Modern approaches to the diagnosis and treatment of meningiomas of the craniocervical junction region

Abstract

34 cases of craniocervical junction region meningiomas are analyzed. It was about 1.6% of the general number of patients with primary symptomatic intracranial meningiomas. Lateral or anterolateral meningiomas were in 31 cases (91.2%), posterior – in 2 cases (5.9%), anterior without lateralization – in 1 case (2.9%). 27 patients (79.4%) are operated on through the suboccipital approach, 7 patients (20.6%) – through the far-lateral suboccipital (transcondyllar) approach. Total removal of tumors was made in 24 cases (70.6%), subtotal removal – in 6 cases (17.6%), partial removal – in 4 cases (11.8%). Mortality was not observed. Intraoperative monitoring significantly improved the preservation of neurological functions. There were no cases of tumors recidivating during a long-term observation.The suboccipital lateralized approach with laminectomy till the level of the lower pole of the tumor was sufficient to provide an adequate microsurgical removal of meningiomas of the craniocervical junction without resection of an atlantooccipital joint. The approach to the neoplasm matrix should be carried out after partial tumor resection without traction of brain stem parts. The use of intraoperative neuromonitoring supervised the stem functions at all stages of tumor removal and during the vertebral artery allocation.