Abdul Jalil Muhammad Fahmi, Story Rowan D, Rogers Myron
Department of Neurosurgery, Austin Hospital, Heidelberg, Victoria 3084, Australia.
Department of Maxillofacial Surgery, Austin Hospital, Heidelberg, Victoria 3084, Australia.
J Clin Neurosci. 2017 May;39:212-215. doi: 10.1016/j.jocn.2017.01.031. Epub 2017 Feb 20.
Minimally invasive approaches to the central skull base have been popularized over the last decade and have to a large extent displaced 'open' procedures. However, traditional skull base surgery still has its role especially when dealing with a large clival chordoma where maximal surgical resection is the principal goal to maximize patient survival. In this paper, we present a case of a 25year-old male patient with chordoma in the inferior clivus which was initially debulked via a transnasal endoscopic approach. He unfortunately had a large recurrence of tumor requiring re-do resection. With the aim to achieve maximal surgical resection, we then chose the technique of a transoral approach with Le Fort 1 maxillotomy and midline palatal split. Post-operative course for the patient was uneventful and post-operative MRI confirmed significant debulking of the clival lesion. The technique employed for the surgical procedure is presented here in detail as is our experience over two decades using this technique for tumors, inflammatory lesions and congenital abnormalities at the cranio-cervical junction.
在过去十年中，微创入路治疗中央颅底疾病已得到广泛应用，并在很大程度上取代了“开放”手术。然而，传统的颅底手术仍有其作用，特别是在处理大型斜坡脊索瘤时，最大限度的手术切除是提高患者生存率的主要目标。在本文中，我们报告了一例25岁男性患者，其斜坡下部患有脊索瘤，最初通过经鼻内镜入路进行了肿瘤减容。不幸的是，他的肿瘤大量复发，需要再次手术切除。为了实现最大限度的手术切除，我们随后选择了经口入路联合Le Fort 1上颌骨切开术和中线腭部劈开术。患者术后恢复顺利，术后MRI证实斜坡病变明显减容。本文详细介绍了手术所采用的技术，以及我们二十多年来使用该技术治疗颅颈交界区肿瘤、炎性病变和先天性异常的经验。
