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Introduction: Since the landmark publication by Smith and Robinson, approaches to the cervical spine anteriorly have undergone many modifications and even additions. Nevertheless, at its core, the anterior approach remains an elegant and efficient approach to deal with majority of cervical spine pathologies including the degenerative cervical spine. Methodology: For this review, we searched for all major cases series and randomized control trials of anterior cervical approaches using the PubMed databases. Articles having the details of clinical variables and outcomes were tabulated and analyzed. Results: A total of 9 case series for transoral, 7 case series for transmanubrial, 19 case series for anterior cervical discectomy and fusion (ACDF), 6 studies for ACDF versus posterior cervical foraminotomy, 37 case series for ACDF versus arthroplasty, and 7 studies for ACDF versus anterior cervical corpectomy and fusion have been included. The majority of the case series suggested that the anterior cervical procedures have good clinical outcomes. The upper cervical spine approached by the transoral route had good outcomes in ventral compressive pathologies, with morbidity of cerebrospinal fluid leak in 7% of patients. The midcervical spine approached by ACDF had better clinical outcomes equivalent to the majority of modifications even in multiple-level pathologies. The transsternal approach had provided greater access and stability to the cervicothoracic junction with minimal morbidity. Conclusion: The anterior cervical approach can address the majority of cervical pathologies. They provide adequate corridor from craniovertebral junction to T4 with minimal morbidity, thus providing a good clinical outcome.

Extradural spinal nerve root hemangioblastoma is a rare entity with very few cases reported in the literature. A comprehensive picture of the treatments and outcomes of the same is thus not available. A systematic search was done according to PRISMA guidelines. Search criteria included terms: spinal extradural hemangioblastoma, extradural hemangioblastoma, and spinal root hemangioblastoma. The parameters considered were treatment, motor, and sensory outcome, association with von-Hippel-Lindau (VHL) syndrome. Twenty-two studies (19 full text articles) were available for the review. A total of 39 cases of extradural spinal nerve root hemangioblastoma have been reported. These cases had a median age of 44 years with male predominance (2:1) and up to 48% occur in the thoracic level, similar to our case. Thirty-six percent of patients were associated with VHL syndrome. Surgical resection was the primary modality of treatment with embolization used in selected cases (20%). They had mean follow-up of 23 (±11) months. The prognosis was better than the intradural counterpart with no motor deficit and sensory deficit in only 9%. Preoperative identification of the extradural nature of this pathology and complete excision at the first surgery offers excellent outcomes compared to intradural lesion. Targeted embolization may be used in cases anticipated with high blood loss.

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Background: The extent of resection of eloquent cortex low-grade glioma is improved by intraoperative magnetic resonance imaging (IOMRI) which is faced with challenges such as difficulty in automated registration after the MRI and prolongation of operative time. Objective: We describe an easier and foolproof method of resection using bone wax as fiducial. Surgical Procedure: A young male with right-frontal low-grade glioma anterior and superficial to the motor fibers was operated using IOMRI and awake craniotomy under neuromonitoring. Motor cortex mapping using phase reversal and continuous motor evoked potential (MEP) monitoring was used initially followed by continuous sub-cortical suction stimulation for deeper decompression until stimulation was seen. Bone wax in a triangular shape was placed at the suspicious margin and IOMRI was done. Results: The tumor residue was seen anterior and deeper to the bone wax and removed subsequently. Conclusion: The use of bone wax as a fiducial can aid in IOMRI-guided resection of eloquent cortex glioma in awake patients.