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Background: Despite advances in surgical techniques and various implants, the treatment of intra-articular distal femoral fractures poses a challenge to the clinicians worldwide. In this study we aimed to evaluate the clinical outcomes of lateral locking plate combined with medial assisted plate for treating intraarticular comminuted distal femoral fractures. Materials and Methods: We conducted a retrospective study which consisted of 10 cases of distal femur fracture with intraarticular extension and treated with open reduction and internal fixation with dual column plating using single incision anterior midline approach. Results: The mean age was 40.75±12.39 with a range of 20-70 years. There were 7 males and 3 females. Mean time for union was 16.15±1.35 weeks. 1 patient had decreased ROM due to stiffness at the knee joint. 1 patient had superficial infection. No deep infection was noted. 1 case of non-union was noted in this study. Range of motion at knee at final follow up was 124.25±17.34 degrees. The mean NEER score was 82.15±9.19 with a range of 54-91. Conclusion: Single-incision dual plating approach for distal femoral fractures is effective and provides stable construct without loss of reduction and allows early rehabilitation and good functional outcomes.

Background Data: Cauda equina syndrome (CES) is a rare situation and is one of the few surgical emergencies in neurosurgery. While L4-L5 disc is the most common cause of CES, ependymoma and schwannoma are the most common tumors affecting cauda equina. Purpose: To present our experience and outcome of management of cauda equina tumors. Study Design: A retrospective clinical case study. Patients and Methods: We operated upon 22 cases with known cauda equina tumors at our institution in the period between October 2016 and April 2020. All patients were subjected to detailed general, neurological, and radiological evaluation both preoperatively and postoperatively according to our follow-up protocol. Moreover, the modified McCormick scale (MMS) has been used for pre- and postoperative functional evaluation. Patients underwent operation using the posterior midline approach, with neuromonitoring applied in 50% of patients. Results: The mean age was 44 ± 12.5 years. Nine (41%) patients were female and 13 (59%) were male. Ninety-one percent of patients presented with radiculopathy. Fifty percent of cases presented with schwannoma. Growth total tumor resection was achieved in 20 cases (91%). The last follow-up showed marked improvement in radiculopathy, motor power deficit, and MMS compared to preoperative values. Immediate postoperative motor power deterioration was reported in two cases. Recurrence was reported in one case of ependymoma at a two-year follow-up visit that underwent operation with no further recurrence after 1-year follow-up. Conclusion: The data of this study may suggest that most cauda equina tumors are benign and favorable outcome could be achieved in small-sized lesions with a short history and good preoperative clinical status. (2020ESJ220)

Posterior spinal instrumentation and fusion is the gold standard of surgical treatment for adolescent idiopathic scoliosis (AIS). This procedure is conventionally performed open, through a posterior midline approach. Minimally invasive spinal surgery (MIS) has been found to be associated with decreased blood loss, shorter duration of hospital stays, earlier mobilization, and decreased analgesic requirements in other areas of spinal surgery. In the treatment of patients with AIS, these principles can be applied via a posterior MIS approach and an anterior thoracoscopic approach. This article aimed to provide an overview of the current state of knowledge of MIS for AIS surgery. We will describe the rationale for the use of posterior MIS for AIS, a description of the surgical technique and a discussion of the current evidence for its use. We will also describe the indications, surgical technique, and evidence for MIS anterior spinal fusion as a definitive procedure for AIS and for non-fusion convex growth modulation procedures.

BACKGROUND Concern has been raised that Sprotte needles predispose to spinal anes-thesia failure. Nevertheless, these needles are associated with a low incidence of postdural puncture headache. The impact of the paramedian approach to postdural puncture headache remains controversial. The objective of this prospective randomized study was to compare Sprotte, Quincke and Atraucan needles as well as the midline and the paramedian approach in terms of postdural puncture headache and spinal anesthesia failure in patients undergoing Caesarean section. METHODS 655 patients were randomized to 5 groups. A midline approach was used in four groups. The spinal needles were the 25G Sprotte, 27G Sprotte, 26G Atraucan and 25G Quincke. In the fifth group a 25G Quincke needle was used by the paramedian approach. RESULTS The incidence of postdural puncture headache was 0% in both 25G and 27G Sprotte groups, 2.5% in the 26G Atraucan group, and 7.2% and 2.7% in the 25G Quincke midline and paramedian approach respectively. A significant difference in terms of postdural puncture headache was found between 25G Sprotte and 25G Quincke needles (P = 0.004), while the failure rate was similar between these two needles. A significant difference in spinal anesthesia failure rate was observed between midline and paramedian approaches (P = 0.041). CONCLUSIONS Sprotte but not Atraucan needle design correlates with lower incidence of postdural puncture headache compared to Quincke design. Sprotte needles are not associated with a higher spinal anesthesia failure compared to Quincke needles. The incidence of postdural puncture headache by the paramedian approach is not significantly reduced whereas the spinal anesthesia failure rate is increased in comparison to the midline approach.

