{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:23:47Z","timestamp":1756383827301,"version":"3.41.2"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T00:00:00Z","timestamp":1629158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Removal of anteriorly located tumors of the upper cervical spine and craniovertebral junction (CVJ) is a particular surgical challenge. Extensive approaches are associated with pain, restricted mobility of neck and head and, in case of foramen magnum and clivus tumors, with retraction of brainstem and cerebellum.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Four symptomatic patients underwent resection of anteriorly located upper cervical and lower clivus meningiomas without laminotomy or craniotomy using a minimally invasive posterior approach. Distances of natural gaps between C0\/C1, C1\/C2, and C2\/C3 were measured using preoperative CT scans and intraoperative lateral x-rays.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> In all patients, safe and complete resection was conducted by the opening of the dura between C0\/C1, C1\/C2, and C2\/C3, respectively. There were no surgical complications. Local pain was reported as very moderate by all patients and postoperative recovery was extremely fast. All tumors had a rather soft consistency, allowing mass reduction prior to removal of the tumor capsule and were well separable from lower cranial nerves and vascular structures.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> If tumor consistency is appropriate for careful mass reduction before removal of the tumor capsule and if tumor margins are not firmly attached to crucial structures, then upper cervical, foramen magnum, and lower clivus meningiomas can be safely and completely removed through natural gaps in the CVJ region. Both prerequisites usually become clear early during surgery. Thus, this tumor entity may be planned using this minimally invasive approach and may be extended if tumor consistency turns out to be less unfavorable for resection or if crucial structures cannot be easily separated from the tumor.<\/jats:p>","DOI":"10.3389\/fsurg.2021.666699","type":"journal-article","created":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T15:49:38Z","timestamp":1629215378000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case Report: A Case Series Using Natural Anatomical Gaps\u2014Posterior Cervical Approach to Skull Base and Upper Craniocervical Meningiomas Without Bone Removal"],"prefix":"10.3389","volume":"8","author":[{"given":"Nadine","family":"Lilla","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Almuth F.","family":"Kessler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith","family":"Weiland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralf-Ingo","family":"Ernestus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Westermaier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,8,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"E535","DOI":"10.1097\/BRS.0000000000001320","article-title":"Surgical morbidity and mortality associated with transoral approach to the cervical spine","volume":"41","author":"Steinberger","year":"2016","journal-title":"Spine."},{"key":"B2","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1016\/j.wneu.2016.12.001","article-title":"Gardner outcomes of endonasal and lateral approaches to petroclival meningiomas","volume":"99","author":"Koutourousiou","year":"2017","journal-title":"World Neurosurg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1093\/neuros\/nyw002","article-title":"Occipitocervical instability after far-lateral transcondylar surgery: a biomechanical analysis","volume":"80","author":"Mazur","year":"2017","journal-title":"Neurosurgery."},{"key":"B4","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/j.wneu.2015.10.037","article-title":"transtubular microsurgical approach to treat lateral cervical disc herniation","volume":"88","author":"Eicker","year":"2016","journal-title":"World Neurosurg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1007\/s10143-013-0457-y","article-title":"Custom-tailored minimally invasive partial C2-corpectomy for ventrally located intramedullary cavernous malformation","volume":"36","author":"Eicker","year":"2013","journal-title":"Neurosurg Rev."},{"key":"B6","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1097\/01.bsd.0000169062.77005.78","article-title":"DuPlessis. SJ. Minimally invasive anterior approach to upper cervical spine: surgical technique","volume":"18","author":"Fong","year":"2005","journal-title":"J Spinal Disord Tech."},{"key":"B7","doi-asserted-by":"publisher","first-page":"S509","DOI":"10.1007\/s00586-011-2138-2","article-title":"C2 lamina reconstruction using locking miniplate for the intradural tumor of the craniocervical junction (two case reports)","volume":"4","author":"Ikuma","year":"2012","journal-title":"Eur Spine J, 21 Suppl."