• Shashank Sharad Kale, Sandeep Mishra, Kanwaljeet Garg, SinghPankaj KumarPKDepartment of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India., Sachin Borkar, Deepak Agrawal, Rajender Kumar, Manmohan Singh, Ashish Suri, and P S Chandra.
• Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.
• World Neurosurg. 2024 Sep 1; 189: e652e661e652-e661.

BackgroundCraniovertebral junction (CVJ) tumors are challenging due to their unique anatomical location. This study aimed to evaluate the complexities in dealing with such precarious CVJ extradural lesions over the decade.MethodsTwenty-seven patients of extradural CVJ tumors operated between 2009 and 2018 were included. The demographic details, neurological status, surgical approach, extent of resection, type of fixation, complications, and outcome at final follow-up were recorded for each patient.ResultsThe mean age of the patients was 39.5 ± 20 years. Most (17/27) of the patients had involvement of a single level. Clivus was the most common (9/17) involved region followed by atlas (7/17) vertebrae. Majority of the patients (13/27) were operated through the posterior-only approach. About 15 patients (55.5%) had instability or extensive lesions that necessitated posterior fixation. None of the patients underwent anterior fixation. Gross and near total excision were achieved in 10 patients (37%) and 3 patients (11%) respectively while 14 patients underwent subtotal excision of tumor. On histopathological analysis, clival chordoma (8/27) was found to be the most common pathology followed by giant cell tumor (6/27), plasmacytoma (4/27), and multiple myeloma (2/27). Most patients (13 out of 27) had the same neurological status after the surgery. Six patients (22%) improved post-operatively with decreased weakness and spasticity. Thirteen (48%) patients underwent adjuvant radiotherapy.ConclusionsThis retrospective study provides valuable insights into managing extradural CVJ tumors and highlights the importance of individualized approaches for optimal outcome.Copyright © 2024 Elsevier Inc. All rights reserved.

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