Surgical treatment of ventral and ventrolateral intradural extramedullary tumors of craniovertebral and upper cervical localization

Abstract

Background:Surgical treatment of extramedullary craniovertebral and upper cervical tumors differs essentially, depending on the peculiarities of their localization.Materials and Methods:In the Spinal Department of the Institute of Neurosurgery during the period from 2000 to 2010, 96 patients with ventral and ventrolateral intradural extramedullary craniovertebral tumors and tumors of upper cervical localization were examined and operated.Results:The patients were distributed as follows. Tumors of the craniovertebral localization: These are neoplasms spreading in rostral direction up to the boundary of the lower third of the clivus and in caudal direction up to the upper edge body of the axis (C0–C1) – 12 patients; tumors at the C1–C2 level: 28 patients; and tumors at the C1–C2–C3 level: 56 patients. The tumors were divided into ventral (60) and ventrolateral (36).Conclusion:Therefore, the adequate choice of a surgical approach first depends on the localization of the tumor, its size and the extent to which it has spread. In most cases of extramedullary ventrolateral tumors of craniovertebral and upper cervical localization, far lateral and posterolateral approaches are the most optimum and the least traumatic. The extreme lateral approach is advisable in cases of big size ventral craniovertebral tumors.

Case Report: A Case Series Using Natural Anatomical Gaps—Posterior Cervical Approach to Skull Base and Upper Craniocervical Meningiomas Without Bone Removal

“…In many cases, far lateral approaches or CVJ approaches with the removal of C1 and/or a craniotomy, including the foramen magnum, were chosen. Even larger, more extensive approaches have been described for this kind of pathology (9)(10)(11). One of the most direct and "logical" approaches for ventral lesions would be the transoral approach, which is known to be challenging and with a high risk of CSF leakage, subsequent infections, velopharyngeal function impairment, and a loss of stability.…”

“…Multiple variants for the posterior or posterolateral suboccipital approach have been described, for example, the far lateral and the extreme lateral variants are well established and have a clear indication for large lesions (9)(10)(11). In cases of foramen magnum meningioma, almost all of these lesions were resected by George and coworkers via a posterolateral approach (far-lateral approach), as detailed in a major publication with more than 100 cases (15).…”

“…In addition, Zozulya et al described in 2011 that the ratio between the squared spinal cord and dural sac crosssection areas on C1-level is 1:3 on average, which means that 1/3 of the area is occupied by the spinal cord and 2/3 of the area by subarachnoid space. The latter can potentially be used as a trajectory and space for surgical access (11).…”