Introduction Favorable short-term outcomes have been reported following muscle-preserving interlaminar decompression (MILD), a less invasive decompression surgery for lumbar spinal canal stenosis (LSCS). However, there are no reports of mid- to long-term outcomes. The purpose of this study was to evaluate the clinical outcomes five or more years after treatment of LSCS with MILD. Methods Subjects were 84 cases with LSCS (44 males; mean age, 68.7 years) examined five or more years after MILD. All patients had leg pain symptoms, with claudication and/or radicular pain. The patients were divided into three groups depending on the spinal deformity: 44 cases were without deformity (N group); 20 had degenerative spondylolisthesis (DS group); and 20 had degenerative scoliosis (DLS group). The clinical evaluation was performed using Japanese Orthopedic Association (JOA) scores, and revision surgeries were examined. Changes in lumbar alignment and stability were evaluated using plain radiographs. Results The overall JOA score recovery rate was 65.5% at final follow-up. The recovery rate was 69.5% in the N group, 65.2% in the DS group, and 54.0% in the DLS group, with the rate of the DLS group being significantly lower. There were 16 revision surgery cases (19.0%): seven in the N group (15.9%), three in the DS group (15.0%) and six in the DLS group (30.0%). There were no significant differences between pre- and postoperative total lumbar alignment or dynamic intervertebral angle in any of the groups, slip percentage in the DS group, or Cobb angle in the DLS group. Conclusions The mid-term clinical results of MILD were satisfactory, including in cases with deformity, and there was no major impact on radiologic lumbar alignment or stability. The clinical outcomes of cases with degenerative scoliosis were significantly less favorable and the revision rate was high. This should be taken into consideration when deciding on the surgical procedure.

Introduction: Removal of intracranial supra-sellar masses continues to be a surgical challenge. Various approaches have been used by different authors with varying results. Anterior basal interhemispheric approach is most suitable with better results than other approaches for craniopharyngiomas Materials and methods: Fifteen patients with large craniopharyngiomas having third ventricular and or retro or supra-sellar extensions or reaching the interpeduncular cisterns were operated by this approach, over a period of seven years since the first use of this approach at our institute. The data of patients opearated by this approach were then retrospectively analysed. There were eleven males and four females with five patients in the pediatric age group. Follow up range was from 2 to 83 months with a mean of 21.6 months. Results: Total excision was achieved in seven (46.6%) and near total excision in another seven (46.6%), partial excision was done in only one (6.66%). Seven patients with total excision were disease free at mean follow up of 6.8 months. There was asymptomatic recurrence in two (13.33%) patient with near total excision at 11 and 63 months respectively and were given radiotherapy post-operatively. All patients were symptom free except one with diabetes insipidus (DI) and one mortality, and one with post operative visual deterioration. Conclusion: Anterior basal interhemispheric approach is a useful alternative to other transcranial approaches in the management of the craniopharyngiomas. It has the advantage of being a midline approach and displays the tumour brain interface better. Keywords: Intracranial, transcranial, craniopharyngiomas

Introduction: Thoracolumbar fractures account for approximately 20% of fractures of the spinal column, the majority of which are unstable. In terms of management the aims proposed are to prevent further neurological injury, decompress the spinal canal in the presence of canal stenosis, and stabilize the spine. Materials and methods: We performed a prospective cohort study of 32-patients who presented to the Department of Orthopaedics, Lahore General Hospital, in Pakistan, from the 01 April 2018–31 March 2019, with unstable thoracolumbar fractures that were operatively stabilized. Sixteen subjects underwent a mini-open muscle splitting Wiltse approach (Cohort A), and 16-subjects underwent a traditional open midline approach (Cohort B). The data captured and analysed in this study included subject age; gender; type of surgical approach performed; length of operative procedure; volume of intra-operative blood loss; and amount of post-operative thoracolumbar pain assessed by the Visual Analogue Pain Scale Score. Results: The mean age of subjects in Cohort A was 36 ± 9.7 years, and the mean age of subjects in Cohort B was 36 ± 8.0 years. The male to female ratio was 1.7:1 in Cohort A, and 2.2:1 in Cohort B. Considering duration of surgery, a significant difference was demonstrated between Cohort A and Cohort B, favouring a shorter duration of surgery in Cohort A (p

