Multicentric Chordoma With Initial Resection by Bilateral Transcondylar Approach: 2-Dimensional Operative Video

Foramen magnum (FM) meningiomas are challenging lesions. We present the case of a 38-year-old female with neck pain, dysphonia, and slight twelfth nerve palsy. Imaging workup was highly suggestive of an FM meningioma, and microsurgical resection with the aid of intraoperative neurophysiological monitoring was indicated. A transcondylar approach was employed, the vertebral artery was mobilized, and the tumor was completely removed. Postoperative MRI demonstrated complete resection. There were no signs of cervical instability. The patient presented with improvement of her symptoms and no new neurological deficit on follow-up. FM meningiomas can be successfully resected using a transcondylar approach, since it increases the exposure of the ventral FM, allowing the surgeon to work parallel to the skull base and flush with the tumor’s attachment. Informed consent was obtained from the patient for publication of this operative video.The video can be found here: https://youtu.be/itfUOB-6zM0.

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Superficial Bladder Tumors (Stage pTa, Grades 1 and 2): The Importance of Recurrence Pattern Following Initial Resection

The Journal of Urology ◽

10.1016/s0022-5347(17)45923-4 ◽

1986 ◽

Vol 135 (5) ◽

pp. 920-922 ◽

Cited By ~ 160

Author(s):

J.M. Fitzpatrick ◽

A.B. West ◽

M.R. Butler ◽

V. Lane ◽

J.D. O’Flynn

Keyword(s):

Recurrence Pattern ◽

Bladder Tumors ◽

Initial Resection

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Adjuvant Radiotherapy in Grade II, Atypical Meningioma of the Skull Base

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1735879 ◽

2021 ◽

Author(s):

David P. Bray ◽

Bryan E. Buster ◽

Joseph W. Quillin ◽

Robert H. Press ◽

Bree R. Eaton ◽

...

Keyword(s):

Skull Base ◽

Adjuvant Radiotherapy ◽

Recurrence Rates ◽

Time To Recurrence ◽

Grade Ii ◽

Atypical Meningiomas ◽

Mean Time ◽

Two Populations ◽

Initial Resection

Abstract Introduction Atypical meningiomas (AM) are meningiomas that are more aggressive than their grade-I counterparts and have a higher rate of recurrence. The effect of adjuvant radiotherapy (ART) on AM of the skull base is not defined. Methods A retrospective review of all AM's of the skull base primarily resected at our institution from 1996 to 2018 was completed. ART was defined as radiotherapy (RT) that occurred within 6 months of initial resection, regardless of Simpson's grade. Minimum time length of follow-up after resection was 2 years. Statistical analysis was performed using SAS. Results There were a total of 59 skull base–located (SBL) AMs resected at our institution from 1996 to 2018. The average age of our cohort was 53.2 years. Gross total resection, defined as Simpson's grades I to III resection, was achieved in 36 (61%) of cases. Thirty-five of 59 (59%) patients received ART. Recurrence was observed in 14 patients (24%), and mean time to recurrence was 63.8 months. Patients who received ART had a lower observed rate of recurrence (8 vs. 46%); however, time to recurrence was not significantly different between the two populations. Conclusion We observe that AM in the skull base location have higher recurrence rates than we would expect from grade-I meningioma. These data suggest that ART may offer benefit to the overall observed frequency of recurrence of SBL AM; however, the time to recurrence between patients who received ART and those who did not was not statistically significant in survival analysis.

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“Recurrence” of a Plasma Cell Granuloma 11 Years After Initial Resection

Southern Medical Journal ◽

10.1097/00007611-198704000-00028 ◽

1987 ◽

Vol 80 (4) ◽

pp. 519-521 ◽

Cited By ~ 23

Author(s):

PAUL B. WEINBERG ◽

PHILIP A. BROMBERG ◽

FREDERIC B. ASKIN

Keyword(s):

Plasma Cell ◽

Plasma Cell Granuloma ◽

Initial Resection

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The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction

Neurosurgery ◽

10.1097/00006123-199112000-00002 ◽

1991 ◽

pp. 815 ◽

Cited By ~ 49

Author(s):

H Bertalanffy ◽

W Seeger

Keyword(s):

Craniocervical Junction ◽

Anterior Portion ◽

Transcondylar Approach ◽

Lower Clivus

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Risk factors and control of seizures in 778 Chinese patients undergoing initial resection of supratentorial meningiomas

Neurosurgical Review ◽

10.1007/s10143-019-01085-5 ◽

2019 ◽

Vol 43 (2) ◽

pp. 597-608 ◽

Cited By ~ 6

Author(s):

Xiangrong Li ◽

Chengjun Wang ◽

Zhiqin Lin ◽

Meng Zhao ◽

Xiaohui Ren ◽

...

