Artikel
Contemporary approaches to the ventral craniospinal junction
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Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Design: Single centre retrospective case series.
Subjects: 7 patients underwent approaches to the ventral craniospinal junction (clivus-C2) for: meningioma, schwannoma, chordoma, sarcoma, basilar invagination, inflammatory rheumatoid pannus and medullary compression secondary to delayed cranial settling.
Methods: We describe the technical considerations that determine the choice of operative approaches to the ventral craniospinal junction; the risks and benefits of each approach; and the requirement for stabilization
Results: Factors that influence the type of approach include: the extent of exposure in the sagittal plane relative to the hard palate; the location of the pathology relative to the neuroaxis in the axial plane and access to the tumour in the coronal plane. A C1/2 meningioma was approached by a transoral transpharyngeal microsurgical route; medullary compression secondary to basilar invagination by a transnasal endoscopic route; medullary compression secondary to inflammatory rheumatoid pannus by a transnasal transpharyngeal endoscopic route; clival chordoma by a transoral transpharyngeal combined microscopic and endoscopic route; medullary compression secondary to cranial settling by an endoscopic transnasal transphenoidal route; a foramen magnum schwannoma with ventral extension by a lateral transforaminal approach and a C2 sarcoma by a high cervical retropharyngeal route. The surgical approaches were well tolerated. One patient suffered significant complications due to a delayed CSF fistula.
Conclusions: Rare pathologies of the ventral craniospinal junction may be successfully managed using a combination of microsurgical and endoscopic anterior, anterolateral and posterolateral approaches.