Tumors placed Anteriorly at Cervico Medullary Junction like meningiomas, chordomas and chondrosarcomas can be approached by a route called far out postero lateral transcondylar pathway. The approach although excellent is surgically tasking as it involves mobilization of vertebral artery medially. The condyles of occiput and C1 are drilled away along with rim of occipital bone and mastoid.

For extradura tumours the dura is incised lateral to the vertebral artery and the tumor is removed piecemeal by separating the blood vessels and preserving all the lower cranial nerves. Much against the apprehension the surgery is quite rewarding without significant complication.