Tumor of the Craniovertebral Junction and Its Total Removal

Shcherbuk Yu.A., Martynov B.V., Trufanov G.E., Baranenko Yu.M.

(The Chair of Neurosurgery of the Medicomilitary Academy)

Female patient S. was treated in the Clinic of Neurosurgery since May19 up to June 7, 2000.

Diagnosis: subdural meningioma of an anterior left-sided surface of the spinal cord at the level of C1-C2, spreading to the basilar bone clivus.

On admission the patient complained of pain in the neck and back of the head, which worsened during turning of the head to the sides, weakness in the left arm and leg, a sensation of burning in the right shin and foot. A general state was satisfactory. The patient had no peculiarities from the somatic point of view.

The head was in a forced position and slightly bent forward. Movements in the cervical spine were limited due to pain. Palpation of spinous processes caused pain at the level of C2.

Neurologic examination was indicative of right-sided tetraparesis, reflex hemiparesis, moderate left-sided hemiparesis, more marked in the lower extremity. Babinsky's symptom was positive on the right. There was hyperesthesia in dermatomas C1-C2 on the left. Hyperesthesia of a conductive type manifested itself from the level of the right knee joint. Examination of the eye fundus showed engorged disks.

Radiation diagnosis (spondylography, CT, CT-angiography, MRI, selective angiography of the region of the left vertebral artery) was indicative of tumor, spreading along anterior and left anterolateral surfaces of the spinal cord from the middle of C2 up to the great foramen. Its upper pole intruded into the skull cavity up to the level of the clivus inferior border and filled the intervertebral foramen of C1-C2 on the left and 4/5 of the vertebral canal lumen. The tumor had its own vascular network, supplied mainly by the radicular artery, going in the intervertebral foramen of C1-C2 on the left.

The patient was operated on May 22, 2000 (Shcherbuk Yu.A., Doctor of Medical Science). The operation consisted in laminectomy of C1-C2 and removal of subdural meningioma of anterior and left anterolateral surfaces of the spinal cord at the level of C1-C2 with applying endoscopic video monitoring.

A postoperative course was favorable. Conductive sensation and motor disorders regressed. There was anesthesia in the dermatoma of C1 root on the left. Control CT and MRI examination of the craniovertebral junction was carried out on June 5 and June 2, 2000 respectively. Findings of MRI examination of February 5, 2001 were indicative of a postoperative subdural cyst at the level of C1-C2.

The demonstration goal:

To discuss efficacy of surgical approaches and endoscopic video monitoring in removal of tumors of the spinal cord anterior surface at the level of the craniovertebral junction.