Outcome Analysis of Surgical Treatment of Craniovertebral Junction Tumors

Objective: Surgical management of craniovertebral junction (CVJ) tumors is one of the challenging problems in skull base surgery. The main difficulties are due to the fact that the area of the CVJ is a complicated anatomical and biomechanical system—understanding that system will allow us to choose the best surgical approach that provides a good functional result. The purpose of our study was evaluation of results in surgical treatment for CVJ tumors.

Material: In the period between 2005 and 2011, 32 patients were operated on in the CVJ: 11 patients with foramen magnum meningiomas, 8 with meningiomas of the lower third of the clivus, 9 with C2 nerve root neurinomas, 2 with hemangioblastomas in the cerebellar vermis, and 2 with C2 vertebra plasmocytomas. The study did not include patients with tumors arising from other anatomic regions and extending into the CVJ, such as cerebellopontine angle, jugular foramen, and the upper and middle third of the clivus. Preoperative evaluation consisted of plain x-ray imaging, CT, MRI, and different measurement scales (Karnofsky, EMS, NDI, VAS).

Results: The study included 11 men and 21 women with a mean age of 41.5 years (± 1.1) with an age range of 39 to 68 years. Average follow-up period was 32 months (range, 6-68 months). Mean duration of symptoms before surgery was 9.2 months (± 8.7). There were 31.1% of patients with anterior location of tumor and 34.4% with anterolateral tumor location. The 32 patients underwent 34 surgical interventions. Anterior transoral, posterolateral, and lateral approaches were used. Patients with CVJ instability underwent two-stage surgery: transoral tumor removal with posterior fixation. The average value of the Karnofsky scale was 69.3. The Karnofsky score in the early postoperative period was a great deal lower (64.2) than in the late postoperative one (85.3).

Conclusion: The anterior transoral approach is a method of choice for anterior extradural tumors. The transoral approach should be individually adapted for each patient with a deep understanding of the individual patient’s anatomic and biomechanical considerations. Far-lateral and posterolateral approaches are appropriate for intradural tumors with anterior and anterolateral location. Preoperative planning of extent of condyle resection provides the ability to predict instability of the CVJ.