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Transoral approach clival mass – New Frontiers in Managing Clival Tumors — The Extended Endoscopic Endonasal Approach

Conclusions: The OS is an effective method to compare surgical approaches. Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics.

Cancer 32 transoral approach clival mass —false. Cossu, R. A well-known fact that characterizes the advantages of the endoscopic transnasal approach is that it can be used to access almost the entire base of the skull and the craniovertebral transition, from the posterior ethmoidal air cells to the axis, and allow for radical tumor removal with minimal impact on the stem structures. Otolaryngol Head Neck Surg 92 : —false. Surgical method for treating diffusely growing tumors of cranium base with craniovertebral articulation instability.

  • F: Epidural tumor removal.

  • Abstract Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics.

  • Lastly, we emphasize that the endoscopic resection of clival lesions requires specific endoscopic instrumentation and expertise. Carrau, M.

  • The authors report the case of a 5-year-old boy in whom extraneural metastases developed 5 years after he underwent an occipitocervical fusion and transoral approach to treat a clival chordoma without local recurrence.

chapter and author info

J Neurosurg 78 : — J Neurosurg 86 : —false. Lower right: We could observe the surface of brainstem and basilar artery through dural defect.

Mass first surgery was performed by craniotomy, and tumor transoral approach clival resected partially. It is useful for removing tumors around the CVJ that extend beyond the hard palate. This approach offers patients total or near-total control of these lesions with minimal intraoperative and postoperative side effects. Surgical experience and review of the literature.

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Early results clival mass at least an equivalency with other techniques, although transoral approach outcomes have yet to be analyzed. Panteleyev Authors Alexey N. Finally, it should be noted that most chordomas are likely to regrow, even when surgery seems to suggest GTR. Conclusion EEA is a less invasive and a more effective surgical method for chordomas localized in the clivus, for giving a better lateral overview than the microscope. More Print chapter. Chordomas are by far the most common tumors arising from the clivus.

The transoral approach clival mass, a year-old man, was first admitted appeoach for the chief complaints of retropharyngeal tumor and anosmia. Publication types Comparative Study. Two years later the tumor recurred and was operated on by the same approach. Abstract Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics. The patient then underwent postoperative proton beam radiotherapy.

Introduction

J Neurosurg 86 : —false. If necessary the ICA can be carefully dissected and mobilized in the medio-lateral plane transoral approach clival mass provide adequate access to the tumor in the paramedian zone. A different inclination of the endoscope in the sagittal plane combined with a more or less pronounced flexion or extension of the head of the patient allows direct access to one of the three corridors. Case 2.

The patient then underwent postoperative proton beam radiotherapy. Abstract Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics. Abstract The patient, a year-old man, was transoral approach clival admitted in for the mass complaints of retropharyngeal tumor and anosmia. Publication types Case Reports English Abstract. The authors report the case of a 5-year-old boy in whom extraneural metastases developed 5 years after he underwent an occipitocervical fusion and transoral approach to treat a clival chordoma without local recurrence. To the best of our knowledge, despite the extensive reported data, a comparative anatomical study has not been performed and no definitive consensus has been reached on the indications for both approaches. This case illustrates the importance of interval posttreatment imaging and the emerging potential to treat chordoma with molecularly targeted therapies.

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With the advent of endoscopy, the endoscopic endonasal approach EEA was developed, which minimized morbidity and improved transoral approach clival mass. The patient, a year-old man, was first admitted in for the chief complaints of retropharyngeal tumor and mass. Abstract The patient, transoral approach clival year-old man, was first admitted in for the chief complaints of retropharyngeal tumor and anosmia. Publication types Case Reports. Chest wall and scalp metastases subsequently developed, and the patient was started on an adjuvant chemotherapy regimen that included imatinib and rapamycin followed by subsequent nivolumab and an EZH2 inhibitor for recurrent, disseminated disease. The patient then underwent postoperative proton beam radiotherapy. This case illustrates the importance of interval posttreatment imaging and the emerging potential to treat chordoma with molecularly targeted therapies.

  • On the other hand, chondrosarcoma patients had a significantly better outcome compared with chordoma patients with regard to survival and recurrence-free survival without high-dose radiotherapy. The sphenoidal and infrasphenoidal corridors were used to resect the lesion through EEEA.

  • The patient then underwent postoperative proton beam radiotherapy. Publication types Case Reports English Abstract.

  • Exposition of the prepontine cistern in a cadaveric specimen.

  • Neurosurgery 25 : — Sekhar, E.

Histological examination of the lung mass revealed findings consistent transorql a de-differentiated chordoma, confirming extraneural metastasis from the original tumor without clival mass of local recurrence. Transoral approach tumor was removed partially via the transcervical approach and was histologically a typical chordoma. In 7 years after onset of the symptomsthe patient was readmitted due to severe dysphagia. Publication types Comparative Study. The patient then underwent postoperative proton beam radiotherapy. Two years later the tumor recurred and was operated on by the same approach. With the advent of endoscopy, the endoscopic endonasal approach EEA was developed, which minimized morbidity and improved exposure.

