Meningiomas and neurofibromas are the most common intradural extramedullary tumors of the foramen magnum and cervical spine. Many of these tumors are located ventral or ventrolateral to the spinal cord and medulla. Posterior approaches, although adequate for the management of most of these tumors, can sometimes result in incomplete removal of the tumor and exacerbation of the neurological deficits. Although the transoral and transcervical approaches provide a direct route to the tumor, the exposure of the lateral margins in the case of large tumors is inadequate. In addition, because of the removal of vertebral bodies, subsequent fusion may be necessary. In the present report, an extreme lateral approach to the foramen magnum and cervical spine for the removal of intradural tumors is described. The approach provides a lateral exposure of the tumor-cord/stem interface, thus permitting safe dissection without retraction of the cord. The entire longitudinal and lateral extent of the tumor and also its extradural extension can be can be managed by this approach. This approach can be considered in such a group of patients harboring entirely ventral or recurrent tumors for which the conventional posterior approach has failed. Six patients who underwent this procedure are described to illustrate its application.
Meningiomas and neurofibromas are the most common intradural extramedullary tumors of the foramen magnum and cervical spine. Many of these tumors are located ventral or ventrolateral to the spinal cord and medulla. Posterior approaches, although adequate for the management of most of these tumors, can sometimes result in incomplete removal of the tumor and exacerbation of the neurological deficits. Although the transoral and transcervical approaches provide a direct route to the tumor, the exposure of the lateral margins in the case of large tumors is inadequate. In addition, because of the removal of vertebral bodies, subsequent fusion may be necessary. In the present report, an extreme lateral approach to the foramen magnum and cervical spine for the removal of intradural tumors is described. The approach provides a lateral exposure of the tumor-cord/stem interface, thus permitting safe dissection without retraction of the cord. The entire longitudinal and lateral extent of the tumor and also its extradural extension can be can be managed by this approach. This approach can be considered in such a group of patients harboring entirely ventral or recurrent tumors for which the conventional posterior approach has failed. Six patients who underwent this procedure are described to illustrate its application.
The extended frontal approach is a modification of the transbasal approach of Derome. The addition of a bilateral orbitofrontal or orbitofrontoethmoidal osteotomy improves the exposure of midline lesions of the anterior, middle, and posterior skull base, while minimizing the need for frontal lobe retraction. The authors present a 5-year experience with 49 patients operated on via the extended frontal approach. In seven patients, the extended frontal approach was used alone; in the remaining 42, it was combined with other skull base approaches. Highly malignant tumors were removed en bloc, whereas benign tumors and low-grade malignancies were removed either en bloc or piecemeal. Reconstruction was usually performed using fascia lata, a pericranial flap, and/or autologous fat. A temporalis muscle flap or a distant microvascular free flap was required for some patients. One patient died 1 month postoperatively due to superior mesenteric artery thrombosis. Three patients had postoperative infections, two had cerebrospinal fluid leaks requiring reoperation, and four had brain contusions or hematomas. All but two patients recovered to their preoperative functional level. After an average follow-up period of 26 months (range 6 to 56 months), 64% of patients with benign lesions, 64% of patients with low-grade malignancies, and 44% of patients with high-grade lesions were alive with no evidence of disease.
Nasopharynx, clivus, and cavernous sinus are difficult regions of the cranial base in which to perform oncologie surgery. We have developed an approach to this area by using facial soft tissue translocation and craniofacial osteotomies. Surgical field ob tained at the skull base can extend from the contralateral eustachian tube to ipsilateral geniculate ganglion. It includes the nasopharynx, clivus, sphenoid, and cavernous sinus, as well as the entire infratemporal fossa and superior orbital fissure. Our expe rience with this technique in 12 patients is reported. All patients healed primarily, (οτο- LARYNGOL HEAD NECK SURG 1990:103:413.)
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