Introduction: After resection of more than 70% of the condyle, craniocervical fusion is recommended. However, it is unclear if chronic destruction of the condyle due to tumor growth results in clinical evident craniocervical instability. We reviewed cases with condyle resection/destruction with regard to necessity of craniocervical fusion.
Methods: A retrospective analysis from 2007 till 2011 reviewed the cases of 15 patients in whom an extended far lateral approach with condyle resection of various extents was performed or a bony destruction of the condyle was found due to tumor growth. There were 7 male and 8 female patients with a median age of 61 (range 22- 83) years and median follow up of 8,5 (range 3 – 54) months, including 6 meningiomas, 3 glomus paragangliomas, 2 metastases, 2 cholesteatomas, 1 hypoglossal schwanomma, and 1 chondrosarkoma. The extent of condyle resection/destruction was 25% or less in 11 cases, 25 – 50 % in 1 case, and >75% in 3 further cases. Occipitocervical fusion was not performed in any case.
Results: With condyle resection of 50% or less all patients neither received a collar postoperatively nor developed neck pain. The 3 patients with condyle resection of >75% received a rigid collar for a period of 3 months postoperatively and were free of pain after this period. At last follow-up all 3 cases showed instability of the occipitocervical junction on flexion-extension radiographs. However, there was no neck pain or clinical signs for compression of the medulla.
Conclusions: In patients with condyle resection/destruction of = 70% the necessity for occipitocervical fusion may not be absolute. Even with radiographic signs for craniocervical instability, we found no clinical signs for instability in 3/3 patients. A close follow-up and fusion in those cases with clinical evident instability may be recommended.
Patient Care: To possibly avoid unnessesary craniocervical fusion following an Extreme far lateral approach with partiall condylectome in an asymptomatic patient.
Learning Objectives: By the conclusion of this session, participants should be able to discuss the option of avoiding a craniocervical fusion following an Extreme far lateral approach with partiall condylectome in an asymptomatic patient.