Transoral labiomandibular approach to basiocciput chordomas in childhood

Nagib, Mahmoud G.; Wisiol, Erich S.; Simonton, Susan C.; Levinson, Richard

doi:10.1007/bf00308487

Cited by 18 publications

(4 citation statements)

References 11 publications

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“…10,22,28,[34][35][36]39,45 These include the transbasal, 13 extended frontal, 45 transseptal-transsphenoidal, 29-32 facial translocation, 26 transmaxillary, 25,38 midfacial degloving, 39,40 transoral, 9,12 mandible-splitting transoral, 29 transcervical-transclival, 50 and anterior cervical 8 approaches. 10,22,28,[34][35][36]39,45 These include the transbasal, 13 extended frontal, 45 transseptal-transsphenoidal, 29-32 facial translocation, 26 transmaxillary, 25,38 midfacial degloving, 39,40 transoral, 9,12 mandible-splitting transoral, 29 transcervical-transclival, 50 and anterior cervical 8 approaches.…”

Section: Choice Of Surgical Approach In Treating Clival Chordomasmentioning

confidence: 99%

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LTHOUGH it is generally agreed that surgery is the treatment of choice for clival chordomas, the question is still debated as to whether it is preferable to attempt a radical removal, which implies wide exposure, extensive dissection, and the potential for significant surgical morbidity, 17 or to determine the oncological features of the tumors and plan local control through more limited approaches. 2,7,17,19,36,38,[43][44][45][46][47]49 Nevertheless, experienced skull base surgeons have continued to advocate the valuable role of the transsphenoidal approach in the treatment of clival chordomas. 2,7,17,19,36,38,[43][44][45][46][47]49 Nevertheless, experienced skull base surgeons have continued to advocate the valuable role of the transsphenoidal approach in the treatment of clival chordomas.

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confidence: 99%

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Surgical treatment of clival chordomas: the transsphenoidal approach revisited

Maira

Pallini

Anile

et al. 1996

Journal of Neurosurgery

105

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This is a report of 12 cases of clival chordomas that were surgically treated at the Catholic University Medical School, Rome, Italy, over a 7-year period. The study emphasizes the role of the transsphenoidal approach. The study group included seven men and five women whose ages ranged from 26 to 80 years (mean 49.8 years). Diplopia was the most common presenting symptom (eight cases). The tumor involved the upper and middle clivus in five cases, the middle clivus in five, and the lower clivus in two cases. One patient developed spinal metastasis. On histological examination, eight cases proved to be typical chordomas, three cases had a chondroid component, and one case of chordoma had atypical features. Immunohistological staining for vimentin and epithelial membrane antigen was positive in all cases. Follow-up periods ranged from 14 to 86 months (mean 40.2 months). The primary treatment consisted of surgery. Ten patients with chordomas of the upper and middle clivus underwent a total of 13 transsphenoidal procedures. Total tumor removal was achieved in seven cases, subtotal removal in two, and partial removal in one case. In the two cases of lower clival chordomas, total removal was accomplished in one and partial removal in the other. After total removal, no recurrence was noted at 14 to 86 months (mean 37.5 months). In the cases undergoing operation via a transsphenoidal approach, there was zero morbidity and one cerebrospinal fluid fistula that resolved without surgery. The tumor recurred in two patients after subtotal and partial removal, respectively. The authors opted to reoperate in cases of recurrence. Postoperative radiotherapy was administered in only two cases in which further surgery was not indicated because of medical reasons or because such a procedure was contrary to the patient's wishes. When mortality and morbidity rates of this group are compared to those of chordoma patients who were treated with extensive skull-base surgery, the results prompt a reappraisal of the transsphenoidal approach in the treatment of clival chordomas.

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Section: Choice Of Surgical Approach In Treating Clival Chordomasmentioning

confidence: 99%

“…

…”

mentioning

confidence: 99%

Surgical treatment of clival chordomas: the transsphenoidal approach revisited

Maira

Pallini

Anile

et al. 1996

Journal of Neurosurgery

105

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“…This is especially significant because the edges of a midline pharyngotomy can rarely, if ever, be completely approximated. Nagib, et al, 11 reported a case of CSF leakage through a midline pharyngotomy that led to meningitis in a patient who had undergone resection of a clival chordoma. Although CSF leakage was not identified, Delagado, et al, 5 have reported the occurrence of meningitis in one of their three patients following resection; a midline pharyngotomy was used.…”

Section: Discussionmentioning

confidence: 99%

Transmandibular, circumglossal, retropharyngeal approach for chordomas of the clivus and upper cervical spine

DeMonte

Dı́az

Callender

et al. 2001

FOC

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Extensive clival tumors that involve both the midline and lateral skull base compartments, or those that extend inferiorly to the anterior cervical spine, are difficult to expose in a wide fashion using any of the transmaxillary, transoral, or transcervical routes. In the transmandibular, circumglossal, retropharyngeal (TCR) approach wide access of this region can be obtained, thus allowing for a more complete resection of tumor and infiltrated bone. It also provides for an improved ability to perform dural reconstruction, should it be necessary. Over the past 4 years four patients with extensive clival chordomas underwent resection via the TCR approach. Gross-total resection was achieved in two patients, a greater than 98% resection in one patient, and a greater than 95% resection in the fourth patient. The surgical technique, all approach-related complications and morbidity, and patient outcome are discussed. If an expanded exposure of the clivus is necessary, the TCR approach is a good choice as well as a useful surgical technique to have available.

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“…5,8,[16][17][18][19][20] If the lesion extends more inferiorly from C2 to C4, additional inferior exposure can be gained with a median labiomandibular glossotomy or a mandibular swing-transcervical approach. 7,[21][22][23][24][25] This article focuses on the technical aspects of the transoral approach for accessing lesions of the ventral foramen magnum and craniovertebral junction. The transmaxillary, transpalatal, and transmandibular extensions are also reviewed.…”

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confidence: 99%

Transoral Approach and Extended Modifications for Lesions of the Ventral Foramen Magnum and Craniovertebral Junction

2008

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Objectives: To describe our method of performing the transoral approach and the extended approaches to the ventral foramen magnum and craniovertebral junction and review the technical aspects and operative nuances. Design: Review. Results: The transoral approach provides direct midline exposure to access extradural disease located at the craniovertebral junction and ventral foramen magnum. The corridor of exposure is generally limited by the extent to which the patient can open his or her mouth. The location of the hard palate relative to the craniovertebral junction limits superior exposure, whereas the mandible and base of the tongue limit the inferior exposure. In most cases, exposure can be obtained from the inferior clivus to the middle to lower C2 vertebral body. Extended transoral approaches can be performed to increase exposure if necessary. These approaches include transmaxillary (Le Fort I maxillotomy), transmaxillary with a midline palatal split (extended ''open-door'' maxillotomy), transpalatal, and median labiomandibular glossotomy (transmandibular split). Conclusions: The transoral approach effectively provides direct access to extradural midline lesions of the craniovertebral junction. A specialized retractor system can expose the inferior clivus to the C2 body. Extended approaches as described can access lesions that extend beyond these limits.

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Transoral labiomandibular approach to basiocciput chordomas in childhood

Cited by 18 publications

References 11 publications

Surgical treatment of clival chordomas: the transsphenoidal approach revisited

Surgical treatment of clival chordomas: the transsphenoidal approach revisited

Transmandibular, circumglossal, retropharyngeal approach for chordomas of the clivus and upper cervical spine

Transoral Approach and Extended Modifications for Lesions of the Ventral Foramen Magnum and Craniovertebral Junction

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