Surgical Treatment of Tumors of the Cranio-Cervical Junction

Treatment of tumors of the cranio-cervical junction requires a large variety of skull base approaches.

Between 1999 and 2004 we operated on 16 tumors of this area. The selection of approach was based on size, presumed histopathology, and location (extradural, intradural, intramedullar). Extradural lesions were resected with approach determinated by location. For intradural lesions located anteriorly we never used the transoral approach because of risk of CSF leak. We prefer posterolateral approaches (far lateral, supracondylar, transcondylar). For intramedullary lesions we chose the approach according to a two-point method.

We present classification of posterolateral approaches on anatomical cadaverous specimens. The most important conditions for successful treatment are precise anatomical knowledge from anatomical laboratory.

In our experience, the majority of large anterior foramen magnum meningiomas can be resected with the standard far lateral approach (Heros). A large tumor itself creates sufficient trajectory for resection without traction of nerve structures. We use condylar resection with/without vertebral artery mobilization for small midline tumors.