This is an updated version of a clinical decision making article originally published in Vet Record in June 2018.7 #### Bottom line Dr Perry brings her five-month-old female domestic shorthair kitten, Kylie, in to be spayed. She has read on the internet that cats can be spayed using either a midline or a flank incision. She is very concerned about Kylie being in pain and asks you which is the least painful surgical option for Kylie. You wonder if one approach is less painful than the other. In \[female cats that are being neutered] does [a midline approach compared with a flank approach\] \[decrease pain following surgery\]? The search strategy can be viewed at https://bestbetsforvets.org/bet/567, and it is also available as a supplement to this article on Vet Record ’s website at https://veterinaryrecord.bmj.com/content/186/17/565 ### Supplementary data [vetrecm2008supp001.docx] Search last performed: 24 April 2020 Only five of the six papers identified were evaluated for this evidence summary. Coe et al 1 contains the same data set as Grint et al , …

C2 schwannomas are rare lesions that may develop in the spinal canal, in the area of the C2 ganglion situated posterior to the C1C2 articulation, in the extraspinal area or in a combination of these 3 sectors.1,2 The surgical removal of these lesions is delicate because of the intimate relationships the schwannomas develop with the V3 segment of the vertebral artery. A variety of lateral, far-lateral, or extreme lateral approaches have been described in order to tackle these lesions. We use a posterior midline approach that takes advantage of the predominantly extradural development of C2 schwannomas. In this technique, the main step is the debulking of the posterior articular sector of the tumor, which is easily accessible through a midline posterior approach and necessitates minimal bone removal. In most cases, removal of the homolateral posterior arch of C1 is sufficient in order to create an adequate access. These maneuvers create the necessary space for dissecting both the intradural and extraspinal sectors of the schwannoma. We present this technique through a case with a minimal intradural component exerting mainly a lateral compression of the spinal cord. The tumor was operated through the midline mini-invasive posterior approach with a favorable result. We demonstrate the surgical technique in video and discuss the nuances.

Transoral robotic thyroidectomy (TORT) is one of the latest approaches in remote-access thyroid surgery. This review presents the current indications for TORT, an in-depth description of the surgical procedure, and discusses the advantages, disadvantages, potential complications, and latest advances for this procedure. TORT has the advantages of excellent cosmesis, short distance from oral vestibule to the neck, and midline approach which allows easy access to bilateral thyroid glands and central compartment. In addition, the use of robotic arms ensures wristed instruments, tremor elimination, and reduced clashing of instruments with endoscope. Complication rates are low; however, the use of robotic systems is costly and there may be a steep learning curve. TORT can be performed safely with careful patient selection and with an experienced robotic surgeon and it is an acceptable alternative for the treatment of certain thyroid conditions.

BackgroundSpinal anesthesia using the midline approach might be technically difficult in geriatric population. We hypothesized that pre-procedural ultrasound (US)-guided paramedian technique and pre-procedural US-guided midline technique would result in a different spinal anesthesia success rate at first attempt when compared with the conventional landmark-guided midline technique in elderly patients.MethodsIn this prospective, randomized, controlled study,one hundred-eighty consenting patients scheduled for elective surgery were randomized into the conventional surface landmark-guided midline technique (group LM), the pre-procedural US-guided paramedian technique (group UP), or the pre-procedural US-guided midline technique (group UM) with 60 patients in each group. All spinal anesthesia were performed by a novice resident.ResultsThe successful dural puncture rate on first attempt (primary outcome) was higher in groups LM and UM (77 and 73% respectively) than in group UP (42%;P P P P ConclusionsA pre-procedural US scan did not improve the ease of midline and paramedian spinal anesthesia as compared to the conventional landmark midline technique when performed by junior residents in elderly population.Trial registrationRetrospectively registered at Clinicaltrials.gov, registration numberNCT02658058, date of registration: January 18, 2016.

