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68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
7. Joint Meeting mit der Britischen Gesellschaft für Neurochirurgie (SBNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

14. - 17. Mai 2017, Magdeburg

Contemporary approaches to the ventral craniospinal junction

Meeting Abstract

  • Mark Nowell - Southmead Hospital, Bristol, United Kingdom
  • G. Malcolm - Southmead Hospital, Bristol, United Kingdom
  • N. Patel - Southmead Hospital, Bristol, United Kingdom
  • C. Wigfield - Southmead Hospital, Bristol, United Kingdom
  • R. Nelson - Southmead Hospital, Bristol, United Kingdom

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.23.08

doi: 10.3205/17dgnc314, urn:nbn:de:0183-17dgnc3144

Veröffentlicht: 9. Juni 2017

© 2017 Nowell et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

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.