Management of Benign Craniovertebral Junction Tumors

Objective: We report our surgical experience in the treatment of 15 consecutive patients with benign craniovertebral junction tumors, observed from 2000 to 2008, to emphasize the role of predicting histological tumor type by neuroradiological findings. Preoperative neuroradiological evaluations on presumptive tumor type could be helpful to define the surgical approach.

Methods: We observed 7 meningiomas, 3 epidermoids, 3 C1 neurinomas, and 2 neurinomas of the lower cranial nerves. Clinical results were evaluated by the Karnofsky Performance Scale, and all patients underwent preoperative neuroradiological evaluation with CT, MRI, and MRA; angiography was not routinely performed and was considered for each individual case.

Results: Eleven partial transcondylar and 4 retrocondylar approaches were performed. Total removal was achieved in 11 cases (73.3%), and subtotal removal in 4 patients (26.7%). None of the patients required occipitocervical fusion. Clinical and radiological follow-up showed no recurrence in cases with total removal. In all patients, a statistically significant postoperative increase of KPS scores was observed. The treatment of epidermoid tumors presented particular issues: debulking the lesion, we obtained a surgical window, avoiding a large removal of bone. As you see in the video, we carried out the total removal of neurinomas and Nakasu grade 1 or 2 meningiomas by piecemeal resection and without complete condylectomy and bone fixation.

Conclusion: The choice of these approaches and the extent of bone resection should be defined according to the tumor's location and size. Moreover, we emphasize that preoperative neuroradiological evaluations on presumptive tumor type could be helpful to the surgeon to tailor the technique to different lesions, providing the required exposure, without unnecessary surgical steps.