Minimalistic Approaches to Craniovertebral Junction Tumors

Craniovertebral junction (CVJ) tumor removal is challenging due to their close relationships with critical neurovascular structures and the brainstem. First attempts at removal of these lesions through the midline posterior suboccipital route were associated with significant postoperative morbidity and mortality. Hence, various neurosurgical approaches have been proposed for dealing with such lesions more safely. Anterolateral, extreme, and far lateral approaches have been developed with the aim to move more anterolaterally the angle of dissection, thus minimizing the retraction needed to reach CVJ tumors. However, there is still no clear evidence about the optimal approach for dealing with such lesions. If the brainstem retraction is minimized by more lateral routes, these approaches are time-consuming and are linked with a high risk of approach-related complications that is proportionate to the extent of bony drilling and to the neural and vascular manipulations.Here we present our technique for the microsurgical removal of CVJ tumors through a simple posterolateral approach. In addition, we briefly summarize the pros and cons of the different surgical approaches for CVJ lesions.