Surgical Treatment of the Craniocervical Junction Tumors

Introduction: The purpose of the study was to evaluate outcomes of craniocervical junction tumor surgery.

Methods: Extradural lesions are resected with the approach determinated by location. For intradural lesions located anteriorly we never use the transoral approach because of a risk of CSF leak. We prefer posterolateral approaches (far lateral, supracondylar, transcondylar). For intramedullary lesions we choose an approach according to a two-point method. We present classification of posterolateral approaches on anatomical cadaverous specimens.

Results: Between 2001 and 2007 we operated on 25 tumors of this area, 6 extradural, 11 intradural, 8 intramedullar. There were 12 males and 12 females, ages ranged from 21 to 69 (mean, 41 years), and the extent of surgical excision was 16 patients (66%) total and 8 (33%) subtotal.

Conclusion: From our experience, the majority of large anterior foramen magnum tumors can be resected with a standard far-lateral approach (Heros). A large tumor itself creates a sufficient trajectory for the resection without traction of the nerve structures. We use the condylar resection without vertebral artery mobilization for small midline tumors. The most important conditions for successful treatment are precise anatomical knowledge from the anatomical laboratory and the electrophysiologically monitored surgery (mapping of motor cranial nerve nuclei and MEP).