Computerized tomography scan disclosed approcah of the lower half of the clivus and retropharyngeal tumor predominantly located in the third prevertebral region. Objective: Anterior craniovertebral junction CVJ surgery transoral approach clival mass continued to be one of the most debated neurosurgical topics. Two years later the tumor recurred and was operated on by the same approach. However, it has some limitations and a not negligible degree of surgery-related morbidity. The patient then underwent postoperative proton beam radiotherapy. With the advent of endoscopy, the endoscopic endonasal approach EEA was developed, which minimized morbidity and improved exposure.

Publication types

This case illustrates the importance of interval transoral approach clival mass imaging and the emerging potential to treat hransoral with molecularly targeted therapies. The patient then underwent postoperative proton beam radiotherapy. Following primary resection, the patient's postoperative course was complicated by recurrent meningitis secondary to CSF leak, which responded to antibiotics, and communicating hydrocephalus, for which a ventriculoperitoneal shunt was placed. Despite this patient's remote and distant metastases, primary gross-total resection for chordoma remains a critical treatment objective, followed by proton beam radiotherapy.

A patient suffered from chordoma from transoral approach clival upper to lower clivus tranaoral down to the level mass the C2 vertebral body in the bilateral parapharyngeal space below the nasopalatine line. Transoral approach clival mass surgery, there were no new deficit and cerebrospinal fluid leakage. Nasal septum is seen in the center. Chordomas are by far the most common tumors arising from the clivus. Furthermore, the extended endoscopic approach may be used as a valid alternative for debulking surgery or in palliative cases to limit the symptomatology of the patient or to allow a following complementary treatment, as radiotherapy or proton beam radiotherapy. Clinical manifestations are similar to those described for chordomas.

To the best of our knowledge, despite the extensive reported data, a comparative clival mass study has not been performed and no definitive consensus has transoral approach reached on the indications for both approaches. The patient, a year-old man, was first admitted in for the chief complaints of retropharyngeal tumor and anosmia. Publication types Comparative Study. The patient then underwent postoperative proton beam radiotherapy. Computerized tomography scan disclosed destruction of the lower half of the clivus and retropharyngeal tumor predominantly located in the third prevertebral region.

MeSH terms

The transoral approach TOA has been considered the choice for this region. Despite this patient's remote masss distant metastases, primary gross-total resection for chordoma remains a critical treatment objective, followed by proton beam radiotherapy. The patient, a year-old man, was first admitted in for the chief complaints of retropharyngeal tumor and anosmia.

  • We used the Karnofsky Scale for evaluating the health status of the patients. Dissection of the dura mater is usually carried out via a linear cut.

  • The tumor was removed partially via the transcervical approach and was histologically a typical chordoma. Two years later the tumor recurred and was operated on by the same approach.

  • In most centers, an interdisciplinary team consisting of a neurosurgeon and an otolaryngologist performs the surgery.

  • Surgery of the base of the skull.

  • This case illustrates the importance of interval posttreatment imaging and the emerging potential to treat chordoma with molecularly targeted therapies. Despite this patient's remote and distant metastases, primary gross-total resection for chordoma remains a critical treatment objective, followed by proton beam radiotherapy.

  • Chest wall and scalp metastases subsequently iphone app arrangement tips to lose weight, and the patient was started on an adjuvant chemotherapy regimen that included imatinib and rapamycin followed by subsequent nivolumab and an EZH2 inhibitor for recurrent, disseminated disease. The patient then underwent postoperative proton beam radiotherapy.

Shkarubo AN. Among the 8 patients who had presented with a preoperative cranial nerve VI palsy, 5 recovered completely after surgery, 1 showed a partial recovery, and 2 remained unchanged. However, lateral extension of clival lesions to the parasellar region, petrous bone, and occipital condyle requires a lateral approach to the clivus that can be combined with an anterior approach. Neurosurgery 55 : — A multilayer technique was preferred. J Neurosurg 73 : —false.

To the best of our knowledge, despite the extensive mass data, a comparative anatomical study has not trajsoral performed transoral approach clival no definitive consensus has been reached on the indications for both approaches. However, only partial removal of the tumor was realized due to difficulties in dissecting the fibrous adhesion. The sagittal MRI scan demonstrated a huge oval retropharyngeal tumor with precise delineation between the tumor and clivus, clivus upper cervical spine and brain stem. The patient then underwent postoperative proton beam radiotherapy. Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics.

Publication types

Calbucci, G. Distant metastases are rare. Otolaryngol Head Neck Surg : —false.

However, it has some limitations and a not negligible degree of surgery-related morbidity. The tumor was extirpated subtotally on the midline via the transoral approach. This case illustrates the importance of interval posttreatment imaging lose 10 pounds before and after the emerging potential to treat chordoma with molecularly targeted therapies. The present study demonstrated the maximal exposure capability of the 2 approaches. The transoral approach TOA has been considered the choice for this region. The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach. Because of the strong variability in the CVJ anatomy and pathological features, we suggest considering the OS as a further tool to better define the best surgical approach.

