Surgical outcomes of craniocervial junction meningiomas: A series of 22 consecutive patients

Objective We present our experience in managing craniocervical junction meningiomas and discuss various surgical approaches and outcomes. Methods We retrospectively reviewed 22 consecutive cases of craniocervical junction meningiomas operated on between August 1995 and May 2012. Results There were 15 female and 7 male patients (mean age: 54 years). Meningiomas were classified based on origin as spinocranial (7 cases) or craniospinal (15 cases). Additionally, the tumors were divided into anatomical location relative to the brainstem or spinal cord: there were 2 anterior tumors, 7 anterolateral, 12 lateral, and 1 posterolateral. Surgical approaches included the posterior midline suboccipital approach (9 cases), the far lateral approach (12 cases) and the lateral retrosigmoid approach (1 case). Gross-total resection was achieved in 45% of patients and subtotal in 55%. The most common post-operative complications were cranial nerve (CN) IX and X deficits. The mortality rate was 4.5%. There have been no recurrences to date with a mean follow-up was 46.5 months and the mean Karnofsky score at the last follow-up of 82.3. In this series, spinocranial tumors were detected at a smaller size (p = 0.0724) and treated earlier (p = 0.1398) than craniospinal tumors. They were associated with a higher rate of total resection (p = 0.0007), fewer post-operative CN IX or X deficits (p = 0.0053), and shorter hospitalizations (p = 0.08). Conclusion Our experience suggests that posterior midline suboccipital or far-lateral approaches with minimal condylar drilling and vertebral artery mobilization were suitable for most cases in this series.