Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Tailored Surgical Approaches for Benign Craniovertebral Junction Tumors

  • Jung, Seung-Hoon (Department of Neurosurgery, Chonnam National University Hwasun Hospital & Medical School) ;
  • Jung, Shin (Department of Neurosurgery, Chonnam National University Hwasun Hospital & Medical School) ;
  • Moon, Kyung-Sub (Department of Neurosurgery, Chonnam National University Hwasun Hospital & Medical School) ;
  • Park, Hyun-Woong (Department of Neurosurgery, Chonnam National University Hwasun Hospital & Medical School) ;
  • Kang, Sam-Suk (Department of Neurosurgery, Chonnam National University Hwasun Hospital & Medical School)
  • Received : 2010.04.14
  • Accepted : 2010.08.03
  • Published : 2010.08.28
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Abstract

Objective : We report our surgical experience in the treatment of 16 consecutive patients with benign craniovertebral junction (CVJ) tumor, observed from 2003 to 2008 at our department. Methods : We had treated 6 foramen magnum meningiomas, 6 cervicomedullary hemangioblastomas, 1 accessory nerve schwannoma, 1 hypoglossal nerve schwannoma, 1 C2 root schwannoma, and 1 cavernous hemangioma. Clinical results were evaluated by Karnofsky Performance Scale (KPS) and all patients underwent preoperative neuroradiological evaluation with computed tomography (CT) and magnetic resonance image (MRI). Angiography was performed in 15 patients and preoperative embolization was done in 2 patients. Results : Five far-lateral, 1 supracondylar and 10 midline suboccipital approaches were performed. Gross total removal was achieved in 15 cases (94%) and subtotal removal in 1 patient (6%). None of the patients required occipitocervical fusion. Radiological follow-up showed no recurrence in cases totally removed. Postoperative decrease of KPS scores was recorded in only 1 patient. The treatment of cervicomedullary solid hemangioblastoma presented particular issues : by preoperative embolization, we removed tumor totally without an excessive bleeding or brainstem injury. In one of foramen magnum meningioma, we carried out subtotal removal due to hard tumor consistency and encasement of neurovascular structures. Conclusion : The choice of surgical approaches and the extent of bone resection should be defined according to the location and size of individual tumors. Moreover, we emphasize that preoperative neuroradiological evaluations on presumptive tumor type could be helpful to the surgeon in tailoring the technique and providing the required exposure for different lesions, without unnecessary surgical steps.