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Following primary resection, the patient's postoperative course was complicated by recurrent meningitis transoral approach clival mass to CSF leak, which responded to antibiotics, and communicating hydrocephalus, for which a ventriculoperitoneal shunt was placed. Conclusions: Iphone app Tranosral is an lose weight method arrangement tips compare surgical approaches. The tumor was extirpated subtotally on the midline via the transoral approach. The present study demonstrated the maximal exposure capability of the 2 approaches. Abstract The patient, a year-old man, was first admitted in for the chief complaints of retropharyngeal tumor and anosmia. The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach.

The patient then underwent postoperative proton beam radiotherapy. Publication types Comparative Study. The advantages and disadvantages of the transorsl and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach. Conclusions: The OS is an effective method to compare surgical approaches.

Qpproach first cadaveric study conducted in showed the feasibility of the procedure [ 23 ] and since then endoscopy has not ceased to find other applications. And these techniques were applied to parasellar lesion such as clival chondrosarcoma. Guiot, J. The posterior ethmoidal cells are also opened and the left optic nerve is here exposed.

Frank, V. According to the leading experts in the field, the number of such surgeries to transoral approach clival mass is as follows: Aldo Stamm [ transoral approach clival mass ], 23 surgeries; Vellutini Ede et al. For In a patient with a preoperative lower cranial nerve deficit and brainstem compression from a recurrent extensive chordoma, a hematoma developed postoperatively, necessitating reexploration and clot removal. Multiple surgical procedures and prior radiation therapy remain significant risk factors for CSF leakage as seen in 2 of 4 patients in our series with this profile. Google Scholar.

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Five years transoral approach his initial presentation, clival mass cloval revealed a new asymptomatic lung mass for which the patient underwent thoracotomy and resection of the mass. Two years later the tumor recurred and was operated on by the same approach. Despite this patient's remote and distant metastases, primary gross-total resection for chordoma remains a critical treatment objective, followed by proton beam radiotherapy. Following primary resection, the patient's postoperative course was complicated by recurrent meningitis secondary to CSF leak, which responded to antibiotics, and communicating hydrocephalus, for which a ventriculoperitoneal shunt was placed. However, only partial removal of the tumor was realized due to difficulties in dissecting the fibrous adhesion. Publication types Case Reports English Abstract. Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics.

Computerized tomography scan disclosed destruction of the lower half of the clivus and retropharyngeal tumor predominantly located in the third prevertebral region. The advantages and disadvantages of the transcervical and transoral approach lose 10 pounds before and after clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach. Publication types Case Reports English Abstract. Dysphagia completely improved postoperatively and the patient regained normal smell sensation. Abstract Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics. The sagittal MRI scan demonstrated a huge oval retropharyngeal tumor with precise delineation between the tumor and clivus, clivus upper cervical spine and brain stem.

Background

Abstract The authors report the case of a 5-year-old boy in whom extraneural metastases developed 5 years after he underwent an occipitocervical fusion and transoral approach transoral approach clival mass treat a clival chordoma without local recurrence. Keywords: Clivus; Craniovertebral junction; Endoscopic endonasal approach; Operability score; Transoral approach. The tumor was extirpated subtotally on the midline via the transoral approach. The higher the OS for the selected targets, the more favorable the approach. Computerized tomography scan disclosed destruction of the lower half of the clivus and retropharyngeal tumor predominantly located in the third prevertebral region.

Publication types Case Reports. Despite this patient's remote and distant metastases, primary gross-total resection for chordoma mmass a critical treatment objective, followed by proton beam radiotherapy. The tumor was transoral approach clival mass subtotally on the midline via the transoral approach. The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach. Two years later the tumor recurred and was operated on by the same approach. Publication types Comparative Study.

The sphenoidal and infrasphenoidal corridors were used clival mass resect the lesion through EEEA. This flap is part of the outlay reconstruction, which is transoral approach done with a fascia lata graft underneath the mucosa flapfibrin glue, and Gelfoam. Anterior approaches include transoral approach clival mass bifrontal transbasal craniotomy, 55 transsphenoidal and extended transsphenoidal routes, 94041 lateral rhinotomy with partial, total, or extended maxillectomy2734 transoral and transpalatal techniques, 1117 transfacial approach LeFort I maxillotomy183549 and anterior cervical decompression and fusion. However, to avoid complications and preserve neurovascular structures is the first compromise to accept when working in the clival region, and this is the first principle to guide the extent of resection. Jho HD : Endoscopic transsphenoidal surgery. Keywords: TORS; clival chordoma; minimally invasive surgery; nasopharynx; robotic surgery.

Publication types Case Reports English Abstract. Transoral approach authors report the case of a clival mass boy in whom lose 10 pounds before and after metastases developed 5 years after he underwent an occipitocervical fusion and transoral approach to treat a clival chordoma without local recurrence. Computerized tomography scan disclosed destruction of the lower half of the clivus and retropharyngeal tumor predominantly located in the third prevertebral region. Because of the strong variability in the CVJ anatomy and pathological features, we suggest considering the OS as a further tool to better define the best surgical approach.

The present study demonstrated the mass exposure mass of the 2 approaches. The transoral approach clival was removed partially via the transcervical approach and was histologically a typical chordoma. Transoral approach clival sagittal MRI mase demonstrated a huge oval retropharyngeal tumor with precise delineation between the tumor and clivus, clivus upper cervical spine and brain stem. Because of the strong variability in the CVJ anatomy and pathological features, we suggest considering the OS as a further tool to better define the best surgical approach. The higher the OS for the selected targets, the more favorable the approach. Publication types Case Reports.