Keyword(s):

Risk Factors ◽

Chinese Patients ◽

And Control ◽

Initial Resection

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Far Lateral Transcondylar Approach: Dimensional Anatomy

Neurosurgery ◽

10.1097/00006123-199907000-00023 ◽

1999 ◽

Vol 45 (1) ◽

pp. 95-100 ◽

Cited By ~ 29

Author(s):

Gregory C. Dowd ◽

Steve Zeiller ◽

Deepak Awasthi

Keyword(s):

Transcondylar Approach ◽

Far Lateral

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Transcondylar Approach

10.18791/nsatlas.v5.ch04.6 ◽

2016 ◽

Author(s):

Aaron Cohen-Gadol

Keyword(s):

Transcondylar Approach

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Endoscope-assisted far-lateral transcondylar approach for craniocervical junction chordomas: a retrospective case series and cadaveric dissection

Journal of Neurosurgery ◽

10.3171/2020.9.jns202611 ◽

2021 ◽

pp. 1-12

Author(s):

Arianna Fava ◽

Paolo di Russo ◽

Valentina Tardivo ◽

Thibault Passeri ◽

Breno Câmara ◽

...

Keyword(s):

Vertebral Artery ◽

Tumor Resection ◽

Case Series ◽

Craniocervical Junction ◽

Anatomical Landmarks ◽

Total Resection ◽

Female Ratio ◽

Cadaveric Dissection ◽

Transcondylar Approach ◽

Far Lateral

OBJECTIVE Craniocervical junction (CCJ) chordomas are a neurosurgical challenge because of their deep localization, lateral extension, bone destruction, and tight relationship with the vertebral artery and lower cranial nerves. In this study, the authors present their surgical experience with the endoscope-assisted far-lateral transcondylar approach (EA-FLTA) for the treatment of CCJ chordomas, highlighting the advantages of this corridor and the integration of the endoscope to reach the anterior aspect and contralateral side of the CCJ and the possibility of performing occipitocervical fusion (OCF) during the same stage of surgery. METHODS Nine consecutive cases of CCJ chordomas treated with the EA-FLTA between 2013 and 2020 were retrospectively reviewed. Preoperative characteristics, surgical technique, postoperative results, and clinical outcome were analyzed. A cadaveric dissection was also performed to clarify the anatomical landmarks. RESULTS The male/female ratio was 1.25, and the median age was 36 years (range 14–53 years). In 6 patients (66.7%), the lesion showed a bilateral extension, and 7 patients (77.8%) had an intradural extension. The vertebral artery was encased in 5 patients. Gross-total resection was achieved in 5 patients (55.6%), near-total resection in 3 (33.3%), and subtotal resection 1 (11.1%). In 5 cases, the OCF was performed in the same stage after tumor removal. Neither approach-related complications nor complications related to tumor resection occurred. During follow-up (median 18 months, range 5–48 months), 1 patient, who had already undergone treatment and radiotherapy at another institution and had an aggressive tumor (Ki-67 index of 20%), showed tumor recurrence at 12 months. CONCLUSIONS The EA-FLTA provides a safe and effective corridor to resect extensive and complex CCJ chordomas, allowing the surgeon to reach the anterior, lateral, and posterior portions of the tumor, and to treat CCJ instability in a single stage.

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Surveillance with Serial Serum Carcinoembryonic Levels Detect Colorectal Cancer Recurrences in Patients who are Initial Nonsecretors

The American Surgeon ◽

10.1177/000313481007601017 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1100-1103 ◽

Cited By ~ 4

Author(s):

Alicia Holt ◽

Rebecca A. Nelson ◽

Lily Lai

Keyword(s):

Colorectal Cancer ◽

Carcinoembryonic Antigen ◽

Retrospective Review ◽

Stage I ◽

Recurrent Colorectal Cancer ◽

Serum Carcinoembryonic Antigen ◽

Serial Serum ◽

Resected Stage ◽

Initial Resection

Serum carcinoembryonic antigen (CEA) levels, elevated in a subgroup of patients with colorectal cancer (CRC) at presentation, are serially followed as part of recommended surveillance after initial resection. The value of following serial CEA levels in patients who initially present with less than or normal levels of CEA (nonsecretors) is controversial. This study sought to determine the use of follow-up CEA levels in nonsecretors. A retrospective review was performed of patients with resected Stage I, II, and III CRC. We excluded patients who did not have a pretreatment CEA level, at least two follow-up CEA levels, or in whom CEA levels did not normalize after resection. The patients were grouped by initial CEA values: CEA 5 ng/mL or less (nonsecretors) and CEA 5 + ng/mL: (secretors). We identified 186 patients with CRC; 146 were initial nonsecretors. We identified 22 patients with recurrent colorectal cancer; 6 were secretors and 16 patients were nonsecretors. In the secretors group, CEA was elevated with recurrence in four (66%) of the patients. In the nonsecretors, CEA was elevated with recurrence in eight (50%) of the patients. In summary, many recurrences of CRC are marked by an elevation of CEA regardless of whether the patients initially presented as secretors or nonsecretors.

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