Craniovertebral Junction Tumor [Neurosurgery Wiki]

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====== Craniovertebral Junction Tumor ======

**Definition:**  
CVJ tumors are neoplastic lesions involving the occipital bone, atlas (C1), axis (C2), and adjacent structures. These tumors may be extradural, intradural-extramedullary, or intramedullary.

===== Common Tumor Types =====
  * Meningioma  
  * Chordoma  
  * Schwannoma (CN XI, XII)  
  * Paraganglioma  
  * Metastasis  
  * Epidermoid cyst  
  * Neurofibroma

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===== Treatment =====

===== Goals of Treatment =====
  * Maximal safe resection or control  
  * Preservation of neurological function  
  * Stabilization of the craniovertebral junction (if destabilized)  
  * Symptom relief (e.g., brainstem compression, myelopathy, cranial nerve dysfunction)

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===== Multidisciplinary Planning =====
  * **Imaging:** MRI with contrast ± CT with bone windows  
  * **Neuro-navigation / intraoperative neuromonitoring**  
  * **Preoperative angiography ± embolization** (esp. in vascular tumors like meningiomas or paragangliomas)  
  * **Histology:** Biopsy when necessary (for chordomas, metastases)

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===== Surgical Indications =====
  * Neurological deterioration  
  * Brainstem compression  
  * Spinal cord compression or instability  
  * Progressive symptoms  
  * Tumor growth


===== Surgical Approaches =====

[[Craniovertebral Junction Tumor Surgical Approaches]].



===== Non-Surgical Management =====
  * **Stereotactic Radiosurgery (SRS):** e.g., for chordomas, schwannomas, or residuals  
  * **Fractionated Radiotherapy:** if high risk for injury with surgery  
  * **Chemotherapy:** rarely indicated, unless lymphoma or metastasis  
  * **Observation:** for small, asymptomatic, benign tumors in high-risk locations

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===== Complications =====
  * Lower cranial nerve palsies  
  * CSF leak  
  * Vertebral artery injury  
  * Instability requiring fusion  
  * Dysphagia / aspiration  
  * Infection / wound healing issues

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===== Outcome Predictors =====
  * Tumor location and extension (midline vs lateral)  
  * Histology (benign vs aggressive)  
  * Preoperative neurological status  
  * Surgeon’s experience and approach selection  
  * Use of neuromonitoring and neuronavigation