Summary: Introduction: The traditionally taught technique for conventional open thyroidectomy is via a midline splitting of the strap muscles following a skin crease neck incision – midline approach (MA). The lateral “backdoor” approach (LA) uses the same central neck incision but approaches the thyroid gland between the anterior border of sternocleidomastoid (SCM) and strap muscles. This technique is usually reserved for re-do thyroid surgery. We compared the results of the two approaches in patients undergoing conventional thyroidectomy for the first time. Methods: A case-control study was performed on 90 patients undergoing conventional open thyroidectomy from 2012 to 2014. The first 45 patients underwent MA and subsequent 45 patients underwent LA. All patients were given 10 ml of 1% Marcaine infiltration into the neck incision before closure. Basic demographic data, operative time, incision length, weight of gland, need for transection of strap muscles and complications were recorded. Revision thyroid surgery and minimally invasive thyroid operations were excluded. Results: The demographics, operative timing, gland weight and incisional length showed no significant difference. Post-operative pain was significantly lower in the LA group. 5 patients (11%) in MA group needed horizontal transection of strap muscles to extract large goitres compared to 1 patient (2.2%) in the LA group. No major complications occurred in either group. Conclusion: The LA method is as safe as the midline technique with comparable operative time and significantly lower pain scores. It avoids midline separation and suturing of strap muscles and reduces the need for strap muscle transection to removal large goitres. Keywords: Lateral approach, Backdoor, Open throidectomy, Sternomastoid

Purpose: The objective of this study is to describe the removal of retained intraocular foreign body (RIOFB) by bimanual pars plana vitrectomy through midline sclerotomy in phakic patients. Technique: Four eyes with RIOFB and clear lens underwent microincision vitrectomy surgery. A chandelier illumination was placed through one of the existing ports. The foreign body (FB) was localized by direct visualization (intravitreal) or indentation (pars plana), stabilized using an intraocular magnet/FB forceps introduced through a midline sclerotomy and freed of vitreous from all sides using a vitrectomy cutter through the other port bimanually, reoriented along their long axis and extracted through the midline sclerotomy. Results: All four FBs were removed successfully without slippage or damage to the clear lens. Conclusion: Chandelier illumination-assisted removal of FB through midline sclerotomy helps in easier localization, stabilization and removal, avoiding lens touch even in anteriorly located FBs such as at pars plana.

Background and Aims: Identification of subarachnoid space in pregnant patients can pose a great challenge to anaesthesiologists. This study was designed to compare conventional landmark technique with pre-procedural ultrasonography-assisted midline approach for identification of the subarachnoid space in elective caesarean section. Methods: After institute ethics committee approval and written informed consent, 100 parturients scheduled for elective caesarean section under spinal anaesthesia were included in this prospective randomised control trial and divided into Group L (n = 50) (landmark technique) and Group U (n = 50) (ultrasound-guided technique). Parameters such as time taken for the identification of the interspace, distance between skin and dura mater, number of insertion attempts (the primary outcome), number of passes and time taken were recorded in both the groups. Statistical analysis was done using SPSS software 16. Results: Demographic profiles of both groups were comparable. The number of attempts for needle insertion (1.04 ± 0.19 vs. 1.97 ± 0.77), number of passes in the same interspinous space (1.26 ± 0.44 vs. 1.90 ± 0.51) and the total time for successful lumbar puncture (31.90 ± 6.30 vs. 51.80 ± 12.28 s) were significantly less in Group U as compared to Group L, but the time of identification of interspinous space was significantly more in Group U (56.70 ± 13.08 s) as compared to Group L (47.10 ± 10.45 s). Conclusion: Pre-procedural ultrasound is a useful tool for successful lumbar puncture in parturients as it reduces the number of attempts with fewer side effects as compared to conventional landmark technique.

