A Surgical Corridor for the Craniocervical Junction: A 360-Degree View

The craniocervical junction (CCJ) forms a transition between the brain and cervical spine and comprises the foramen magnum, atlas (C1), axis (C2), ligaments, and musculature associated with the C1-C2 vertebrae. The CCJ is comprised of the inferior surface of the skull, the atlas, and axis, as well as muscles and connective tissue that attach the skull to the cervical spine. The major vascular and nervous structures surrounding this junction make it one of the most challenging, not only in terms of approach but also in terms of stabilization. Multiple approaches to the CCJ have been described, including anterior, ventral, posterior, and lateral. The choice of approach is dictated by the location and nature of the tumor compression, and it is important to understand the growing pattern in tumoral cases. In this chapter, we will review some of the most common approaches to the CCJ and the indications for each of these.