Surgical Treatment of Lateral Skull Base Tumors Extending to the Craniovertebral Junction

OBJECTIVE: To evaluate the clinical manifestation, surgical strategies, and long-term outcomes of lateral skull base tumors extending to the craniovertebral junction (CVJ), with a focus on the infratemporal fossa approach (IFA) and individualized treatment options for cervical-occipital stability. METHODS: This retrospective cohort study included 12 patients with lateral skull base tumors extending to the CVJ who underwent surgical treatment between 2018 and 2024. Surgical resection via IFA (Type A, Type B, or Type A + Type B), with OCF performed when indicated by the extent of occipital condyle and C1-C2 resection. RESULTS: Primary presenting symptoms included hearing loss (42%), headache (25%), and neck mass (17%). Imaging demonstrated that the original lateral skull base primary tumors often involved the temporal bone (92%), foramen magnum (92%), and jugular foramen (83%). Eight patients (67%) needed staged resections, while four (33%) patients underwent one-stage surgery. Occipitocervical fusion (OCF) was performed in five patients (42%), and the others received rigid collar or Halo-vest immobilization. Gross-total resection was accomplished in 11 patients (92%); one patient (8%) received palliative treatment. No recurrence was observed in these cases during a median follow-up of 45 months (range 6-78). Persistent posterior cranial nerve deficits occurred in 83% of the patients, and 33% developed transient aspiration pneumonia, both of which resolved with treatment. CONCLUSION: In a multidisciplinary context, the IFA, when combined with selective OCF, allows for complete resection and long-term tumor control of complex lateral skull base-CVJ tumors. This approach achieves both oncologic radicality and biomechanical stability.