Fava Arianna, Russo Paolo di, Tardivo Valentina, Passeri Thibault, Câmara Breno, Penet Nicolas, Abbritti Rosaria, Giammattei Lorenzo, Mammar Hamid, Bernat Anne Laure, Mandonnet Emmanuel, Froelich Sébastien
1Department of Neurosurgery, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris.
2Laboratory of Experimental and Skull Base Neurosurgery, Department of Neurosurgery, Lariboisière Hospital, Paris.
J Neurosurg. 2021 Apr 2;135(5):1335-1346. doi: 10.3171/2020.9.JNS202611. Print 2021 Nov 1.
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.
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.
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.
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.
颅颈交界区（CCJ）脊索瘤是一种神经外科挑战，因其位置深、向外侧延伸、骨质破坏以及与椎动脉和低位颅神经关系紧密。在本研究中，作者介绍了他们使用内镜辅助远外侧经髁入路（EA - FLTA）治疗CCJ脊索瘤的手术经验，强调了该手术通道的优势以及内镜在到达CCJ前方和对侧的应用，还有在同一手术阶段进行枕颈融合（OCF）的可能性。
回顾性分析2013年至2020年间连续9例采用EA - FLTA治疗的CCJ脊索瘤病例。分析术前特征、手术技术、术后结果及临床转归。还进行了尸体解剖以明确解剖标志。
男女比例为1.25，中位年龄为36岁（范围14 - 53岁）。6例患者（66.7%）病变呈双侧延伸，7例患者（77.8%）有硬膜内延伸。5例患者椎动脉被包绕。5例患者实现了全切除（55.6%），3例近全切除（33.3%），1例次全切除（11.1%）。5例患者在肿瘤切除后同期进行了OCF。未发生与手术入路相关的并发症或与肿瘤切除相关的并发症。在随访期间（中位18个月，范围5 - 48个月），1例在另一机构已接受治疗和放疗且肿瘤侵袭性强（Ki - 67指数为20%）的患者在12个月时出现肿瘤复发。
EA - FLTA为切除广泛且复杂的CCJ脊索瘤提供了一个安全有效的手术通道，使外科医生能够到达肿瘤的前、外侧和后部，并在单一阶段治疗CCJ不稳。