Introduction: A cadaveric study for comparison of dorsal pedicular diameters in Indian males and females. Morphometric study of pedicles of spine of dorsal region is thus relevant and critical for proper placement of the transpedicular screw to avoid inadvertent penetration of pedicular wall.Material and Methods: It’s a observational study done at a tertiary health care centre in which 30 cadavers were studied using posterior midline approach. Direct measurements were taken on the vertebra with using a sliding vernier caliperResults: Thirty cadavers were studied out of which 23 were males and seven wee females. I studied vertical as well as horizontal diameter at the middle of pedicle and calculate mean of these two and did comparison between Indian males and females. When compared with males of the same height, females have thinner pedicles. This means the average diameter of the pedicular screws which is safe for the males at the particular level cannot be considered safe for females of the same height and age.Conclusion: On the basis of this study we have idea about average screw size for male and female at particular level to avoid untoward complication of current pedicular system. In males average diameter goes on increasing from D1to D12 with highest at D12 -5.6mm while lowest at D2 and D3 i.e. 4.5 mm. In females we found average diameter goes on increasing from D1to D12 with highest diameter at D9 i.e, 5.2mm and lowest at D2 i.e. 4.2 mm. As compared to the males females have thinner pedicles.

Lesions lateral to the lower brainstem in an area extending from the foraminae of Luschka to the foramen magnum are rare and include different pathologies. There is no consensus on an ideal surgical approach. To gain access to this area, we use the midline suboccipital subtonsillar approach (STA). This midline approach with unilateral retraction of the cerebellar tonsil enables entry into the cerebellomedullary cistern. The STA offers excellent access with a panoramic view of the cerebellomedullary cistern and its structures and therefore can be useful for a number of different pathologies in the lower petroclival area.

Background and Objectives Neuraxial blockade using a midline approach can be challenging. Part of this challenge lies in finding the optimal approach of the needle to its target. The present study aimed at finding (1) the optimal point of insertion of the needle between the tips of 2 adjacent spinous processes and (2) the optimal angle relative to the skin at which the needle should approach the epidural or subarachnoid space. Methods A computer algorithm systematically analyzed computed tomography scans of vertebral columns of a cohort of 52 patients. On midsagittal sections, the possible points of insertion of a virtual needle and the corresponding angles through which the epidural or subarachnoid space can be reached were calculated. Results The point chosen to introduce the needle between 2 adjacent spinous processes determines the range of angles through which the epidural or subarachnoid space can be reached. At the thoracic interspaces 1-2 through 3-4, thoracic interspaces 5-6 through 9-10, and at the lumbar vertebral interspaces 2-3 through 4-5, the optimal point of insertion is slightly inferior to the point halfway between the tips of the spinous processes. For thoracic interspace 4-5, the optimal point of insertion is slightly superior to the point halfway between the tips of the spinous processes. For the other interspaces, the optimal point of insertion is approximately halfway between the tips of the spinous processes. The optimal angle to direct the needle varies from 9 degrees at the thoracolumbar junction and at the lumbar interspaces 3-4 and 4-5, to 53 degrees at the thoracic interspace 7-8. Conclusions Our study has resulted in practical suggestions-based on accurate, reproducible measurements in patients-As to where to insert the needle and how to angulate the needle when performing neuraxial anesthesia using a midline approach.

There is no evidence that either a flank or midline approach for spaying cats is consistently associated with more wound complications, and, overall, complication rates appear to be low.

International audience; Pituitary surgery is performed via a transsphenoidal approach in the vast majority of cases according to various methods that have changed over the years. A microscopic transseptal approach via a sublabial mucosal incision or a nasal mucosal incision has also been extensively used. An endoscopic transnasal approach was first described in the 1990's, followed by the concept of a microscopic transseptal approach and an endoscopic strictly endonasal approach. We use an entirely endoscopic transseptal transsphenoidal approach via an incision in the nasal mucosa for both access and tumour resection. This procedure has a number of advantages: strictly midline approach to the sella turcica, large operative field, no interference between instruments and a low rate of nasal complications.

Mark Vogt,1 Dennis J van Gerwen,2 John J van den Dobbelsteen,2 Martin Hagenaars,3 1Department of Anesthesiology, Erasmus MC Sophia Children Hospital, Rotterdam, the Netherlands; 2Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; 3Department of Anesthesiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands Abstract: Performance of neuraxial blockade using a midline approach can be technically difficult. It is therefore important to optimize factors that are under the influence of the clinician performing the procedure. One of these factors might be the chosen point of insertion of the needle. Surprisingly few data exist on where between the tips of two adjacent spinous processes the needle should be introduced. A geometrical model was adopted to gain more insight into this issue. Spinous processes were represented by parallelograms. The length, the steepness relative to the skin, and the distance between the parallelograms were varied. The influence of the chosen point of insertion of the needle on the range of angles at which the epidural and subarachnoid space could be reached was studied. The optimal point of insertion was defined as the point where this range is the widest. The geometrical model clearly demonstrated, that the range of angles at which the epidural or subarachnoid space can be reached, is dependent on the point of insertion between the tips of the adjacent spinous processes. The steeper the spinous processes run, the more cranial the point of insertion should be. Assuming that the model is representative for patients, the performance of neuraxial blockade using a midline approach might be improved by choosing the optimal point of insertion. Keywords: neuraxial blockade, midline approach, optimal point of insertion, geometrical model

