Meningiomas of the craniovertebral junction: role of posterolateral approach

Abstract

Background: Meningiomas of the craniovertebral junction are complex lesions representing a neurosurgical challenge. The aim of the study is to describe the technique of a posterolateral approach and results in a series of patients with meningiomas of the foramen magnum and the first two cervical vertebrae. This posterior approach route with individualized lateral extension could be a safe technique in terms of morbidity and mortality compared to other approaches for this type of tumors. Material and methods: Sixteen consecutive patients diagnosed with meningioma of the foramen magnum and / or the first 2 cervical vertebrae (C1C2) were treated. Resection of the lesion was performed through a posterior midline corridor with a suboccipital craniectomy of 3 cm with opisthion resection and posterior arch of C1 and according to intraspinal extension, spinous process of C2. For meningiomas of the foramen magnum a side drilling was performed towards the condyle, without altering the latter; while in meningiomas of C1-C2 arches of C1 and C2 were drilled having the lateral masses as a limit. Results: Gross total resection of the lesion was achieved in all patients treated with a minimum recurrence rate. Complications were grouped into intraoperative and postoperative. The complication rate was 6.5%. Fifteen patients showed significant functional recovery. Conclusions: The posterior approach with lateral extension for the treatment of foramen magnum meningiomas and C1-C2 is safe, showing a low morbidity and mortality providing results comparable to other techniques.