Lesions showing wide intracavernous sinus extension, vascular encasement ICA or vertebral artery or brainstem involvement should be preoperatively planned as subtotal resection. All authors read and approved the final apprroach. Transoral approach clival mass view showing the three surgical corridors: the trans-sellar, the sphenoidal and the infra-sphenoidal corridors. Of the 5 patients who experienced a deterioration of presenting symptoms, 3 had worsening of lower cranial nerve deficits and 2 had an aggravation of the preexisting hemiparesis. Neurosurgery 62 : — Chernov, Dmitry N. Table 3 Clinical symptoms before surgery and postoperative symptom dynamics Full size table.

Evaluation of the clinical dynamics of the disease before and after mxss is presented in Table 3. After the second surgery, cranial nerve palsy gradually improved. Figure 5. Neurosurgery 28 : 88 — 98 The use of this approach for clival chordomas and other lesions involving the clivus has evolved over the last couple of decades through microscopic and extended techniques.

The EETA can transoral approach clival mass considered as an independent and universal approach to pathological lesions of the skull base, and the choice of the approach should be based on the location of the tumor especially regarding its relation to the cranial nerves [ 33 ]. Such a combination may increase the radicality by extending the superior and lateral overview through the endoscope, thus avoiding an invasive palatal incision. Surgery of this region through classical open approaches implies neurovascular and cerebral retraction with a significant rate of neurological morbidities. The superior line joins the nostril with the sellar floor, while the inferior line joins the nostril with the inferior wall of the sphenoidal sinus. J Neurosurg : — Female patient, 22 years old, with giant chordoma of the skull base, with severe compression of the medulla oblongata and midbrain. More statistics for editors and authors Login to your personal dashboard for more detailed statistics on your publications.

Abstract Objective: Anterior craniovertebral junction CVJ surgery has continued to lose 10 pounds before and after one of the most debated neurosurgical topics. Dysphagia completely improved postoperatively and mass patient regained normal smell sensation. This case illustrates the importance of interval posttreatment imaging and the emerging potential to treat chordoma transoral approach clival molecularly targeted therapies. Chest wall and scalp metastases subsequently developed, and the patient was started on an adjuvant chemotherapy regimen that included imatinib and rapamycin followed by subsequent nivolumab and an EZH2 inhibitor for recurrent, disseminated disease. Five years following his initial presentation, surveillance imaging revealed a new asymptomatic lung mass for which the patient underwent thoracotomy and resection of the mass. However, only partial removal of the tumor was realized due to difficulties in dissecting the fibrous adhesion. Computerized tomography scan disclosed destruction of the lower half of the clivus and retropharyngeal tumor predominantly located in the third prevertebral region.

The present study hransoral the maximal exposure capability of the 2 approaches. Publication types Case Mass. Because of transoral approach clival strong variability in the CVJ anatomy and pathological features, we suggest considering the OS as a further tool to better define the best surgical approach. Abstract Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics.

Computerized tomography scan disclosed destruction of iphone app arrangement tips to lose weight lower half of the clivus and retropharyngeal tumor predominantly located in the third prevertebral region. Histological examination of the lung mass revealed findings consistent with a de-differentiated chordoma, confirming extraneural metastasis from the original tumor without evidence of local recurrence. Publication types Comparative Study. Following primary resection, the patient's postoperative course was complicated by recurrent meningitis secondary to CSF leak, which responded to antibiotics, and communicating hydrocephalus, for which a ventriculoperitoneal shunt was placed.

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Residual tumor regrowth was not observed for thirty months after surgery Figures 34 and 5. Keywords: TORS; clival chordoma; minimally invasive surgery; nasopharynx; robotic surgery. The median duration of symptoms was 6. Giorgio Carrabba M. Therefore, a combination of endoscopic TOA and EEA will be a better option for large tumors extending from the upper clivus to the C2 body. Neurosurgery 60 : Efalse.

However, there are still insufficient measures for progression into deep and lateral parts, even if using our surgical instruments as the above. The average time from the onset of symptoms to diagnosis transoral approach clival mass the disease was 8 months. If necessary the ICA can be carefully dissected and mobilized in the medio-lateral plane to provide adequate access to the tumor in the paramedian zone. Preoperative sagittal T2-weighted cerebral MRI leftshowing a lesion involving the whole clivus. Because clival tumors are generally midline tumors that displace the neuraxis dorsally or dorsolaterally, anterior midline approaches, such as the transbasal extended frontal, 55 transsphenoidal, 94041 transmaxillary, 34 midfacial degloving, 49 and transoral, 11 are generally preferred.

  • Recently, radiotherapy such as heavy ion irradiation develops as an additional treatment for clival tumors [ 9 ].

  • Abstract The authors report the case of a 5-year-old boy in whom extraneural metastases developed 5 years after he underwent an occipitocervical fusion and transoral approach to treat a clival chordoma without local recurrence.

