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.
