Craniovertebral Junction Instability after Oncological Resection: A Narrative Review

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Oncology

Background:

• The craniovertebral junction (CVJ) is a complex anatomical area prone to instability from pathologies like chordoma, chondrosarcoma, and aneurysmal bone cysts.
• Tumor resections in the CVJ can lead to significant joint instability, necessitating careful preoperative planning.

Purpose of the Study:

• To review the anatomy, biomechanics, and pathology of the CVJ.
• To describe surgical approaches and considerations for joint instability following craniovertebral tumor resections.
• To address the lack of consensus on fixation techniques after CVJ oncological surgery.

Main Methods:

• Literature review summarizing current evidence on CVJ pathologies and surgical management.
• Analysis of anatomical structures crucial for CVJ stability (ligaments, bone).
• Discussion of preoperative assessment strategies for predicting instability.

Main Results:

• Optimal surgical strategy (anterior, posterior, posterolateral) can often be determined preoperatively based on patient-specific needs.
• Preservation of intrinsic/extrinsic ligaments (e.g., transverse ligament) and bony structures (C1 anterior arch, occipital condyle) is key to maintaining stability.
• Tumor disruption or necessary removal of these structures mandates thorough assessment for potential instability.

Conclusions:

• While a universal approach is not feasible for CVJ pathologies, tailored surgical strategies are essential.
• Early detection of instability through clinical and radiological assessment is critical.
• Further research is needed to establish consensus on fixation timing and techniques in CVJ oncological surgery.