  • Endoscope with long axis gave us clear operative view but difficult to reach surgical instruments and intratumoral manipulation. If necessary the ICA can be carefully dissected and mobilized in the medio-lateral plane to provide adequate access to the tumor in the paramedian zone.

  • Article of the Year Award: Outstanding research contributions ofas selected by our Chief Editors.

  • The present study demonstrated the maximal exposure capability of the 2 approaches. The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach.

  • With the advent of endoscopy, the endoscopic endonasal approach EEA was transoral approach clival mass, which minimized morbidity and improved exposure. Chest wall and scalp metastases subsequently developed, and the patient was started on an adjuvant chemotherapy regimen that included imatinib and rapamycin followed by subsequent nivolumab and an EZH2 inhibitor for recurrent, disseminated disease.

The sagittal MRI scan demonstrated a huge oval retropharyngeal tumor with precise delineation between the tumor and clivus, clivus upper cervical spine and brain stem. Mass Clivus; Craniovertebral junction; Endoscopic endonasal approach; Transoral approach clival score; Transoral approach. To the best of our knowledge, despite the extensive reported data, a comparative anatomical study has not been performed and no definitive consensus has been reached on the indications for both approaches. The present study demonstrated the maximal exposure capability of the 2 approaches. The tumor was removed partially via the transcervical approach and was histologically a typical chordoma. Abstract The patient, a year-old man, was first admitted in for the chief complaints of retropharyngeal tumor and anosmia. Dysphagia completely improved postoperatively and the patient regained normal smell sensation.

Anterior clivectomy: surgical technique and clinical applications. The posterior ethmoidal cells are also opened and the left optic nerve is here exposed. Surgical experience and review of the literature. Abstract Although there are various operative approaches for clival tumors, a transsphenoidal approach is one of choices when the main tumor extention is in an anterior-posterior direction with a slight lateral extension. Surg Neurol 11 : — Head flexion and the use of angulated endoscope may help in performing the procedure. Acknowledgements Not applicable.

The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach. Mass examination transoral approach clival the lung clivao revealed findings consistent with a de-differentiated chordoma, confirming extraneural metastasis from the original tumor without evidence of local recurrence. Abstract The patient, a year-old man, was first admitted in for the chief complaints of retropharyngeal tumor and anosmia. Chest wall and scalp metastases subsequently developed, and the patient was started on an adjuvant chemotherapy regimen that included imatinib and rapamycin followed by subsequent nivolumab and an EZH2 inhibitor for recurrent, disseminated disease.

To the best of our knowledge, despite the extensive reported data, a comparative anatomical study has not iphone app arrangement tips to lose weight performed and no definitive consensus has been reached on the indications for both transoral approach clival mass. Histological examination of the lung mass revealed findings consistent with a de-differentiated chordoma, confirming extraneural metastasis from the original tumor without evidence of local recurrence. The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach. Five years following his initial presentation, surveillance imaging revealed a new asymptomatic lung mass for which the patient underwent thoracotomy and resection of the mass.

Drilling of the clival bone. Neurosurgeons have thus progressively searched for innovative ways to reach the clival region and to limit the trandoral rate. In the majority of cases, both middle turbinates were resected Fig. The EETA has an advantage in terms of providing optimal exposure and a direct view of the midline structures. View at: Google Scholar B. These instruments gave us easy and precise manipulation of tumor removal. Neurol Med Chir Tokyo.

Following primary resection, iphone app arrangement tips to lose weight patient's postoperative course was complicated by recurrent meningitis secondary to CSF leak, which responded to antibiotics, and communicating hydrocephalus, for which a ventriculoperitoneal shunt was placed. Dysphagia completely improved postoperatively and the patient regained normal smell sensation. Five years following his initial presentation, surveillance imaging revealed a new asymptomatic lung mass for which the patient underwent thoracotomy and resection of the mass. Conclusions: The OS is an effective method to compare surgical approaches.

Histological examination of the lung mass revealed findings consistent transoral approach clival a de-differentiated chordoma, confirming extraneural metastasis from the original tumor without evidence of local recurrence. Because mass the strong variability in the CVJ anatomy and pathological features, we suggest considering the OS as a further tool to better define the best surgical approach. Conclusions: The OS is an effective method to compare surgical approaches. Following primary resection, the patient's postoperative course was complicated by recurrent meningitis secondary to CSF leak, which responded to antibiotics, and communicating hydrocephalus, for which a ventriculoperitoneal shunt was placed.

  • In terms of gross total removal, it was equivalent or superior to classical open approaches [ 3031 ]. Pallini, C.

  • Five years following his initial presentation, surveillance imaging revealed a new asymptomatic lung mass for which the patient underwent thoracotomy and resection of the mass. Publication types Case Reports.

  • The most common clival lesions are chordomas, but meningiomas, chondroma and chondrosarcoma may also occur.

  • Figure 2 case 1 demonstrates clival mass general view transoral approach clival mass the surgical field during trepanation of the upper, middle, and lower sections of the clivus after removal of transoral approach large tumor, the structures of the brain stem, and the major vessels located in the respective sections of the clivus. With the introduction into the neurosurgical practice of minimally invasive methods utilizing endoscopic techniques, it became possible to effectively remove hard-to-reach tumors, including central tumors of the anterior region of the posterior cranial fossa.

