title: Far lateral paracondylar versus transcondylar approach in the pediatric age group: CT morphometric analysis.
abstract: This study aimed to determine if partial removal of the occipital condyle provides a significant increase in visibility and "angle of attack" for treating lesions with extension ventral to the brainstem in children using CT morphometric data. Morphometric analysis was performed in 199 children using CT scans. Angle of attack was measured for both the paracondylar and transcondylar far lateral approach. Statistical analysis was performed using paired or unpaired Student's t-tests (p<0.05) and linear regression analysis. For the far lateral paracondylar approach, the overall angle of attack was 85 ± 9 degrees (range, 60-119 degrees). The overall angle of attack for the far lateral transcondylar approach was 70 ± 9 degrees (range, 48-105 degrees). This difference was significant (p<0.0001). Based on our data, resection of one-third of the occipital condyle in a far lateral transcondylar approach can improve angle of attack by approximately 15 degrees, regardless of age or sex, in the pediatric age group. It is important to keep in mind that there are risks attendant to resection of the occipital condyle, thus the resection of the occipital condyle in children should not be a mandatory part of the far lateral approach; rather, the decision-making should be individualized and considered on a case-by-case basis.
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6621 Fannin Street, CCC 1230.01, 12th Floor, Houston, TX 77030, USA.
authors.forename: Akash J
authors.initials: AJ
authors.lastname: Patel
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6621 Fannin Street, CCC 1230.01, 12th Floor, Houston, TX 77030, USA.
authors.forename: Loyola V
authors.initials: LV
authors.lastname: Gressot
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6621 Fannin Street, CCC 1230.01, 12th Floor, Houston, TX 77030, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Cherian
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6621 Fannin Street, CCC 1230.01, 12th Floor, Houston, TX 77030, USA.
authors.forename: Sohum K
authors.initials: SK
authors.lastname: Desai
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6621 Fannin Street, CCC 1230.01, 12th Floor, Houston, TX 77030, USA. Electronic address: ahjea@texaschildrens.org.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jea
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001933:Brain Stem / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D012737:Sex Factors; D019291:Skull Base / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Cerebellopontine angle tumors; Far lateral approach; Paracondylar approach; Pediatric skull base