(A171) Surgical Management of Extradural Tumors at the Craniovertebral Junction: A 9-Year AIIMS Delhi Study

Background: Extradural lesions involving the craniovertebral junction (CVJ) are rare. It is difficult to excise these lesions due to their location, relationship to complex neurovascular structures and the requirement of fixation. The aim of this study was to evaluate our experience in dealing with craniovertebral junction extradural lesions.

Methods: A total of 21 patients with CVJ extradural lesions were operated during the period ranging from January 2009 to July 2018 at our institute. Data of these patients was taken out from the computerized database of our hospital. Patients’ symptoms and clinical signs were assessed and analyzed. Levels of involvement were assessed in preoperative imaging studies. Details of the surgical procedure were noted. Patients were followed up clinically and radiologically.

Results: Mean age of the study population was 41 years. There were 16 males and 5 females in the study cohort. Most common symptom was axial neck pain seen in 15 patients (71.42%) followed by weakness in 8 patients, and sensory symptoms in 5 patients. Gross- and near-total excision was achieved in 4 out of 21 patients (19.05%) each, while 13 patients had only subtotal excision of tumor. Fifteen patients (71.42%) required fixation out of which one underwent anterior fixation and 14 (93.3%) underwent posterior fixation. Most common pathology in the study was multiple myeloma followed by giant cell tumor, chordoma, and Langerhans cell histiocytosis. Two patients improved after surgery with decreased weakness and spasticity, while most (15 out of 21) remained neurologically same. Four patients (19.05%) experienced neurological deterioration in postoperative period. One of the two patients who died after surgery had presented with acute respiratory difficulty and quadriparesis. Delayed postoperative deterioration was not seen in any patient.

Conclusion: Patients with CVJ lesions are prone to neurological deficits in perioperative period. Fixation is needed in most cases specially those involving multiple levels. Prognosis depends primarily on the histopathology rather than the extent of involvement. The management of these patients needs to be tailored according to suspected pathology and location.