Management of benign craniovertebral junction tumors.
BACKGROUND
We report our surgical experience in the treatment of fifteen consecutive patients with benign craniovertebral junction tumors, observed from 1993 to 2000 at our department.


METHODS
We treated 7 meningiomas, 3 epidermoids, 3 C1 neurinomas and 2 neurinomas of the lower cranial nerves. Clinical results were evaluated by Karnofsky Performance Scale and all patients underwent preoperative neuroradiological evaluation with CT, MRI and MRA; angiography was not routinely performed and was considered for each individual case.


RESULTS
11 partial transcondilar and 4 retrocondilar approaches were performed. Total removal was achieved in 11 cases (73,3%) and subtotal removal in 4 patients (26,7%). None of the patients required occipitocervical fusion. Patients were followed for an average period of 24+/-31 months. Clinical and radiological follow-up showed no recurrence in cases with total removal. In all patients a statistically significant postoperative increase of KPS scores was recorded. The treatment of epidermoid tumors presented particular issues: debulking the lesion, we obtained a surgical window, avoiding a large removal of bone. In Nakasu grade 1 or 2 meningiomas, we carried out total removal by piecemeal resection and without complete condylectomy and bone fixation.


CONCLUSIONS
The choice of these approaches and the extent of bone resection should be defined according to the tumor's location and size. Moreover we emphasize that preoperative neuroradiological evaluations on presumptive tumor type could be helpful to the surgeon in order to tailor the technique to different lesions, providing the required exposure, without unnecessary surgical steps.
Parlato
C
C
Tessitore
E
E
Schonauer
C
C
Moraci
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D003390:Cranial Nerve Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D004814:Epidermal Cyst / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009442:Neurilemmoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011300:Preoperative Care; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed