Introduction: Craniocervical junction meningiomas pose significant challenges for neurosurgeons. We present a retrospective series of 22 consecutive patients with craniocervical junction meningiomas treated surgically at our institution over a period of 17 years.

Methods: Using clinical notes, radiographical examinations and operative notes, we reviewed 22 operative cases of craniocervical junction meningiomas between 1995 - 2012. Additional follow-up information was obtained from rehabilitation notes, outpatient examination and telephone calls.

Results: There were 15 female and 7 male patients (mean age 54 years, range of 30-96 years). Meningiomas were classified based on origin-7 spinocranial and 15 craniospinal cases- and anatomical location relative to the brainstem or spinal cord- 2 anterior tumors, 7 anterolateral, 12 lateral, and 1 posterolateral. Sensory changes (71%), neck pain (57%) and headache (57%) were the most common presenting symptoms. Surgical approaches included the midline suboccipital approach (9 cases), the far lateral approach (12 cases) and the lateral retrosigmoid approach (1 case). Gross-total resection was achieved in 45% of patients and subtotal in 55%. The most common post-operative complications were cranial nerve (CN) IX and X deficits (10 cases transient, 3 cases permanent). The mortality rate was 4.5% and the recurrence rate was 0%. The mean follow-up was 46.5 months and the mean Karnofsky score at the last follow-up was 83.8 (range 50-100). Spinocranial tumors were detected at a smaller size (p = 0.0724) and treated earlier (p = 0.1398) than craniospinal tumors. They were associated with a higher rate of total resection (P =0.0007), fewer post-operative CN IX or X deficits (P=0.0053), and shorter hospitalizations (p = 0.08).

Conclusions: Our experience suggests that posterior midline suboccipital and far-lateral approaches with minimal condylar drilling and vertebral artery mobilization were most suitable. Total resection remains the “gold standard” but should be balanced with preserving important vascular and neural structures.

Patient Care: By providing surgeons with a better understanding of the surgical outcomes for these challenging patients.

Learning Objectives: By conclusion of this session, participants should be able to: 1) Identify surgical outcomes for meningiomas of the craniocervical junction, 2) Discuss potential differences in outcomes between spinocranial and craniospinal meningiomas.

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