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References

  1. Babu RP, Sekhar LN, Wright DC : Extreme lateral transcondylar approach : technical improvements and lessons learned. J Neurosurg 81 : 49-59, 1994 https://doi.org/10.3171/jns.1994.81.1.0049
  2. Bertalanffy H, Seeger W : The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction. Neurosurgery 29 : 815-821, 1991 https://doi.org/10.1227/00006123-199112000-00002
  3. Boulton MR, Cusimano MD : Foramen magnum meningiomas : concepts, classifications, and nuances. Neurosurg Focus 14 : e10, 2003
  4. Bruneau M, George B : Foramen magnum meningiomas : detailed surgical approaches and technical aspects at Lariboisiére Hospital and review of the literature. Neurosurg Rev 31 : 19-32; discussion 32-33, 2008
  5. Bulsara KR, Sameshima T, Friedman AH, Fukushima T : Microsurgical management of 53 jugular foramen schwannomas : lessons learned incorporated into a modified grading system. J Neurosurg 109 : 794-803, 2008 https://doi.org/10.3171/JNS/2008/109/11/0794
  6. Catapano D, Muscarella LA, Guarnieri V, Zelante L, D'Angelo VA, D'Agruma L : Hemangioblastomas of central nervous system : molecular genetic analysis and clinical management. Neurosurgery 56 : 1215- 1221; discussion 1221, 2005 https://doi.org/10.1227/01.NEU.0000159646.15026.D6
  7. Chaljub G, Van Fleet R, Guinto FC Jr, Crow WN, Martinez L, Kumar R : MR imaging of clival and paraclival lesions. AJR Am J Roentgenol 159 : 1069-1074, 1992 https://doi.org/10.2214/ajr.159.5.1414777
  8. de Oliveira E, Rhoton AL Jr, Peace D : Microsurgical anatomy of the region of the foramen magnum. Surg Neurol 24 : 293-352, 1985 https://doi.org/10.1016/0090-3019(85)90042-4
  9. George B, Dematons C, Cophignon J : Lateral approach to the anterior portion of the foramen magnum. Application to surgical removal of 14 benign tumors : technical note. Surg Neurol 29 : 484-490, 1988 https://doi.org/10.1016/0090-3019(88)90145-0
  10. Guidetti B, Spallone A : Benign extramedullary tumors of the foramen magnum. Adv Tech Stand Neurosurg 16 : 83-120, 1988 https://doi.org/10.1007/978-3-7091-6954-4_3
  11. Hakuba A, Nishimura S, Tanaka K, Kishi H, Nakamura T : Clivus meningioma : six cases of total removal. Neurol Med Chir (Tokyo) 17 : 63-77, 1977
  12. Hammon WM, Kempe LG : The posterior fossa approach to aneurysms of the vertebral and basilar arteries. J Neurosurg 37 : 339-347, 1972 https://doi.org/10.3171/jns.1972.37.3.0339
  13. Heros RC : Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg 64 : 559-562, 1986 https://doi.org/10.3171/jns.1986.64.4.0559
  14. Ho KL : Schwannoma of the trochlear nerve. Case report. J Neurosurg 55 : 132-135, 1981 https://doi.org/10.3171/jns.1981.55.1.0132
  15. Kratimenos GP, Crockard HA : The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours. Br J Neurosurg 7 : 129-140, 1993 https://doi.org/10.3109/02688699309103469
  16. Malis LI : Atraumatic bloodless removal of intramedullary hemangioblastomas of the spinal cord. J Neurosurg 97 : 1-6, 2002 https://doi.org/10.3171/jns.2002.97.1.0001
  17. Mathiesen T, Edner G, Kihlström L : Deep and brainstem cavernomas : a consecutive 8-year series. J Neurosurg 99 : 31-37, 2003 https://doi.org/10.3171/jns.2003.99.1.0031
  18. Menezes AH, Traynelis VC, Gantz BJ : Surgical approaches to the craniovertebral junction. Clin Neurosurg 41 : 187-203, 1994
  19. Miller E, Crockard HA : Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum. Neurosurgery 20 : 966- 968, 1987 https://doi.org/10.1227/00006123-198706000-00026
  20. Parlato C, Tessitore E, Schonauer C, Moraci A : Management of benign craniovertebral junction tumors. Acta Neurochir (Wien) 145 : 31-36, 2003 https://doi.org/10.1007/s00701-002-1024-4
  21. Russel DS, Rubinstein LJ : Pathology of Tumours of the Nervous System, ed 5. Baltimore : Williams & Wilkins, 1989
  22. Samii M, Klekamp J, Carvalho G : Surgical results for meningiomas of the craniocervical junction. Neurosurgery 39 : 1086-1094; discussion 1094-1095, 1996 https://doi.org/10.1097/00006123-199612000-00003
  23. Sen CN, Sekhar LN : Surgical management of anteriorly placed lesions at the craniocervical junction--an alternative approach. Acta Neurochir (Wien) 108 : 70-77, 1991 https://doi.org/10.1007/BF01407670
  24. Stein BM, Leeds NE, Taveras JM, Pool JL : Meningiomas of the foramen magnum. J Neurosurg 20 : 740-751, 1963 https://doi.org/10.3171/jns.1963.20.9.0740
  25. Winestone JS, Lin J, Sanford RA, Boop FA : Subepyndemal hemangioblastomas of the cervicomedullary junction : lessons learned in the management of two cases. Childs Nerv Syst 23 : 761-764, 2007 https://doi.org/10.1007/s00381-006-0279-0

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