Stabilization of the Craniocervical Junction Following Resection of Chordomas and Chondrosarcomas of the Skull Base and Spine

2018 ◽  
pp. 271-278
Author(s):  
Tej D. Azad ◽  
Anand Veeravagu ◽  
Vinod Ravikumar ◽  
John K. Ratliff
Keyword(s):  
Skull Base ◽  
Craniocervical Junction

scholarly journals Craniofacial and Craniocervical Features in Cartilage-Hair Hypoplasia: A Radiological Study of 17 Patients and 34 Controls

2021 ◽  
Vol 12 ◽  
Author(s):  
Heidi Arponen ◽  
Marjut Evälahti ◽  
Outi Mäkitie
Keyword(s):  
Skull Base ◽  
Cranial Base ◽  
Basilar Invagination ◽  
Craniocervical Junction ◽  
Skeletal Class ◽  
Base Angle ◽  
Cartilage Hair Hypoplasia ◽  
Skeletal Class Ii ◽  
Anterior Cranial Base ◽  
Age Range

BackgroundBiallelic mutations in the non-coding RNA gene RMRP cause Cartilage-hair hypoplasia (CHH), a rare skeletal dysplasia in which the main phenotypic characteristic is severe progressive growth retardation.ObjectiveThis study compared the cranial dimensions of individuals with CHH to healthy subjects.MethodsLateral skull radiographs of 17 patients with CHH (age range 10 to 59 years) and 34 healthy individuals (age range 10 to 54 years) were analyzed for relative position of the jaws to skull base, craniofacial height and depth, as well as vertical growth pattern of the lower jaw, anterior cranial base angle, and the relationship between the cervical spine and skull base.ResultsWe found that the length of the upper and lower jaws, and clivus were significantly decreased in patients with CHH as compared to the controls. Anterior cranial base angle was large in patients with CHH. Basilar invagination was not found.ConclusionThis study found no severe craniofacial involvement of patients with CHH, except for the short jaws. Unexpectedly, mandibular deficiency did not lead to skeletal class II malocclusion.Clinical ImpactAlthough the jaws were shorter in patients with CHH, they were proportional to each other. A short posterior cranial base was not associated with craniocervical junction pathology.

scholarly journals Endoscopic Transnasal Approach for Urgent Decompression of the Craniocervical Junction in Acute Skull Base Osteomyelitis

2015 ◽  
Vol 76 (01) ◽  
pp. e37-e42 ◽  
Author(s):  
Terry Burns ◽  
Stefan Mindea ◽  
Arjun Pendharkar ◽  
Nicolae Lapustea ◽  
Ioana Irime ◽  
...  
Keyword(s):  
Skull Base ◽  
Craniocervical Junction ◽  
Transnasal Approach ◽  
Skull Base Osteomyelitis ◽  
Endoscopic Transnasal Approach

scholarly journals The Carotid-Vertebral Space: An ‘Extended’ Lateral Window to the Ventromedial Cranial Base and Lower Craniocervical Junction

2005 ◽  
Vol 84 (5) ◽  
pp. 312-315 ◽  
Author(s):  
Amin B. Kassam ◽  
Atul Patel ◽  
William Welch ◽  
Jeffrey Balzer ◽  
Carl Snyderman ◽  
...  
Keyword(s):  
Skull Base ◽  
Single Incision ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
Cerebellar Hemisphere ◽  
Upper Cervical Spine ◽  
Operative Field ◽  
Upper Cervical ◽  
Unique Method ◽  
Extended Lateral Approach

We describe a unique method of accessing the ventromedial skull base and lower craniocervical junction. Our method employs a trajectory between that of the more anterior transoral or retropharyngeal approaches and the various posterior or posterolateral skull base approaches. This “extended” lateral approach allows surgeons to resect very large tumors of the skull base through a single incision. The operative field is more extensive than that achieved with other approaches; it extends from the cerebellar hemisphere to the extradural ventral upper cervical spine, and it provides access to tissue outside the spinal canal, such as the ventral strap muscles. We describe our use of this approach during a single-stage resection of a large hemangiopericytoma in a 37-year-old man.

scholarly journals Radial Forearm Free Tissue Transfer to Clival Defect

2019 ◽  
Vol 80 (S 04) ◽  
pp. S380-S381 ◽  
Author(s):  
Jennifer D. Moy ◽  
Paul A. Gardner ◽  
Shaum Sridharan ◽  
Eric W. Wang
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Free Tissue Transfer ◽  
Proton Beam Therapy ◽  
Craniocervical Junction ◽  
Csf Leak ◽  
Lateral Nasal Wall ◽  
Endoscopic Endonasal ◽  
Clival Chordoma ◽  
Radial Forearm

