gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Tumors of the craniocervical region: Clinical and surgical results

Tumore der kraniozervikalen Übergangsregion: Klinische und chirurgische Ergebnisse

Meeting Abstract

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  • corresponding author M. Krammer - Neurochirurgische Klinik, Akademisches Lehrkrankenhaus München Bogenhausen, Technische Universität München
  • H. Gumprecht - Neurochirurgische Klinik, Akademisches Lehrkrankenhaus München Bogenhausen, Technische Universität München
  • C. Lumenta - Neurochirurgische Klinik, Akademisches Lehrkrankenhaus München Bogenhausen, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.02.01

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc210.shtml

Veröffentlicht: 11. April 2007

© 2007 Krammer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Tumors located at the craniocervical junction close to vital neurovascular structures are considered to be difficult to access. We performed a retrospective analysis of 63 consecutive patients with mass lesions of the craniocervical region. These patients underwent neurosurgical resection in a ten year period at our service.

Methods: We analyzed the clinical and radiological data as well as the surgical treatment in order to asses the factors affecting the outcome. In our series we used the Clinical Scoring System (CSS) by Samii et al. There were 40 intrinsic and 23 extrinsic tumors of different pathology, mostly meningioma and neurinoma as well as hemangioblastoma, cavernoma and glioma. We used the standard midline or lateral suboccipital approach for all tumors located lateral and dorsal to the brainstem. The transoral approach is adequate for extradural tumors in a ventral location. Intraoperative neurophysiologic monitoring with SSEP, MEP, AEP, EMG as well as CN nuclei monitoring was performed in most cases.

Results: A total removal of the lesion was achieved in 45 patients (72%) and subtotal removal in 18 patients (28%). At the time of follow-up (9 to 78 months) 60% of the patients had improved, 25% were unchanged and 15% had deteriorated. The mean CSS of gait ataxia (3.651) and caudal cranial nerve deficits (4.348) decreased slightly postoperatively (3.641/ 3.897) and improved significantly at the time of the last follow-up examination (4.391/ 4.608).

Conclusions: The relationship of the tumor to adjacent structures and the pathology determines the resectability. Intraoperative monitoring, a proficient surgical approach and technique for total tumor resection are necessary for a good outcome. In all patients but three with an extradural ventral tumor, a median or lateral suboccipital approach was used.