Surgical Management of Anteriorly Located Tumors at the Craniovertebral Junction: Advances and Challenges

Primary tumors affecting the craniovertebral junction (CVJ) range from benign to malignant lesions. The CVJ tumors are challenging due to their critical anatomical location adjacent to neural and vascular structures. Therefore, more detailed planning of the surgical approach is required to achieve complete tumor resection, reduce risks and offer better clinical outcomes. Several surgical approaches have been described for removal of CVJ tumors. Additionally, the removal of anteriorly located tumors at the CVJ is particularly complex and requires precise and demanding surgical strategies. The transoral, anterolateral, labiomandibular, and circumglossal approaches are usually indicated to access these tumors. However, these surgical approaches are still poorly reported in the literature. In this article, we describe the main approaches to access the anterior tumors at the CVJ, the surgical steps, and their main challenges. Level of Evidence II; Review Article.