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To date the posterolateral approach represents the best strategy for the surgery of the intradural ventro-lateral lesions of the cranio-vertebral junction (CVJ). Over the years, several authors have proposed different variations of this technique, but the principle on which all are based is the ability to access to the ventral region of the brainstem and high cervical cord with minimum retraction and maximum control of the neuro-vascular structures. However, comorbidity related to the surgical procedure is still very high. Posterolateral approach is actually considered the best technique to approach the intradural ventrolateral lesions located at the CVJ. Because the peculiarity of the CVJ, surgeons must know very well the anatomy of this region. Due to the high comorbidity of this approach a very precise surgical planning based on the characteristics of the lesion is required to correctly treat this particular anatomical region to manage correctly the pathology and to prevent any complications.

Posterolateral Approach to the Cranio-Vertebral Junction: How, When and Why