Central Nervous System Disorders and Therapeutics

Biography

Biography: Hiroyuki Nakase

Abstract

Surgical management of cranio-vertebral junction (CVJ) tumors continues to present as a challenge to neurosurgeons especially in cases at the anterior aspect or involving neighboring neurovascular structures. We here describe our surgical strategy and results of CVJ tumors in our institute. Of the 146 patients with CVJ lesions surgically treated since 2000 in our institute, tumors included 36. The series consist of 17 males and 19 females; their ages ranged from 6 to 76 years old. Tumor types were neurinoma in 14; meningioma in 10; hemangioblastoma in 5; ependymoma in 4; astrocytoma and chordoma, and medulloblastoma in one patient each. Surgical approach were posterior in 26 and extreme lateral approach in 10 cases. The operations were done under intraoperative neurophysiological monitoring in all cases; somatosensory evoked potentials (SEP) and motor evoked potentials (MEP). Temporary pacemaker was inserted in 4 cases in the tumor located in or around the medulla oblongata. No operations required fusion. Total removal of the tumors could be accomplished in 30 and subtotal in 6 cases. No deaths occurred in the perioperative period, but complications include postoperative hemorrhage in 2, cerebellar infarct in 2, swallowing disturbance in 2, sore throat in 3, CSF leakage in 6 and infection in 2. In conclusions, we concluded, from our experiences, that we have to make surgical strategy for CVJ tumors in consideration of the anatomical complexity and postoperative instability as well. Also, neuromonitorings were effective to decrease the morbidity.