Introduction: Tumors of the craniovertebral junction ( CVJn) are challenging lesions to manage with devastating presentations and post op sequalae. They present with significant morbidity including respiratory involvement .
Methods: This study included 57 cases of CV Jn tumors operated between July 2006 and Dec 2016. The data was retrospectively analysed.
Results: There were 57 lesions in 36 males and 21 females . The axial location was intramedullary in 22(38.59%) , intradural extramedullary in 23 (40.36%) and extradural/osseous in 12 ( 21.05%) . The most common presentation was with spastic quadriparesis of different degrees , which was present in 49(85.96%) cases . Other symptoms were , sensory disturbances in 39 (68.43% ),sphincter involvement in 23(40.35%),respiratory involvement in 22(38.60%) and local nuchal pain in 15(26,32%) .The McCormick classification was Gd I–4 (7.02%),Gd II–4(7.02%),Gd III-11(19.30%),Gd IV-26(45.61%) and Gd V-12(21.05%) . Surgical approaches varied from anterior transoral , anterolateral retropharyngeal , extreme lateral , far lateral , posterolateral and circumferential .The aim of surgery was maximal resection without aggravating pre op deficit and spinal stability.39 patients(68.42%) improved post op,12 patients(21.05%) had no change in status and 06 patients(10.53%) worsened post op . Histologically the intramedullary tumors were ependymomas (12) , astrocytomas (09) and haemangioblastoma(01) : IDEMS were schwannomas (12) , meningiomas ( 09) ,metastasis from NHL (01) , lipoma (01) : extradural/osseous lesions were chordoma (04) , GCT/ABC(04), multiple myeloma mets(01), Prostate mets(01) ,sarcoma (01) and haemangiopericytoma(01).8 patients(14.03%) developed CSF leak and wound complications.04 patients (7.02%) due to chest related complications.
Conclusions: Lesions of the CVJn remain challenging to manage especially when they present with respiratory involvement . Surgery remains the choice of treatment.The approach may vary from anterior to extreme lateral to posterolateral depending on the location of the lesion. Stabilisation of the CV Jn may be required.
Patient Care: It will help us choose the right surgical approach for these lesions and leo help in prognosticate them.
Learning Objectives: By the conclusion of this session , participants should be able to
1) Describe the common lesions encountered at the CV Jn
2) Discuss their management
3) Discuss the surgical strategy for such lesions