Direct and Oblique Approaches to the Craniovertebral Junction: Nuances of Microsurgical and Endoscope-Assisted Techniques Along with a Review of the Literature

Visocchi, Massimiliano; Germanò, Antonino; Umana, Giuseppe Emmanuele; Richiello, A.; Raudino, Giuseppe; Eldella, A. M.; Iacopino, Domenico Gerardo; Barbagallo, Giuseppe

doi:10.1007/978-3-319-39546-3_17

Cited by 15 publications

(2 citation statements)

References 36 publications

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“…The close relationship between CVJ tumors and the arterio-venous structures requires pre-operative angiography or CT angiograms, which may largely aid the surgical planning [ 56 , 57 ]. In particular, these exams may show the VA course on the tumor’s surface and/or the tumor-related displacement/occlusion of the VA complex and venous sinuses, assisting the team to choose the optimal surgical routes for maximizing tumor exposure and vascular control [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Palmisciano

Ferini²,

Watanabe

et al. 2022

Current Oncology

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Background: Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed the literature on CVJ schwannomas. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA statement to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed. Results: We collected 353 patients from 101 included articles. Presenting symptoms were mostly neck pain (30.3%) and headache (26.3%), with most cranial neuropathies involving the XII (31.2%) and X (24.4%) nerves. Most tumors originated from C2 (30.9%) and XII (29.4%) nerves, being extracranial (45.1%) and intradural-extradural (44.2%). Erosion of C1–C2 vertebrae (37.1%), the hypoglossal canal (28.3%), and/or jugular foramen (20.1%) were noted. All tumors were operated, preferably with the retrosigmoid approach (36.5%), with the far-lateral approach (29.7%) or with the posterior approach and cervical laminectomy (26.9%), far-lateral approaches (14.2%), or suboccipital craniotomy with concurrent cervical laminectomy (14.2%). Complete tumor resection was obtained most frequently (61.5%). Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Median follow-up was 27 months (range, 12–252). Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), mostly dysphagia (7.4%), new cranial neuropathies (6.2%), and cerebrospinal fluid leak (5.9%). A total of 16 patients (4.5%) had tumor recurrence and 7 died (2%), with median overall survival of 2.7 months (range, 0.1–252). Conclusions: Microsurgical resection is safe and effective for CVJ schwannomas. Data on SRS efficacy and indications are still lacking, and its role deserves further evaluation.

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Section: Discussionmentioning

confidence: 99%

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Palmisciano

Ferini²,

Watanabe

et al. 2022

Current Oncology

View full text Add to dashboard Cite

show abstract

“…[12][13][14] Furthermore, vertebral corpectomy, invasive as well all know, can be accomplished with MIS technique for both traumatic and tumoral diseases, reducing surgical blood loss, patient's morbidity, and hospital stay saving costs. [5,15] In brain surgery, endoscopic assisted brain surgery is a well-established technique and with proved efficacy. While if we look back in the past, transsphenoidal approaches aimed to reduce brain manipulation with direct access to the pathology, reducing morbidity and mortality.…”

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confidence: 99%