Occipital Condylectomy

Tumors around the cervicomedullary junction are rare and constitute 5% of spinal tumors and 1% of cranial tumors. 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 meningiomas 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. ¹⁾.

2: Fiani B, Jarrah R, Sarno E, Kondilis A, Pasko K, Musch B. An investigation of craniocervical stability post-condylectomy. Surg Neurol Int. 2021 Jul 27;12:380. doi: 10.25259/SNI_456_2021. PMID: 34513147; PMCID: PMC8422489.

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10: Kshettry VR, Healy AT, Colbrunn R, Beckler DT, Benzel EC, Recinos PF. Biomechanical evaluation of the craniovertebral junction after unilateral joint- sparing condylectomy: implications for the far lateral approach revisited. J Neurosurg. 2017 Oct;127(4):829-836. doi: 10.3171/2016.7.JNS16293. Epub 2016 Oct 14. PMID: 27739941.

11: Wang WH, Abhinav K, Wang E, Snyderman C, Gardner PA, Fernandez-Miranda JC. Endoscopic Endonasal Transclival Transcondylar Approach for Foramen Magnum Meningiomas: Surgical Anatomy and Technical Note. Oper Neurosurg (Hagerstown). 2016 Jun 1;12(2):153-162. doi: 10.1227/NEU.0000000000001102. PMID: 29506094.

12: Caplan JM, Jusue-Torres I, Kim JE, Luksik A, Liauw J, Gottschalk A, Tamargo RJ. Far-lateral transcondylar approach for microsurgical trapping of an anterior inferior cerebellar artery aneurysm. Neurosurg Focus. 2015 Jul;39 Video Suppl 1:V6. doi: 10.3171/2015.7.FocusVid.14581. PMID: 26132623.

13: Walkden JS, Cowie RA, Thorne JA. Occipitocondylar hyperplasia and syringomyelia presenting with facial pain. J Neurosurg Pediatr. 2013 Dec;12(6):655-9. doi: 10.3171/2013.8.PEDS13288. Epub 2013 Sep 27. PMID: 24073749.

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