Transoral Removal of Ventrally Located Meningiomas of the Craniovertebral Junction

BACKGROUND: Surgical treatment of ventral pathologic lesions of the craniovertebral junction and upper cervical spine is extremely difficult due to limited accessibility, as well as the difficulty of performing surgical manipulations in a deep, narrow wound in conditions of restricted surgical freedom and angle of attack. METHODS: In this article we present 2 clinical cases in which the transoral approach was used to treat ventral meningiomas of the craniovertebral junction. Endoscopic assistance and an original method of anterior atlantooccipital stabilization were used. RESULTS: Subtotal removal in the first case and complete removal of the tumor in the second case were achieved. In the first case, an unsuccessful attempt of anterior stabilization was made. In the second case, there were no indications for instrumentation (anterior or posterior) as local bone autograft fusion between the condyles and lateral masses of C1 was effectively carried out. CONCLUSIONS: Previously, the transoral approach garnered interest only from a historical point of view, but with technical progress it has acquired a "second life." Novel surgical techniques allow for a more radical resection of named tumors, as well as lower morbidity and invasiveness of the surgical procedures, which, in the long term, leads to lower complication rates.