Department of Human Neurosciences, Neurosurgery, Sapienza University of Rome, Rome, Italy; Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France.
Department of Neurosurgery, The Medical City, Manila, Philippines; Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France.
Clin Neurol Neurosurg. 2023 May;228:107706. doi: 10.1016/j.clineuro.2023.107706. Epub 2023 Mar 30.
Chordomas of craniovertebral junction represent a challenging pathology for neurosurgeons, due to their deep location, proximity with critical neurovascular structures and local aggressiveness. Several surgical options are available for these tumors: both endoscopic extended approaches and open approaches. We present the case of a 24 years old female with a craniovertebral junction chordoma with anterior and right lateral extension. For this case, an anterolateral approach with endoscopic assistance was chosen. Key surgical steps are presented. In the postoperative course the neurological symptoms improved and there were no complications. Unfortunately, she had an early recurrence of tumor two months later, prior the beginning of radiotherapy. After multidisciplinary consultation, we performed a second surgical removal and a posterior cervical spine arthrodesis. The anterolateral approach is a valuable option for craniovertebral junction chordomas with lateral extension and the endoscope assistance allowed to reach the narrowest and furthermost points. The patients must be referred to multidisciplinary skull base surgery centers and be addressed to early adjuvant radiation therapy.
颅颈交界区脊索瘤对神经外科医生来说是一个具有挑战性的病理学问题，因为它们位置深，靠近关键的神经血管结构，并且局部侵袭性强。对于这些肿瘤，有几种手术选择：内镜下广泛入路和开放入路。我们报告了一例 24 岁女性颅颈交界区脊索瘤，肿瘤向前和右侧外侧延伸。对于这种情况，选择了经前路内镜辅助手术。本文介绍了关键的手术步骤。术后患者神经症状改善，无并发症。不幸的是，她在开始放疗前两个月肿瘤早期复发。多学科会诊后，我们进行了第二次手术切除和后路颈椎融合术。前路是治疗颅颈交界区外侧延伸脊索瘤的一种有价值的选择，内镜辅助可以到达最狭窄和最远的部位。患者必须转至多学科颅底外科中心，并尽早进行辅助放疗。
