first-page":"349","article-title":"Meningiomas of the cerebellopontine angle and foramen magnum","volume":"5","author":"Rhoton","year":"1994"},{"key":"b30-focus14784","series-title":"Surg Neurol","first-page":"8","article-title":"Posterior fossa meningiomas: surgical experience in 161 cases","volume":"56","author":"Roberti","year":"2001"},{"issue":"2 Suppl","key":"b31-focus14784","series-title":"J Neurosurg","first-page":"206","article-title":"Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients","volume":"90","author":"Salas","year":"1999"},{"key":"b32-focus14784","series-title":"Neurosurgery","first-page":"1086","article-title":"Surgical results for meningiomas of the craniocervical junction","volume":"39","author":"Samii","year":"1996"},{"key":"b33-focus14784","series-title":"Neurosurgery","first-page":"472","article-title":"Cranial base approaches to intracranial aneurysms in the sub-arachnoid space","volume":"35","author":"Sekhar","year":"1994"},{"key":"b34-focus14784","series-title":"J Neurooncol","first-page":"249","article-title":"Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls","volume":"29","author":"Sekhar","year":"1996"},{"key":"b35-focus14784","series-title":"Neurosurgery","first-page":"197","article-title":"An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum","volume":"27","author":"Sen","year":"1990"},{"key":"b36-focus14784","series-title":"J Neurosurg","first-page":"824","article-title":"Quantitative description of the far-lateral transcondylar transtubercular approach to the foramen magnum and clivus","volume":"92","author":"Spektor","year":"2000"},{"key":"b37-focus14784","series-title":"BNI Q","first-page":"35","article-title":"The far lateral approach to the inferior clivus and the upper cervical region. 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