Craniocervical Junction Neoplastic Conditions

ABSTRACT

Neoplastic conditions of the craniocervical region are uncommon. Primary tumors arising at the craniocervical junction include meningiomas, neurinomas, and chordomas. Metastatic disease is exceedingly uncommon at the craniocervical junction, but may involve the atlantoaxial region. The clinical presentation of primary tumors of the craniocervical region is generally that of slowly progressive neurologic dysfunction.

The clinical characteristics of metastatic disease of the atlantoaxial region are markedly different from those of metastatic disease of the subaxial cervical spine because of differences in regional anatomy and biomechanics. Metastatic lesions of C1 and C2 most frequently present with severe pain and only rarely with neurologic involvement.

Optimal treatment is dependent on the tumor location and pathology. Primary tumors often require surgical resection, although complete resection is difficult because of the location and intimate involvement of adjacent structures. Goals of treatment for patients with atlantoaxial metastatic disease are stabilization of the spine, prevention of neurologic deterioration, maintenance of mobility, and amelioration of pain.

KEYWORDS

Neoplasm - craniocervical - atlanto-axial

REFERENCES

• 1 Batsakis J G, Soloman A R, Rice D H. The pathology of head and neck tumors: neoplasms of cartilage, bone, and the notochord.  Head Neck Surg . 1980;  3 43-57
• 2 Kratimenos G P, Crockard H A. The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours.  Br J Neurosurg . 1993;  7 129-140
• 3 Abdu W A, Provencher M. Primary bone and metastatic tumors of the cervical spine.  Spine . 1998;  23 2767-2777
• 4 Caspar C, Pitzer T, Papavero L, Geisler F, Johnson T. Anterior cervical plating for the treatment of neoplasms in the cervical vertebrae.  J Neurosurg (Spine 1) . 1999;  90 27-34
• 5 Dunn E J, Anas P P. The management of tumors of the upper cervical spine.  Orthop Clin North Am . 1978;  9 1065-1080
• 6 Hastings D E, Macnab I, Lawson V. Neoplasms of the atlas and axis.  Can J Surg . 1968;  11 290-296
• 7 Rao S, Badani K, Schildhauer T. Metastatic malignancy of the cervical spine. A nonoperative history.  Spine . 1992;  17 S407-S412
• 8 York J E, Kaczaraj A, Abi-Said D. Sacral chordoma: 40-year experience at a major cancer center.  Neurosurgery . 1999;  44 74-80
• 9 Richter H J, Batsakis J G, Boles R. Chordomas: nasopharyngeal presentation and atypical long survival.  Ann Otol . 1975;  84 327-332
• 10 Abumi K, Kaneda K, Shone Y, Fujuja M. One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems.  J Neurosurg (Spine 1) . 1999;  90 19-26
• 11 Harrington K D. Metastatic disease of the spine.  J Bone Joint Surg Am . 1986;  68 1110-1115.
• 12 Samii M, Klekamp J, Carvalho G. Surgical results for meningiomas of the craniocervical junction.  Neurosurgery . 1996;  39 1086-1095
• 13 Yasargil M G, Mortara R W, Curic M. Meningiomas of basal posterior cranial fossa.  Adv Tech Stand Neurosurg . 1980;  7 3-115
• 14 Levine A M, Boriani S, Donati D, Campanacci M. Benign tumors of the cervical spine.  Spine . 1992;  17(10 suppl) S399-S406
• 15 Phillips E, Levine A M. Metastatic lesions of the upper cervical spine.  Spine . 1989;  14 1071-1077
• 16 Sundaresan N, Galicich J H, Lane J M, Greenberg H S. Treatment of odontoid fractures in cancer patients.  J Neurosurg . 1981;  54 187-192
• 17 Nakamura M, Toyama Y, Suzuki N, Fujimura Y. Metastases to the upper cervical spine.  J Spinal Disord . 1996;  9 195-201
• 18 Jonsson B, Jonsson Jr H, Karlstrom G, Sjostrom L. Surgery of cervical spine metastases: a retrospective study.  Eur Spine J . 1994;  3 76-83
• 19 Atanasiu, Badatcheff F, Pidhorz L. Metastatic lesions of the cervical spine: a retrospective analysis of 20 cases.  Spine . 1993;  18 1279-1284
• 20 Abumi K, Kaneda K. Pedicle screw fixation for nontraumatic lesions of the cervical spine.  Spine . 1997;  22 1853-1863
• 21 Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M. Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems.  Spine . 1999;  24 1425-1434
• 22 Apfelbaum R, Lonser R, Veres R, Casey A. A two-center experience with direct anterior screw fixation for recent and remote odontoid fractures.  J Neurosurg . 2000;  S227-S236
• 23 Apostolides P J, Dickman C A, Golfinos J G, Papadopoulos S M, Sonntag V K. Threaded Steinmann pin fusion of the craniovertebral junction.  Spine . 1996;  21 1630-1637
• 24 Dickman C A, Sonntag V K, Papadopoulos S M, Hadley M N. The interspinous method of posterior atlantoaxial arthrodesis.  J Neurosurg . 1991;  74 190-198
• 25 Hertlein H, Mittlmeier T, Schurmann M, Lob G. Posterior stabilization of C2 metastases by combination of atlantoaxial screw fixation and hook plate.  Eur Spine J . 1994;  3 52-55
• 26 McAfee P C, Bohlman H H, Ducker T B, Zeidman S M, Goldstein J A. One-stage anterior cervical decompression and posterior stabilization. A study of one hundred patients with a minimum of two years of follow-up.  J Bone Joint Surg Am . 1995;  77 1791-1800
• 27 Newman P, Sweetnam R. Occipito-cervical fusion. An operative technique and its indications.  J Bone Joint Surgery Br . 1969;  51 423-431
• 28 Piper J G, Menezes A H. Management strategies for tumors of the axis vertebra.  J Neurosurg . 1996;  84 543-551
• 29 Song G S, Theodore N, Dickman C A, Sonntag V K. Unilateral posterior atlantoaxial transarticular screw fixation.  J Neurosurg . 1997;  87 851-855
• 30 Fehlings M G, Errico T, Cooper P, Benjamin V, DiBartolo T. Occipitocervical fusion with a five-millimeter malleable rod and segmental fixation.  Neurosurgery . 1993;  32 198-208
• 31 Jackson R J, Gokaslan Z L. Occipitocervicothoracic fixation for spinal instability in patients with neoplastic processes.  J Neurosurg . 1999;  91(1 suppl) 81-89
• 32 Rea G L, Mullin B B, Mervis L J, Miller C L. Occipitocervical fixation in nontraumatic upper cervical spine instability.  Surg Neurol . 1993;  40 255-261