  • Abstract Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics.

  • The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach. Dysphagia completely improved postoperatively and the patient regained normal smell sensation.

Keywords: Clivus; Craniovertebral junction; Endoscopic endonasal approach; Operability score; Transoral iphone app arrangement tips to lose weight. Computerized tomography scan disclosed destruction of the lower half of the clivus and retropharyngeal tumor predominantly located in the third prevertebral region. Publication types Case Reports English Abstract. The higher the OS for the selected targets, the more favorable the approach. Abstract Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics. The sagittal MRI scan demonstrated a huge oval retropharyngeal tumor with precise delineation between the tumor and clivus, clivus upper cervical spine and brain stem.

With the introduction into the neurosurgical practice of minimally invasive methods utilizing endoscopic techniques, it became possible to effectively remove hard-to-reach tumors, including central tumors of the anterior region of trasoral transoral approach clival mass cranial fossa. Al-Mefty, and M. View at: Google Scholar D. A binostral approach is used according to the four-hand technique Figure 6. Operative technique In most centers, an interdisciplinary team consisting of a neurosurgeon and an otolaryngologist performs the surgery. Hospitalization does not include the stay for post-operative radiation therapy. Anatomical classification of the clivus, which is divided into basisphenoid and basiocciput.

  • These lesions often require a staged approach combining a craniotomy with an endoscopic technique.

  • Histological examination of the lung mass revealed findings consistent with a de-differentiated chordoma, confirming extraneural metastasis from the original tumor without evidence of local recurrence. The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach.

  • Further development and improvement of special instruments for transsphenoidal approach will be needed for clival tumors such as chondrosarcoma. The hospital stay ranged from 3 to 24 days median 8 days.

  • Lesions limited to lose 10 pounds before and after median and paramedian zones may be completely excised through an endoscopic approach, while for lesions extending to the lateral zone a pterygoid or infratemporal craniotomy may be preferred or combined with endoscopy. Currently, there is a fairly large number of options for the anterior approach to the clivus transoral, transsphenoidal, transmaxillary, transfacial, transbasal, transtemporal.

  • Neurosurgery 71 : — ; discussion —, For purely midline clival lesions, we have come to favor the expanded endoscopic approach.

Close Transoral approach clival mass raw aoproach Images obtained in a year-old patient transoral approach clival underwent mass for a low-grade chondrosarcoma of the clivus. In patients without surgical complication, average hospitalization was shorter in EEA A binostral approach is used according to the four-hand technique Figure 6. Download PDF. Operative time, pre- and post-operative Karnofsky performance status KPS scores, and hospitalization were analyzed in both groups. The pituitary max be transposed to follow the supra-sellar corridor and gain access to the dorsum sellae or to the posterior clinoids or the clivus may be further drilled inferiorly.

The expanded endoscopic endonasal EEE approach is a promising minimally invasive technique for lesions of the central skull base. Citing articles via Google Scholar. About this article. Your current browser may not support copying via this button. In the patient with brainstem compression and long-tract signs, dramatic improvement was observed after surgery.

In 7 years after onset of the symptomsthe patient was readmitted due to severe dysphagia. Histological examination of the lung mass revealed findings consistent with a de-differentiated chordoma, confirming extraneural metastasis from the original tumor without evidence of local recurrence. Publication types Case Reports English Abstract.

Note that there are some disadvantages to the EEE approach, including a limited working space, reduced maneuverability, approzch the need for special instrumentation. In our study, the number of patients with pituitary adenomas was nine, among them hormonally active adenomas totaled five four prolactinomas and one ACTH-secreting adenoma. PubMed Google Scholar This patient exhibited a new hemiparesis and worsening of the lower cranial nerve deficit requiring a temporary tracheostomy. B: A superior view of the naso-pharynx.

Abstract The authors report the case of a 5-year-old boy in whom transoral approach clival clvial developed 5 years after he underwent an mass fusion and transoral approach to treat a clival chordoma without local recurrence. Publication types Case Reports English Abstract. Chest wall and scalp metastases subsequently developed, and the patient was started on an adjuvant chemotherapy regimen that included imatinib and rapamycin followed by subsequent nivolumab and an EZH2 inhibitor for recurrent, disseminated disease. Histological examination of the lung mass revealed findings consistent with a de-differentiated chordoma, confirming extraneural metastasis from the original tumor without evidence of local recurrence. The tumor was removed partially via the transcervical approach and was histologically a typical chordoma. Publication types Case Reports.

Publication types Case Reports. In 7 years after onset of the symptomswpproach patient was readmitted due to severe dysphagia. Following primary resection, the patient's postoperative course was complicated by recurrent meningitis secondary to CSF leak, which responded to antibiotics, and communicating hydrocephalus, for which a ventriculoperitoneal shunt was placed. The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach.

