Tumors of the craniocervical junction: Overview and update

Abstract

The craniocervical junction (CCJ) is a complex region that represents the transition zone between the cranium and the mobile cervical spine from the occiput to C2 [ 42 ]. Of particular interest in this region is the foramen magnum (FM) area, which is limited anteriorly, from the lower third of the clivus to the upper part of the body of C2; posteriorly, from the anterior edge of the squamous occipital bone to C2 spinous process; and laterally, from the jugular tubercles to the superior aspect of C2 laminae and C1–C2 facet joints [ 7, 13, 14 ]. The cisterna magna, the prebulbar, laterobulbar, lateromedullary, and premedullary cisterns are the intradural spaces confi ned to these bone limits [ 14 ]. Such limits also include several neurovascular structures, which can be affected by a broad spectrum of lesions from osseous, neural, vascular, congenital, degenerative, metastatic, and rarely infl ammatory or infectious, as well as traumatic origin [ 6, 8, 10, 13, 14, 24 – 26, 28, 43 ]. Tumors are the hallmark pathology in the FM area occurring in up to 93.8 % of surgically treated lesions [ 14, 43 ]. Meningiomas and neurinomas are by far the most common pathologies corresponding to 40.5–75 % of all FM tumors [ 1, 4, 13, 14, 25, 28, 32, 38, 43 ], while chordomas and chondrosarcomas have been reported in circa 7–41 % of the patients [ 13, 14, 24, 25, 32 ].