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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Pedicled rhinotomy for clival chordomas invaginating the brainstem
G Harsh1, R Ojemann, M Varvares
1Brain Tumor Center, Department of Neurosurgery, Stanford Medical School, Stanford, California, USA.
Neurosurgical Focus
|June 1, 2006
Summary
Pedicled rhinotomy effectively resects clival chordomas, relieving brainstem compression. This surgical approach enables curative proton beam radiotherapy for these challenging midline tumors.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Clival chordomas are midline tumors that can grow posteriorly, invading the brainstem and dura.
- This invasion complicates surgical resection and prevents effective high-dose proton radiotherapy.
Purpose of the Study:
- To evaluate the efficacy of pedicled rhinotomy for resecting clival chordomas.
- To assess the technique's ability to relieve brainstem compression and facilitate radiotherapy.
Main Methods:
- Pedicled rhinotomy, a transnasal approach, was used to access and resect 10 clival chordomas.
- The procedure involves extensive nasal and sinus dissection to expose the clivus and craniovertebral junction.
- Tumor removal was performed even with dural breach; closure included dural repair and reconstruction.
Main Results:
- Complete tumor resection relieving brainstem compression was achieved in 8 of 10 patients.
- No new neurological deficits occurred; pre-existing symptoms improved in 8 patients.
- One patient experienced cerebrospinal fluid leakage and meningitis, successfully treated.
Conclusions:
- Pedicled rhinotomy offers excellent exposure for midline clival chordomas.
- The technique allows for effective brainstem decompression and subsequent proton beam radiotherapy.
