Mohamad Bydon1, Ting Martin Ma2, Risheng Xu3, Jon Weingart4, Alessandro Olivi4, Ziya L Gokaslan1, Rafael J Tamargo4, Henry Brem4, Ali Bydon5. 1. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA; Johns Hopkins Spinal Column Biomechanics and Surgical Outcomes Laboratory, Baltimore, USA. 2. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA; Johns Hopkins Spinal Column Biomechanics and Surgical Outcomes Laboratory, Baltimore, USA; Graduate Program of Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, USA. 3. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA; Johns Hopkins Spinal Column Biomechanics and Surgical Outcomes Laboratory, Baltimore, USA; Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, USA. 4. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA. 5. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA; Johns Hopkins Spinal Column Biomechanics and Surgical Outcomes Laboratory, Baltimore, USA. Electronic address: abydon1@jhmi.edu.
Abstract
OBJECTIVE: We present our experience in managing craniocervical junction meningiomas and discuss various surgical approaches and outcomes. METHODS: We retrospectively reviewed 22 consecutive cases of craniocervical junction meningiomas operated on between August 1995 and May 2012. RESULTS: There were 15 female and 7 male patients (mean age: 54 years). Meningiomas were classified based on origin as spinocranial (7 cases) or craniospinal (15 cases). Additionally, the tumors were divided into anatomical location relative to the brainstem or spinal cord: there were 2 anterior tumors, 7 anterolateral, 12 lateral, and 1 posterolateral. Surgical approaches included the posterior 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. The mortality rate was 4.5%. There have been no recurrences to date with a mean follow-up was 46.5 months and the mean Karnofsky score at the last follow-up of 82.3. In this series, 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). CONCLUSION: Our experience suggests that posterior midline suboccipital or far-lateral approaches with minimal condylar drilling and vertebral artery mobilization were suitable for most cases in this series.
OBJECTIVE: We present our experience in managing craniocervical junction meningiomas and discuss various surgical approaches and outcomes. METHODS: We retrospectively reviewed 22 consecutive cases of craniocervical junction meningiomas operated on between August 1995 and May 2012. RESULTS: There were 15 female and 7 male patients (mean age: 54 years). Meningiomas were classified based on origin as spinocranial (7 cases) or craniospinal (15 cases). Additionally, the tumors were divided into anatomical location relative to the brainstem or spinal cord: there were 2 anterior tumors, 7 anterolateral, 12 lateral, and 1 posterolateral. Surgical approaches included the posterior 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. The mortality rate was 4.5%. There have been no recurrences to date with a mean follow-up was 46.5 months and the mean Karnofsky score at the last follow-up of 82.3. In this series, 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). CONCLUSION: Our experience suggests that posterior midline suboccipital or far-lateral approaches with minimal condylar drilling and vertebral artery mobilization were suitable for most cases in this series.