• Michaël Bruneau, Jan Frédérick Cornelius, and Bernard George.
• Department of Neurosurgery, Hôpital Lariboisière, Paris, France. bruneau@tiscali.be
• Spine. 2005 Oct 1; 30 (19): E567-71.

Study DesignWe describe our surgical experience to remove osteoid osteomas and osteoblastomas of the occipitocervical junction. In this location, vertebral artery vicinity requires special consideration.ObjectivesWe illustrate our surgical approaches to remove lesions confidently, while minimizing bone resection to preserve stability.Summary Of Background DataUp until now, osteoid osteomas and osteoblastomas of the occipitocervical junction are reported as case reports. Several treatment methods have been described to treat osteoid osteomas. Nevertheless, surgery is the treatment of choice for lesions located in the C0-C2 region.MethodsA retrospective review of 7 patients, including 5 men and 2 women, with a mean age of 21.0 years (range 3.0-38.0) was conducted. Clinical outcomes were evaluated immediately and after a mean follow-up of 27.6 months.ResultsThere were 6 and 1 patients who underwent surgery with the anterolateral and posterolateral approaches, respectively. In osteoid osteomas, the nidus was removed, and the peripheral condensation was drilled up to normal bone (n = 4) or partially resected (n = 2). One osteoblastoma was removed extensively up to soft tissues. No osteo-arthrodesis was performed. Before surgery, all patients complained of pain, 3 presented with neck stiffness, and 2 with a torticollis. Immediately after surgery, all complaints disappeared. One patient underwent repeat surgery 15 months later for a recurrence. At the end of the follow-up, all patients were symptom-free, and partially resected peripheral condensations were stable on computerized tomography.ConclusionsRemoval of osteoid osteomas and osteoblastomas of the occipitocervical junction is safe and efficient. Stability is preserved if more than half the joints are preserved with a proper surgical approach that minimizes bone resection.

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