SURGICAL RESULTS FOR MENINGIOMAS OF THE CRANIOCERVICAL JUNCTION

OBJECTIVE: We have undertaken a retrospective analysis of 38 patients who were operated on for 40 meningiomas of the craniocervical junction between September 1977 and August 1995 to determine which factors inf luenced resectability, complications, and postoperative outcomes. METH ODS: Radiological examinations, clinical data, and operation notes wer e evaluated, and additional follow-up information was obtained from ou tpatient examinations, telephone calls, and questionnaires. RESULTS: F our groups could be distinguished according to dural attachment as fol lows: 1) 15 spinocranial meningiomas originated from the spinal canal and extended intracranially; 25 craniocervical meningiomas of intracra nial origin were divided into 2) meningiomas of the lower clivus (10 p atients with 11 tumors), 3) lateral meningiomas (11 patients with 12 t umors), and 4) posterior meningiomas (2 patients). Standard midline or lateral suboccipital approaches with opening of the foramen magnum an d laminectomy of the involved cervical segments were sufficient for th e great majority of tumors. In seven instances only, drilling the post erior third of an occipital condyle was needed. Twelve of 15 spinocran ial meningiomas and 13 of 25 craniocervical meningiomas could be remov ed totally. One patient underwent ventriculoperitoneal shunting only. With a rate of 63% of totally removed and 30% of subtotally removed me ningiomas in this region, we observed clinical recurrences for two pat ients only. Complications were encountered in 30% of patients, predomi nantly with recurrent and/or infiltrative or en plaque meningiomas. Wh ereas motor weakness and gait ataxia tended to improve postoperatively , cranial nerve deficits usually remained unaltered. CONCLUSION: The r elationship of the tumor to neighboring structures, i.e., the vertebra l artery in particular, determines its respectability. We recommend us ing extreme caution with recurrent or en plaque meningiomas and tumors associated with extensive arachnoid scarring.