},{"key":"B8","doi-asserted-by":"publisher","first-page":"202","DOI":"10.5137\/1019-5149.JTN.6744-12.1","article-title":"Supracondylar transjugular tubercle approach to intradural lesions anterior or anterolateral to the craniocervical junction without resection of the occipital condyle","volume":"23","author":"Li","year":"2013","journal-title":"Turk Neurosurg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1227\/01.NEU.0000080070.16099.BB","article-title":"Comparison of the far lateral and extreme lateral variants of the atlanto-occipital transarticular approach to anterior extradural lesions of the craniovertebral junction","volume":"53","author":"Kawashima","year":"2003","journal-title":"Neurosurgery."},{"key":"B10","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1227\/01.NEU.0000176848.05925.80","article-title":"Far-lateral approach to the craniocervical junction","volume":"57","author":"Lanzino","year":"2005","journal-title":"Neurosurgery."},{"key":"B11","doi-asserted-by":"publisher","first-page":"18","DOI":"10.4103\/1793-5482.85629","article-title":"Surgical treatment of ventral and ventrolateral intradural extramedullary tumors of craniovertebral and upper cervical localization","volume":"6","author":"Zozulya","year":"2011","journal-title":"Asian J Neurosurg."},{"key":"B12","first-page":"115","article-title":"Surgery of ventral intradural midline cervical spinal pathologies via anterior cervical approach: our experience","volume":"56","author":"Banczerowski","year":"2003","journal-title":"Ideggyogy Sz."},{"key":"B13","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1016\/0090-3019(88)90145-0","article-title":"Lateral approach to the anterior portion of the foramen magnum. Application to surgical removal of 14 benign tumors: technical note","volume":"29","author":"George","year":"1988","journal-title":"Surg Neurol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1227\/01.NEU.0000360131.78702.9B","article-title":"Anterolateral approach without fixation for resection of an intradural schwannoma of the cervical spinal canal: technical note","volume":"65","author":"Yasuda","year":"2009","journal-title":"Neurosurgery."},{"key":"B15","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/s10143-007-0097-1","article-title":"Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisiere Hospital and review of the literature","volume":"31","author":"Bruneau","year":"2008","journal-title":"Neurosurg Rev."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1592","DOI":"10.1016\/j.spinee.2018.02.002","article-title":"\u201cMicroendoscopic\u201d versus \u201cpure endoscopic\u201d surgery for spinal intradural mass lesions: a comparative study and review","volume":"18","author":"Dhandapani","year":"2018","journal-title":"Spine J."},{"key":"B17","doi-asserted-by":"publisher","first-page":"615","DOI":"10.3171\/2018.4.SPINE171156","article-title":"The full-endoscopic uniportal technique for decompression of the anterior craniocervical junction using the retropharyngeal approach: an anatomical feasibility study in human cadavers and review of the literature","volume":"29","author":"Ruetten","year":"2018","journal-title":"J Neurosurg Spine."},{"key":"B18","doi-asserted-by":"publisher","first-page":"254","DOI":"10.3171\/jns.1995.83.2.0254","article-title":"Posterolateral cervical or thoracic approach with spinal cord rotation for vascular malformations or tumors of the ventrolateral spinal cord","volume":"83","author":"Martin","year":"1995","journal-title":"J Neurosurg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1007\/s00776-008-1309-4","article-title":"Upper cervical spinal cord tumors: review of 13 cases","volume":"14","author":"Fountas","year":"2009","journal-title":"J Orthop Sci."},{"key":"B20","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1227\/01.NEU.0000339121.20101.85","article-title":"Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations","volume":"64","author":"Dehdashti","year":"2009","journal-title":"Neurosurgery"},{"key":"B21","doi-asserted-by":"publisher","first-page":"86","DOI":"10.4103\/0974-8237.77672","article-title":"Approaches to anterior and anterolateral foramen magnum lesions: A critical review","volume":"1","author":"Komotar","year":"2010","journal-title":"J Craniovertebr Junction Spine."}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.666699\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T15:49:42Z","timestamp":1629215382000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.666699\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,17]]},"references-count":21,"alternative-id":["10.3389\/fsurg.2021.666699"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2021.666699","relation":{},"ISSN":["2296-875X"],"issn-type":[{"type":"electronic","value":"2296-875X"}],"subject":[],"published":{"date-parts":[[2021,8,17]]},"article-number":"666699"}}