The Surgical Management of Craniocervical Junction Tumors Involving the Occipital Condyle

Cranial base lesions involving the occipital condyle are uncommon. We describe four patients with tumors in this location who were treated with aggressive resection and simultaneous occipitocervical fusion. Diagnoses included metastatic tumor, hemangioendothelioma, and chondrosarcoma. Two patients had severe pain associated with neck movement preoperatively requiring cervical bracing.

Preoperative embolization was performed in three cases. Operative procedures were performed by a combined neurosurgery–neurootology team, and a far–lateral suboccipital approach with exposure of the upper cervical spine was utilized in all cases. The condylar joint was substantially disrupted by tumor and fully opened during surgery in all cases.

All patients tolerated the procedure well and were maintained in a halo vest after surgery. The only complication occurred in one patient who developed ulnar neuropathy presumably due to positioning. These represent challenging cases because of practical considerations related to positioning, planning an incision to allow for complete tumor resection and fusion without vascular compromise to the skin flap, and protecting the local neural elements and vertebral artery.

A thorough understanding of the local anatomic relationships and careful preoperative planning are absolute prerequisites to successful surgery in this location. The surgical management of lesions involving the condylar region including pertinent anatomy of the craniocervical junction will be discussed in detail.