Surgical Treatment of Craniocervical Junction Tumors

Treatment for tumors located at the craniocervical junction is challenging because of their variety and the consequent difficulty of selecting the optimal surgical approach. We studied the long-term follow-up results of surgical treatment. Between 1984 and 2000, we treated 24 patients with tumors located at the craniocervical junction; seven meningiomas, five chordomas, four schwannomas, two neurofibromas, and six others. Age range was from 1 to 77 years old (average, 44). Surgical approaches consisted of the far lateral-transcondylar approach for six patients, the transoral approach for four, the transmaxillary approach for one, the transcervical approach for one, the frontobasal approach for two and laminectomy or the suboccipital approach for ten. Cranio-cervical fixation was performed for four patients. The mean follow-up period was 7.3 years. Total removal was performed for 17 patients and subtotal removal for seven. All meningiomas and schwannomas were totally removed and there was no recurrence. No surgical mortality was experienced. One case of CSF leakage after transoral removal of a foramen magnum meningioma and three cases of swallowing disturbance after removal of a meningioma, a metastatic tumor and an intramedullary hemangio-blastoma were encountered. Craniocervical fixation was successful for all patients. At the last follow-up, 15 patients had survived without recurrence, four had locally controlled tumors, and five patients had died. Total removal of meningiomas and schwannomas at the cranio-cervical junction should be attempted at the first operation. Postoperative craniocervical stability is an important factor in the treatment of metastatic tumors, chordomas and neurofibromas invading bony structures.