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Introduction: The surgical treatment of craniovertebral junction (CVJ) lesions remains a difficult process requiring advanced experience. The aim of this study was to present our experience and the clinical results of a posterior and posterolateral approach used for CVJ lesions in our clinic, and to discuss these in light of current literature., Methods: Clinical, radiologic, and surgical aspects of 30 patients with CVJ tumors were retrospectively evaluated. Age, sex, symptoms, tumor localizations, pre- and postoperative neurologic examinations, performed surgical techniques, postoperative complications, and tumor pathologies were analyzed. The modified McCormick classification was used in the evaluation of the neurologic examination., Results: There were 30 patients (12 men, 18 women; mean age: 41.8 years). Hemilaminectomy was performed in 14 cases, and total laminectomy or laminoplasty in 16 cases; additional suboccipital craniectomy was performed in 6. Postoperative mortality was observed in 1 (3.3%) patient in the early postoperative period following tetraparesis, motor deficit in 2 (6.6%), cerebrospinal fluid leakage in 2 (6.6%), and wound site infection in 1 (3.3%). A tumor rest was detected in 2 patients (6.6%)., Conclusions: A posterior or a posterolateral approach is a safe surgical technique that can provide total tumor resection for CVJ region lesions, including posterior, posterolateral, lateral, and anterolaterally located tumors. Isolated anterior and anterolateral tumors with small lateral extension may require a far lateral or extreme lateral approach combined with other cranial base techniques., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Cranial base chordomas are complex lesions centered on the clivus that surgically can be approached from either a midline or a lateral corridor., Objective: To compare the surgical outcomes from midline versus lateral approaches by conducting a meta-analysis of the literature., Methods: Studies were identified between 2000 and 2018. The primary outcome was gross total resection (GTR) rate. The secondary outcomes were recurrence rate and rates of cerebrospinal fluid (CSF) leak and new cranial nerve palsy. Odds ratios were calculated with a random-effect model using studies describing both approaches. An indirect (proportion) meta-analysis was performed pooling studies describing either of the approaches. Individual patient data were analyzed for differences in GTR or recurrence rate with different tumor extensions., Results: Thirty-three studies were found suitable for indirect meta-analysis and 10 studies for direct meta-analysis. The overall odds of GTR with a midline approach compared with a lateral approach was 0.83 (95% confidence interval [CI], -0.43 to 1.62). The odds ratios for recurrence, CSF leak, and new cranial nerve palsy were 0.82 (95% CI, 0.26-2.56), 1.49 (95% CI, 0.14-15.5), and 0.14 (95% CI, 0.04-0.56), respectively. With individual patient data analysis, no statistically significant difference was observed in GTR or recurrence rates between the 2 approaches with different tumor extensions., Conclusions: The meta-analysis did not show any significant difference in GTR or recurrence rates between the midline versus lateral approaches. Tumor extension to different compartments did not affect the GTR or recurrence rates with either approach. In terms of complications, CSF leak rate was higher in midline approaches and cranial nerve palsy was higher in lateral approaches., (Copyright © 2020 Elsevier Inc. All rights reserved.)