The present study investigated the clinical outcomes of the posterior midline approach in the treatment of 34 patients with significantly calcified insertional Achilles tendinopathy. The posterior midline approach was applied for the surgical treatment of 34 patients with chronic significantly calcified insertional Achilles tendinopathy after failed conservative treatment. Gastrocnemius recession was performed simultaneously for patients with gastrocnemius contracture. The Fowler-Philip angle and parallel pitch lines were measured before surgery, and the visual analog scale, Tegner score, and Victorian Institute of Sport tendon study group score were recorded before and after surgery. The mean follow-up period was 45.2 ± 17.7 (range 24 to 84) months. After surgery, the visual analog scale score had decreased notably, and the Tegner score and Victorian Institute of Sport tendon study group score had increased significantly. The posterior midline approach can achieve satisfactory outcomes in the treatment of significantly calcified insertional Achilles tendinopathy, and gastrocnemius recession (Strayer procedure) should be performed for patients with gastrocnemius contracture to improve the surgical outcome.

Background: Spinal anaesthesia in elderly patients is frequently associated with significant technical difficulties. Spinal anaesthesia can be given by either paramedian or median approach. Paramedian approach has been used as an alternative in case of failure with median approach. The goal of this study is to determine which of these two approaches should be preferred as a first choice of spinal anaesthesia in elderly patients. Methods: The study included 100 patients of either sex, aged 50 years and above, who received spinal anaesthesia either with the midline approach (group M, n=50) or paramedian approach (group PM, n=50). Results: The success rate of paramedian group was 100% as compared to 96 % in median group. The first attempt success rate was 90% in group PM and 70% in group M. Paraesthesia was felt in 5 patients (10%) in midline group and in 2 patients (4%) in paramedian group. Hemorrhagic tap was seen in 2 patients each in both the groups . None of the patients in Group M had postdural puncture headache (PDPH) as opposed to 2 patients in Group M. Conclusions: Thus the study conclude that paramedian approach is a better approach for spinal anaesthesia in elderly patients in terms of success rate, success at first attempt, complications like paraesthesia, PDPH and failure of sub-arachnoid block. Thus study recommends the routine use of paramedian approach for sub-arachnoid block in elderly patients as first choice.

Background Cranial base chordomas are complex lesions centered on the clivus that surgically can be approached from either a midline or a lateral corridor. Objective To compare the surgical outcomes from midline versus lateral approaches by conducting a meta-analysis of the literature. Methods Studies were identified between 2000 and 2018. The primary outcome was gross total resection (GTR) rate. The secondary outcomes were recurrence rate and rates of cerebrospinal fluid (CSF) leak and new cranial nerve palsy. Odds ratios were calculated with a random-effect model using studies describing both approaches. An indirect (proportion) meta-analysis was performed pooling studies describing either of the approaches. Individual patient data were analyzed for differences in GTR or recurrence rate with different tumor extensions. Results Thirty-three studies were found suitable for indirect meta-analysis and 10 studies for direct meta-analysis. The overall odds of GTR with a midline approach compared with a lateral approach was 0.83 (95% confidence interval [CI], –0.43 to 1.62). The odds ratios for recurrence, CSF leak, and new cranial nerve palsy were 0.82 (95% CI, 0.26–2.56), 1.49 (95% CI, 0.14–15.5), and 0.14 (95% CI, 0.04–0.56), respectively. With individual patient data analysis, no statistically significant difference was observed in GTR or recurrence rates between the 2 approaches with different tumor extensions. Conclusions The meta-analysis did not show any significant difference in GTR or recurrence rates between the midline versus lateral approaches. Tumor extension to different compartments did not affect the GTR or recurrence rates with either approach. In terms of complications, CSF leak rate was higher in midline approaches and cranial nerve palsy was higher in lateral approaches.