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.

• Meningioma
• Chordoma
• Schwannoma (CN XI, XII)
• Paraganglioma
• Metastasis
• Epidermoid cyst
• Neurofibroma

• 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)

• 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)

• Neurological deterioration
• Brainstem compression
• Spinal cord compression or instability
• Progressive symptoms
• Tumor growth

Craniovertebral Junction Tumor Surgical Approaches.

• 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

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

• 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