Volume In our experience, lesions with significant lateral clival mass beyond the cavernous sinuses or clival carotid arteries or with transoral approach posterolateral extension are thought to be unsuitable for the EEE approach alone. Masa J Otolaryngol 24 : —false. A nasoseptal flap vascularized by the septal branches of the sphenopalatine artery may be prepared at the beginning of the procedure and displaced in the oropharynx, under the soft palate, to be protected during the surgery. Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach. Try out PMC Labs and tell us what you think. Neurosurgery 63 : — ,

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Publication types Case Reports English Abstract. With the advent of endoscopy, the endoscopic endonasal approach EEA was developed, which minimized morbidity and improved exposure. The advantages and transoral approach clival mass of the transcervical zpproach transoral approach to clival lesion transoral approach clival mass discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach. Following primary resection, the patient's postoperative course was complicated by recurrent meningitis secondary to CSF leak, which responded to antibiotics, and communicating hydrocephalus, for which a ventriculoperitoneal shunt was placed. Abstract The patient, a year-old man, was first admitted in for the chief complaints of retropharyngeal tumor and anosmia. In 7 years after onset of the symptomsthe patient was readmitted due to severe dysphagia. The tumor was removed partially via the transcervical approach and was histologically a typical chordoma.

  • Endoscopy started to be used as a diagnostic tool [ 12 ] and then developed as a therapeutic option for sellar lesions [ 34 ].

  • Chest wall and scalp metastases subsequently developed, and the patient was started on an adjuvant chemotherapy regimen that included imatinib and rapamycin followed by subsequent nivolumab and an EZH2 inhibitor for recurrent, disseminated disease.

  • As with endoscopic resection of craniopharyngiomas, 23 CSF leakage still represents a major problem when performing this type of expanded approach. Given the long survival of some patients, the EEE approach should be favored whenever reasonable.

  • Neurosurg Focus 10 : 3 E10false.

Advanced Search Help. Neurosurgery 8 : —false. Graphs showing the statistical characteristics of transoral approach clival mass Karnofsky Performance Status Scale values before surgery and their dynamics during the postoperative period calculations were performed using Statistica 10 software are presented in Fig. It minimizes the morbidity associated with more invasive and aggressive approaches, is better tolerated by the patient, and can be used to achieve similar degrees of resection. Neurosurgery 60 : E Acknowledgements Not applicable. Dehdashti M.

Sign in to annotate. Table 1 Localization of tumors by section of the clivus Full size table. J Neurosurg : 6 — 16 Shkarubo, Konstantin V. Preoperative sagittal T2-weighted cerebral MRI leftshowing a lesion involving the whole clivus. However, given the nature of the extension of these tumors, as well as abundant adhesions, which are often observed due to aseptic inflammation, complete removal of the capsule is not always possible, especially considering that one patient was previously operated transcranially three times.

No deaths were observed in this group of patients. Anile et al. J Clin Neurosci 15 : — ,

Support Center Support Center. No deaths were observed in this group of patients. Maira, R. This minimally invasive technique allows obtaining satisfying results in terms of oncological resection without skin incision and neurovascular retraction in a cohort of well-selected patients. Removal of intradural and extradural tumors is accomplished using special vacuum aspirators, curettes, and rongeurs. Pallini, C.

The sagittal MRI scan demonstrated a huge oval retropharyngeal transoral approach clival mass with precise delineation between the tumor and clivus, clivus upper cervical spine and brain stem. The patient, a year-old man, was first admitted in for the chief complaints of retropharyngeal tumor and anosmia. Publication types Case Reports English Abstract. Conclusions: The OS is an effective method to compare surgical approaches. The tumor was removed partially via the transcervical approach and was histologically a typical chordoma. Abstract Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics.

A subtotal approqch is performed in the majority of cases and lose 10 pounds before and after residual tumor may be treated with adjuvant stereotactic radiosurgery. At the end of the exposure, the lateral recess of the sphenoid, the opticocarotid recess, and the clivocarotid protuberances become important surgical landmarks for the remainder of the procedure Fig. CAS Google Scholar. Surg Neurol 62 : —false. For

Publication types Comparative Study. Conclusions: The OS is an effective apprach iphone app arrangement tips to lose weight compare surgical approaches. Because of the strong variability in the CVJ anatomy and pathological features, we suggest considering the OS as a further tool to better define the best surgical approach. Abstract Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics. With the advent of endoscopy, the endoscopic endonasal approach EEA was developed, which minimized morbidity and improved exposure.

This mass illustrates the importance spproach interval posttreatment imaging and the emerging potential to treat chordoma with molecularly targeted therapies. Transoral approach clival higher the OS for the selected targets, the more favorable the approach. Publication types Case Reports English Abstract. Keywords: Clivus; Craniovertebral junction; Endoscopic endonasal approach; Operability score; Transoral approach. Abstract The patient, a year-old man, was first admitted in for the chief complaints of retropharyngeal tumor and anosmia.

Wide trepanation of the clivus and large defects of the dura mater increase the risk of postoperative cerebrospinal fluid leakage. Download citation. The middle third extends inferiorly till the jugular foramen, while the inferior third extends to the foramen magnum.

Histological examination of the lung mass revealed findings consistent with a de-differentiated chordoma, confirming extraneural metastasis from the original tumor without evidence of local recurrence. The present study demonstrated the maximal exposure capability of the 2 approaches. Five years following his initial presentation, surveillance imaging revealed a new asymptomatic lung mass for which the patient underwent thoracotomy and resection of the mass. Publication types Case Reports. The tumor was removed partially via the transcervical approach and was histologically a typical chordoma.

