Cranio-Spinal Junction Tumours: Role of Transoral Approach Followed by Stereotactic Radiotherapy

Cranio-spinal junction tumors are usually approached through posterior, postero-lateral and far lateral approaches but, in case of prevalently anterior extension, with posterior and postero-lateral displacement of brainstem, anterior transoral approach should be considered to achieve a satisfactory tumor removal. Anterior transoral approach allows a direct exposition of the tumor without necessity of nervous/vascular structures manipulation. Postoperative instability is not frequent, and usually posterior stabilization is rarely required. Although transoral approach allows removing only the median part of the tumor’s and in few cases radical removal can be performed, it presents an extremely low rate of new neurological deficit and a rapid resumption of vital activities. Postoperative tumor remnant can be treated, in our experience, with hypofractionated stereotactic radiotherapy with very satisfactory results concerning tumor regrow and recurrence. We believe that in the modern era its capital to deal with this extremely challenging tumor’s with a different goal: to achieve the maximal clinical result, not the maximal surgical resection at all costs.