Can Posterior Midline Approach Provide Adequate Exposure for All Craniovertebral Junction Tumors?

The surgical treatment of craniovertebral junction (CVJ) lesions remains a difficult process requiring advanced experience. The aim of this study was to present our experience and the clinical results of a posterior and posterolateral approach used for CVJ lesions in our clinic, and to discuss these in light of current literature.

Clinical, radiologic, and surgical aspects of 30 patients with CVJ tumors were retrospectively evaluated. Age, sex, symptoms, tumor localizations, pre- and postoperative neurologic examinations, performed surgical techniques, postoperative complications, and tumor pathologies were analyzed. The modified McCormick classification was used in the evaluation of the neurologic examination.

There were 30 patients (12 men, 18 women; mean age: 41.8 years). Hemilaminectomy was performed in 14 cases, and total laminectomy or laminoplasty in 16 cases; additional suboccipital craniectomy was performed in 6. Postoperative mortality was observed in 1 (3.3%) patient in the early postoperative period following tetraparesis, motor deficit in 2 (6.6%), cerebrospinal fluid leakage in 2 (6.6%), and wound site infection in 1 (3.3%). A tumor rest was detected in 2 patients (6.6%).

A posterior or a posterolateral approach is a safe surgical technique that can provide total tumor resection for CVJ region lesions, including posterior, posterolateral, lateral, and anterolaterally located tumors. Isolated anterior and anterolateral tumors with small lateral extension may require a far lateral or extreme lateral approach combined with other cranial base techniques.