Abstract Introduction Reconstruction of craniocervical junction (CCJ) defects after endoscopic endonasal skull base surgery (ESBS) remains challenging, despite advancements in vascularized intranasal and regional flaps. Microvascular free tissue transfers have revolutionized reconstruction in open skull base surgery but have been utilized rarely in ESBS. We describe the use of a radial forearm free flap (RFFF) for reconstruction of a recalcitrant CCJ defect after resection of a clival chordoma. Case Report A 54-year-old female who underwent ESBS for a clival chordoma complicated by a C1–C2 epidural abscess after proton beam therapy presented with pneumocephalus 4 years after her resection (Fig. 1). At the CCJ, she developed a 1-cm skull-base defect. An occult cerebrospinal fluid (CSF) leak persisted despite an extracranial pericranial flap and a lateral nasal wall flap. Her definite reconstruction was a RFFF inset through a transmaxillary approach. Using a maxillary vestibular incision, anterior, lateral, and medial maxillotomies allowed the introduction of the flap into the nasal cavity and the passage of the RFFF pedicle across the posterior maxillary wall, into the premassateric space and to the facial vessels at the mandible. An endonasal inset supplemented with transoral suturing of the distal end of the flap to the posterior oropharynx halted further CSF egress. Vascularization of the flap was confirmed with intraoperative indocyanine green angiography and postoperative computed tomography (CT) angiography and magnetic resonance imaging (MRI). Conclusion A RFFF inset through a transmaxillary approach to the facial vessels has an adequate reconstructive surface and pedicle to cover the central and posterior fossa skull base after ESBS (Fig. 2).The link to the video can be found at: https://youtu.be/rQ5vJKyD5qg.

Management of the Vertebral Artery at the Craniocervical Junction

2005 ◽  
Vol 133 (1) ◽  
pp. 84-88 ◽  
Author(s):  
YasLar Çokkeser ◽  
Maged B. Naguib ◽  
Ahmet Kizilay
Keyword(s):  
Vertebral Artery ◽  
Skull Base ◽  
Cervical Vertebra ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
Surgical Anatomy ◽  
Transverse Foramen ◽  
Close Vicinity ◽  
Vertebrobasilar Junction

OBJECTIVES: To study the surgical anatomy of the vertebral artery at the craniocervical junction and its related structures defining reliable landmarks for its safe exposure. DESIGN: Ten sides of 5 fresh cadavers were dissected using the lateral approach to the craniocervical junction. RESULTS: Experience gained in studying the anatomic details of the vertebral artery at the craniocervical junction in cadavers from its exit at the transverse foramen of the second cervical vertebra to the vertebrobasilar junction provided the initial background for us to use the lateral approaches to the skull base to safely manage 4 cases with pathology reaching the close vicinity of vertebral artery at the craniocervical junction. CONCLUSION: Thorough knowledge of the anatomy of the vertebral artery is mandatory before attempting surgery at the craniocervical junction. There are reliable landmarks that, when followed, could facilitate safe exposure and identification of the artery.

Surgical anatomy and quantitation of the branches of the V2 and V3 segments of the vertebral artery

2009 ◽  
Vol 11 (1) ◽  
pp. 84-87 ◽  
Author(s):  
R. Shane Tubbs ◽  
Nemil A. Shah ◽  
Brian P. Sullivan ◽  
Nicholas D. Marchase ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Vertebral Artery ◽  
Skull Base ◽  
Craniocervical Junction ◽  
Surgical Anatomy ◽  
Neurosurgical Procedures ◽  
Spinal Accessory ◽  
Far Lateral ◽  
Lateral Branches

