Craniocervical junction meningioma [Neurosurgery Wiki]

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====== Craniocervical junction meningioma ======

Craniocervical Junction (CCJ) meningiomas account for 1.8–3.2% of all [[meningioma]]s
((Heros RC (1986) Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg 64(4): 559-562.)).

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Tumors around the [[cervicomedullary junction]] are rare and constitute 5% of [[spinal tumor]]s and 1% of [[cranial tumor]]s. The [[approach]] to these lesions is difficult because of the close proximity of the [[medulla]] and cervical spinal cord, [[lower cranial nerves]], and [[vertebral artery]] (VA) as well as the complex articulation between [[occipital condyle]], [[C1]] and [[C2]]. [[Cervicomedullary junction meningioma]]s are commonly classified based on their origin in relation to the [[dentate ligament]], but the relationship to the VA typically plays an important role in deciding the surgical approach. For lesions located dorsal to the dentate ligament and not involving the VA, a midline approach is typically sufficient. However, when the VA is involved a [[far lateral approach]] is preferred as it offers better access to the V4 segment. Budohoski et al. described a case of a 55-yr-old man who presented with [[accessory nerve]] palsy and mild [[upper motor neuron]] signs and was found to have a C1 [[meningioma]] encasing and narrowing the VA at the V3/V4 segment. [[Informed consent]] was obtained. The patient was treated with a right [[far lateral approach]] with limited [[condylectomy]] to gain access to the V4 segment. They described the steps used for safe [[resection]] of the tumor around the VA from distal to proximal. They demonstrated the relationship of the tumor to the VA and the need to completely skeletonize the VA to achieve a [[gross total resection]]. They supplemented the [[discussion]] with a 3D surgical [[video]].
((Budohoski KP, Barone DG, Mediratta S, Ross MI, Kirollos RW, Santarius T,
Trivedi RA. Far Lateral Approaches: C1 Meningioma With Vertebral Artery
Involvement: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2022
Jan 1;22(1):e48. doi: 10.1227/ONS.0000000000000031. PMID: 34982918.)).