Lower third clivus and foramen magnum intradural tumor removal: The plea for a simple posterolateral approach

• Published in: Neuro-chirurgie Vol. 62; no. 2; pp. 86 - 93
• Main Authors: Bernard, F, Lemee, J.M, Delion, M, Fournier, H.D
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.04.2016
• Subjects: Base du crâne; Cerebellar Diseases - etiology; Clivus; Cranial Fossa, Posterior - diagnostic imaging; Cranial Fossa, Posterior - surgery; Cranial Nerve Neoplasms - complications; Cranial Nerve Neoplasms - surgery; Craniotomy - methods; Decompression, Surgical - methods; Dura Mater - surgery; Female; Foramen magnum; Foramen Magnum - diagnostic imaging; Foramen Magnum - surgery; Humans; Male; Meningeal Neoplasms - complications; Meningeal Neoplasms - diagnostic imaging; Meningeal Neoplasms - surgery; Meningioma - complications; Meningioma - diagnostic imaging; Meningioma - surgery; Middle Aged; Neck Muscles - surgery; Neurilemmoma - complications; Neurilemmoma - surgery; Neurosurgery; Neurosurgical Procedures - methods; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Quadriplegia - etiology; Retrospective Studies; Skull base; Skull Base Neoplasms - complications; Skull Base Neoplasms - diagnostic imaging; Skull Base Neoplasms - surgery; Spinal Cord Compression - etiology; Surgery; basilar artery; A; RS; Base du crâne; F; I; transcondylar; anterior; VPI; cranial nerves; OC; anterolateral; far lateral approach; intradural; velopharyngeal insufficiency; EE; Skull base; vertebral artery; AL; CN; radiosurgery; VA; Clivus; occipitocervical; TC; trans-oro-pharyngeal approach; TOP; Foramen magnum; endoscopic endonasal approach; BA
• ISSN: 0028-3770; 1773-0619
• DOI: 10.1016/j.neuchi.2015.10.010

Abstract Background Anterior or anterolateral lesions of the lower third clivus and/or foramen magnum require a surgical exposure that provides a clear visualization of both pathological and normal anatomy without retraction of neural or vascular structures. The posterolateral approach permits access to the anterolateral intradural aspect of the brainstem. The aim of this study was to stress that there is no need for vertebral artery transposition, occipital condyle drilling, occipitocervical fixation or trans-oro-pharyngeal access to remove these lesions. Methods All five consecutive patients treated surgically for an intradural foramen magnum lesion in the Department of Neurosurgery at Angers University Hospital, between May 2012 and January 2015, were included in this retrospective study. In 4 cases, patients were referred to us for a second opinion after an initial surgical proposal at another institution. For all patients, the data collected were age at diagnosis, clinical signs, and quality of rostral and caudal exposure of the lesion, quality of resection, complications and postoperative neurological deficits. Results All patients were operated on with a control of the rostrocaudal part of the lesion, without touching the vertebral artery, or the use of occipital condyle drilling. There was no need for occipitocervical fixation. Total resection was achieved in 4 cases, subtotal resection in one. All had watertight dural closure with no dural patch, or postoperative neurological deficits. No recurrence occurred between 6 and 30 months after surgery. Conclusion Based on these results, the posterolateral approach was a simple, effective and safe procedure for anterior and anterolateral intradural lesion of the foramen magnum.