Object The vertebral artery (VA) and its branches may be encountered during various neurosurgical procedures such as far lateral suboccipital approaches to the skull base and spinal operations. Therefore, a working knowledge of the distribution and significance of such VA branches may be advantageous to the surgeon. To date, quantitation of these branches is lacking in the literature. Methods The authors evaluated the branches of 20 VAs from 10 adult cadavers and assessed the distribution and surgical significance of the branches from the V2 and V3 segments. Results In terms of target tissues, the VA branches encountered at the C1–2 level were most likely to be muscular, branches at C2–3 osseous, and those at C3–6 radicular. No radicular or medullary branches were identified arising from any V3 segment of the VA or C1–2 level of the V2 segment. The greatest concentration of branches per level was found arising from the V2 segment at C2–3. Posterior branches of the VA tended to be radicular or muscular, whereas anterior branches tended to be radicular or osseous. Lateral branches were most commonly radicular and medial branches tended to be osseous or muscular in nature. The largest branches of the VA originated from its V3 segment or the C2–3 part of its V2 segment. Rarely, branches to the extracranial glossopharyngeal and spinal accessory nerves were identified originating from the V3 and V2 segments of the VA, respectively. Conclusions Although seemingly diverse in their distribution, the branches of the V2 and V3 segments of the VA may follow a certain consistent arrangement. The potential for injury to neural branches of the VA is minimal at its V3 segment and the C1–2 portion of its V2 segment. Such knowledge may be of use to the neurosurgeon who operates in the neck and at the craniocervical junction.

scholarly journals TRANSORAL REMOVAL OF SKULL BASE AND C1-C2 VERTEBRAL BODY TUMOURS AND NONTUMOROUS PATHOLOGY IN THE CRANIOCERVICAL JUNCTION ACCOMPANIED BY CRANIOVERTEBRAL INSTABILITY

2010 ◽  
Vol 16 (2) ◽  
pp. 149-152
Author(s):  
A. N. Shkarubo ◽  
A. O. Guscha
Keyword(s):  
Skull Base ◽  
Vertebral Body ◽  
New Technologies ◽  
Surgical Techniques ◽  
Craniocervical Junction ◽  
Early Rehabilitation ◽  
Hospitalization Period ◽  
Csf Leakage ◽  
Upper Cervical ◽  
Spinal Segments

27 patients aged 2,5-61 years with skull base and C1-C2 vertebral body tumours and nontumorous pathology in the craniocervical junction underwent surgery. All patients revealed craniovertebral instability. To perform OSD we used autobone and metallic wire in 1 case, "Ventrofix" - 2; "CCD" - 9, "Vertex" - 15. In 26 cases OSD was followed by transoral tumor removal; in 1 - removal of the skull base chordoma spreading into C1-C2 segments was followed by OSD. In our practice we used original patent instruments, devices and surgical techniques. After the tumor has been removed, the skull defect hermetic closure and plasty were performed using the original patent technique for preventing postoperative CSF leakage as well as different glue compositions. This technique proved to shorten hospitalization period and reduce treatment costs as well as launch an early rehabilitation programme - on the 3d-4th day after operation. Use of new technologies in surgical treatment of skull base tumors invading upper cervical spinal segments accompanied by craniovertebral instability allowed to improve surgical outcome and start up early rehabilitation.

scholarly journals Transpalatal Approaches to the Skull Base and Reconstruction: Indications, Technique, and Associated Morbidity

2020 ◽  
Vol 34 (02) ◽  
pp. 099-105
Author(s):  
Nyall R. London ◽  
Jimmy Y. W. Chan ◽  
Ricardo L. Carrau
Keyword(s):  
Skull Base ◽  
Craniocervical Junction ◽  
Transoral Robotic Surgery ◽  
Surgical Approaches ◽  
Endoscopic Endonasal ◽  
Surgical Access ◽  
Surgeon Experience ◽  
Hypernasal Speech ◽  
Maxillary Swing ◽  
Disease Location

AbstractMultiple anterior surgical approaches are available to obtain access to the nasopharynx, clivus, and craniocervical junction. These include the direct and transoral robotic surgery transpalatal, maxillary swing, and endoscopic endonasal approaches. In this article, we describe the indications for these techniques, surgical steps, and associated morbidities. This article is a PubMed literature review. A review of the literature was conducted to assess the techniques, surgical steps, and associated morbidities with transpalatal approaches to the skull base and nasopharynx. The transpalatal approach has been traditionally utilized to obtain surgical access to the nasopharynx, clivus, and craniocervical junction. Morbidity includes velopalatine insufficiency due to shortening of the soft palate from scar contraction or neuromuscular damage, thus leading to hypernasal speech and dysphagia. Middle ear effusion and oronasal or oronasopharyngeal palatal fistula are additional potential morbidities. The choice of surgical approach depends on a variety of factors including the disease location and extent, surgeon experience, and available resources.

Skull Base Chordomas

1986 ◽  
Vol 19 (4) ◽  
pp. 797-804 ◽  
Author(s):  
Yosef P. Krespi ◽  
Toni M. Levine ◽  
Randy Oppenheimer
Keyword(s):  
Skull Base ◽  
Skull Base Chordomas
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