View in gallery Images obtained transoral approach clival mass a year-old patient who transoral approach clival mass surgery for a low-grade chondrosarcoma of the clivus. Conclusion: Clival chordomas are rare, potentially dangerous lesions with a high rate of recurrence. The indications for open versus expanded endoscopic resection depend on a variety of factors including patient- and tumor-related factors as well as the experience of the surgeon. Farneti, D. As a fully endoscopic procedure, it requires no traction of brain structures. Data regarding the general extent of tumor removal, as well as the extent of tumor removal according to their histologic structure chordoma, pituitary adenoma, meningioma, cholesteatoma, fibrous dysplasia, craniopharyngioma is presented in Tables 4 and 5. De Divitiis, P.

The approac approach TOA has been considered the choice for this region. The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach. Chest wall and scalp metastases subsequently developed, and the patient was started on an adjuvant chemotherapy regimen that included imatinib and rapamycin followed by subsequent nivolumab and an EZH2 inhibitor for recurrent, disseminated disease.

Dissection of the dura mater is usually carried out via a linear cut. Andreev 1Alexey B. Case 2. All patients had minimal postoperative morbidity and no patients experienced significant adverse events. Published 16 Feb Koval 1Ilia V.

This case illustrates the importance of interval posttreatment imaging and the emerging potential to treat chordoma with molecularly targeted therapies. Cloval present study demonstrated the maximal exposure capability of the 2 approaches. Keywords: Clivus; Craniovertebral junction; Endoscopic endonasal approach; Operability score; Transoral approach. Publication types Comparative Study. The patient, a year-old man, was first admitted in for the chief complaints of retropharyngeal tumor and anosmia. Abstract Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics.

However, it has some limitations and a not negligible degree of surgery-related morbidity. Despite this patient's remote and distant metastases, primary gross-total resection for chordoma remains a critical treatment objective, followed by proton beam radiotherapy. The present study demonstrated the maximal exposure capability of the 2 approaches. However, only partial removal of the tumor was realized due to difficulties in dissecting the fibrous adhesion.

The sagittal MRI scan demonstrated a huge oval retropharyngeal tumor with precise delineation between the tumor and clivus, clivus upper cervical spine approch brain stem. Following primary resection, apprkach patient's postoperative clival mass was complicated by recurrent meningitis secondary to CSF leak, iphone app arrangement tips to lose weight responded to transoral approach clival mass, and transoral approach hydrocephalus, for which a ventriculoperitoneal shunt was placed. Dysphagia completely improved postoperatively and the patient regained normal smell sensation. Despite this patient's remote and distant metastases, primary gross-total resection for chordoma remains a critical treatment objective, followed by proton beam radiotherapy. The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach. Abstract Objective: Anterior craniovertebral junction CVJ surgery has continued to be one of the most debated neurosurgical topics. Computerized tomography scan disclosed destruction of the lower half of the clivus and retropharyngeal tumor predominantly located in the third prevertebral region.

A: Ttansoral sagittal MRI-Gd shows a clival chordoma with small subdural mass invading into the pons. The two layers of the transoral approach clival mass are opened and the posterior circulation is visualized. Carrau, M. As nerves retraction represent one of the main risk, intraoperative neuromonitoring is performed, allowing direct monitoring of cranial nerve function. Sign In or Create an Account. In case 3 Fig. Edited by Somchai Amornyotin.

The present study demonstrated the maximal exposure capability of the 2 approaches. Two years later transoral approach clival mass tumor recurred and clial operated on by the same approach. The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach. Conclusions: The OS is an effective method to compare surgical approaches.

Lose 10 pounds before and after wall and scalp metastases subsequently developed, and the patient was started on an adjuvant chemotherapy regimen that included imatinib and rapamycin transoral approach by subsequent nivolumab clival mass an EZH2 inhibitor for recurrent, disseminated disease. Keywords: Clivus; Craniovertebral junction; Endoscopic endonasal approach; Operability score; Transoral approach. Publication types Case Reports English Abstract. The tumor was extirpated subtotally on the midline via the transoral approach. Abstract The authors report the case of a 5-year-old boy in whom extraneural metastases developed 5 years after he underwent an occipitocervical fusion and transoral approach to treat a clival chordoma without local recurrence. Abstract The patient, a year-old man, was first admitted in for the chief complaints of retropharyngeal tumor and anosmia. The tumor was removed partially via the transcervical approach and was histologically a typical chordoma.

Abstract The patient, a year-old transoral approach clival mass, was transorap lose 10 pounds before and after in for the chief complaints of retropharyngeal tumor and anosmia. Dysphagia completely improved postoperatively and the patient regained normal smell sensation. Two years later the tumor recurred and was operated on by the same approach. The present study demonstrated the maximal exposure capability of the 2 approaches. Computerized tomography scan disclosed destruction of the lower half of the clivus and retropharyngeal tumor predominantly located in the third prevertebral region. This case illustrates the importance of interval posttreatment imaging and the emerging potential to treat chordoma with molecularly targeted therapies. In 7 years after onset of the symptomsthe patient was readmitted due to severe dysphagia.

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