gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

The extreme lateral trans-odontoid (ELTO) approach for bilaterally extending clivus chordomas and occipito-cervical stabilisation in a single approach – surgical technique and illustrative clinical case (video)

Extrem lateraler trans-odontoidaler Zugang zur Resektion von bilateral ausgedehnten Clivus-Chordomen und zur Kranio-zervikalen Stabilisierung über einen chirurgischen Zugangsweg – chirurgische Technik und klinisches Fallbeispiel (Video)

Meeting Abstract

  • presenting/speaker Jan Frederick Cornelius - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Thomas Beez - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Sebastian A. Ahmadi - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Jörg Schipper - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Daniel Hänggi - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP025

doi: 10.3205/21dgnc313, urn:nbn:de:0183-21dgnc3132

Published: June 4, 2021

© 2021 Cornelius et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Bilaterally extending clivus chordomas with brain stem compression and instability of the cranio-cervical junction (CCJ) require radical tumor removal and stabilization. Often multiple approaches are necessary. Resection is typically performed by a trans-nasal / -clival/ -oral/ -petrous or -condylar route. Occipito-cervical stabilization (OCS) is only possible by a posterior approach. The extreme lateral trans-odontoid approach (ELTO) was recently described. It allows resection of bilaterally extending tumors at the anterior CCJ and posterior OCS in a single stage.

Methods: Detailed description and illustration of the surgical technique of ELTO. Illustrative presentation of a clinical case (video) and critical discussion of advantages and limitations of the ELTO.

Results: ELTO is performed in a lateral position and via a hockey-stick incision. One main feature is extra-dural access to the anterior CCJ from a very lateral angle. The angle is perpendicular to the trans-nasal or –oral route and therefore well-suited for very laterally extending tumors. The ipsilateral C0C1 articular complex, the anterior arch of atlas, the odontoid process, the lower clivus up to the contralateral C0C1 articular complex are in the line of sight. Anteriorly, the retropharyngeal space and posteriorly, the dura covering the clivus are reachable for tumor resection. At the end a screw-rod construct (C0C4) may be routinely performed via the same approach.

A 15-y.o. girl with a giant clivus chordoma extending bilaterally was operated via ELTO. OCS was performed in the same session. A contralateral tumor remnant extending very posteriorly had to be resected in a second stage by a far lateral approach from the opposite side. At last follow-up (1y), the patient was asymptomatic and tumor free.

ELTO had several advantages over trans-nasal or -oral routes: 1.) uncontaminated corridor, 2.) no muco-septal flap, 3.) single-stage procedure including extensive tumor resection and OCS. In the present case, tumor control of the opposite side seemed not completely safe (blind spot) so that a second approach was decided to resect a small remnant.

Conclusion: ELTO seems very useful for extradural tumors of the anterior CCJ. The angle of attack is perpendicular to classical routes allowing bilateral control. Major advantages are an uncontaminated corridor and the possibility of OCS in a single-stage. Careful pre-operative evaluation of imaging is necessary to judge the possibility to safely reach the opposite side.