Department of Neurosurgery, Roosevelt Hospital, New York, New York 10019, USA.
Neurosurgery. 2010 Mar;66(3 Suppl):104-12. doi: 10.1227/01.NEU.0000365930.95389.60.
Tumors at the craniovertebral junction are difficult to remove because of their location and complex anatomic relations. The lateral transcondylar approach is a versatile approach to this area and allows access to a variety of intra- and extradural tumors. The lateral transcondylar approach has been used for a series of chordomas in this location.
The nuances of this operation and its effectiveness in this group of patients are presented.
There were 29 chordomas (1991-2007) in this region treated by one of the authors (CS) that were retrospectively reviewed. The imaging studies and medical records were evaluated. The location and extent of the tumor were defined, and the postoperative images were studied to determine the degree of resection.
There were 11 male and 18 female patients; their age range was 7 to 67 years. Headache and neck pain were the predominant presenting symptoms, and hypoglossal nerve palsy was the most common cranial nerve palsy. Twelve patients had previous surgery and 9 had previous radiation. Anterior midline and lateral approaches were used independently or in combination to treat these patients. Dural invasion was found in 27 patients requiring resection of the dura. Surgery was performed in 1 stage in 19 patients, and the tumor resection in the remaining patients was done in 2 stages. The lateral transcondylar approach was used in 19 patients. The occipital condyle was involved in all these patients. Radical tumor resection was achieved in 17 patients. Patients who had complete removal of the occipital condyle required occipitocervical fusion (20 patients) in the immediate postoperative period.
The lateral transcondylar approach is an effective approach to chordomas in this region. Most of the tumors were large and extended into multiple anatomic compartments. The approach allowed resection of all the involved tissues, intra- and extracranial, and afforded excellent neurovascular control.
颅颈交界区的肿瘤因其位置和复杂的解剖关系而难以切除。外侧经髁突入路是一种用于该区域的多功能入路，可以进入各种颅内和颅外肿瘤。外侧经髁突入路已用于该部位的一系列脊索瘤。
介绍该手术的细微差别及其在这组患者中的疗效。
作者之一（CS）回顾性分析了 29 例位于该部位的脊索瘤患者（1991-2007 年）。评估了影像学研究和病历。定义了肿瘤的位置和范围，并研究了术后图像以确定切除程度。
患者中男性 11 例，女性 18 例；年龄 7-67 岁。头痛和颈部疼痛是主要的首发症状，舌下神经麻痹是最常见的颅神经麻痹。12 例患者曾接受过手术，9 例曾接受过放疗。采用前正中入路和外侧入路单独或联合治疗这些患者。27 例患者发现硬脑膜侵犯，需要切除硬脑膜。19 例患者在 1 期手术中进行了手术，其余患者的肿瘤切除分 2 期进行。19 例患者采用外侧经髁突入路。所有这些患者的枕骨髁均受累。17 例患者实现了肿瘤的根治性切除。完全切除枕骨髁的患者需要在术后立即进行枕颈融合（20 例）。
外侧经髁突入路是该区域脊索瘤的有效入路。大多数肿瘤较大，延伸到多个解剖部位。该入路允许切除所有受累的组织，包括颅内和颅外组织，并提供了极好的神经血管控制。
