Surgical problems of the base of the skull. An interdisciplinary approach.

Lesions of the clivus, upper cervical vertebrae, and the cervicomedullary junction often present difficulties to the neurologic surgeon. Currently available surgical approaches often provide less than optimal exposure, for both removal of the primary lesion and repair of the dura. A transoral approach that combines a median labiomandibular glossotomy, soft palate "split," and hard palate resection has been used in illustrative cases. This technique not only provides maximum transverse and sagittal exposure, but considerably reduces the operating distance between the neurosurgeon and the cervicomedullary junction. Fresh cadaver dissections helped to better define the surgical landmarks of the clivus and the underlying intradural vascular and neural structures.