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Katsuhiro Mizutani, Takenori Akiyama, Masahiro Toda, Tokunori Kanazawa, Dai Kamamoto, Kazunari Yoshida
BACKGROUND: The endoscopic transclival approach is a method for reaching the anterior side of the brainstem. In making this approach, bleeding from the basilar plexus is often observed when cutting the dura overlying the clivus; controlling such bleeding is essential. CASE DESCRIPTION: We performed a transvenous embolization of the basilar plexus before making the transclival approach. After embolization, bleeding from the basilar plexus during the operation decreased considerably...
October 14, 2016: World Neurosurgery
Stefan Kliesch, Christian Bauknecht, Georg Bohner, Thomas Liebig, Eberhard Siebert
We report a rare case of entrapment of the basilar artery into the sphenoid bone caused by a longitudinal fracture of the clivus. Using high resolution three-dimensional flat panel angiography, we show preservation of the basilar artery perforators in spite of severe stenosis of the entrapped segment of the basilar artery. There were no obvious signs and symptoms of posterior fossa stroke clinically or radiographically as far as could be assessed under given clinical circumstances.
September 23, 2016: Journal of Neurointerventional Surgery
Stefan Kliesch, Christian Bauknecht, Georg Bohner, Thomas Liebig, Eberhard Siebert
We report a rare case of entrapment of the basilar artery into the sphenoid bone caused by a longitudinal fracture of the clivus. Using high resolution three-dimensional flat panel angiography, we show preservation of the basilar artery perforators in spite of severe stenosis of the entrapped segment of the basilar artery. There were no obvious signs and symptoms of posterior fossa stroke clinically or radiographically as far as could be assessed under given clinical circumstances.
2016: BMJ Case Reports
Saleem I Abdulrauf, Ahmed M Ashour, Eric Marvin, Jeroen Coppens, Brian Kang, Tze Yu Yeh Hsieh, Breno Nery, Juan R Penanes, Aysha K Alsahlawi, Shawn Moore, Hussam Abou Al-Shaar, Joanna Kemp, Kanika Chawla, Nanthiya Sujijantarat, Alaa Najeeb, Nadeem Parkar, Vilaas Shetty, Tina Vafaie, Jastin Antisdel, Tony A Mikulec, Randall Edgell, Jonathan Lebovitz, Matt Pierson, Paulo Henrique Pires de Aguiar, Paula Buchanan, Angela Di Cosola, George Stevens
INTRODUCTION: Numerical classification systems for the internal carotid artery (ICA) are available, but modifications have added confusion to the numerical systems. Furthermore, previous classifications may not be applicable uniformly to microsurgical and endoscopic procedures. The purpose of this study was to develop a clinically useful classification system. MATERIALS AND METHODS: We performed cadaver dissections of the ICA in 5 heads (10 sides) and evaluated 648 internal carotid arteries with computed tomography angiography...
July 2016: Journal of Craniovertebral Junction and Spine
Ronnie Sebro, Thomas DeLaney, Francis Hornicek, Joseph Schwab, Edwin Choy, G Petur Nielsen, Daniel I Rosenthal
BACKGROUND: Chordomas are rare malignancies that primarily affect adults, but also rarely affect pediatric patients. We compared the imaging appearance, demographic and anatomic distributions of adult and pediatric chordomas in a large cohort. METHODS: We performed a retrospective review of medical records of 220 subjects with histologically confirmed chordomas of the axial skeleton and pre-treatment magnetic resonance imaging studies. Age, sex, type of chordoma (conventional, chondroid or dedifferentiated), the anatomic location of the chordoma, as well as whether the lesion was primarily extra-osseous were recorded...
2016: BMC Medical Imaging
Omur Gunaldi, Hakan Kina, Osman Tanriverdi, Uzay Erdogan, Lütfi Şinasi Postalci
OBJECTIVE: In recent years, endoscope started to be used for the excision of the brainstem lesions or those localized in the anterior part of the brainstem. In this paper a case of clival meningioma resected through endoscopic endonasal transclival route has been presented with illustrations, live surgery videos demonstrating the surgery step by step. CASE REPORT: A 35-year-old male patient consulted to us with dysphagia,and impaired consciousness. MR imaging detected a mass lesion with a wide base localized clivus and anterior part of brainstem...
May 25, 2016: Turkish Neurosurgery
Vicente Vanaclocha, Juan Manuel Herrera, Deborah Martínez-Gómez, Marlon Rivera-Paz, Cristina Calabuig-Bayo, Leyre Vanaclocha
BACKGROUND: surgical treatment of trigeminal neuralgia (TN) associated with vertebro-basilar dolichoectasia (VBD) is challenging. AIM: to analyze the treatments for this disease discussing its advantages and drawbacks, presenting our own technique and series. METHODS: retrospective study January 2006-January 2016. On pre and postop MRI images VBD deviation from midline, BA and VA diameter, and BA apex distance above posterior clinoid process were measured...
August 29, 2016: World Neurosurgery
Hussam Abou-Al-Shaar, Ari M Blitz, Fausto J Rodriguez, Masaru Ishii, Gary L Gallia
BACKGROUND: Craniopharyngiomas are uncommon benign locally aggressive epithelial tumors mostly located in the sellar and suprasellar regions. An infrasellar origin of these tumors is rare. CASE DESCRIPTION: The authors report a 22-year-old male patient with a purely infrasellar adamantinomatous craniopharyngioma centered in the nasopharynx with extension into the posterior nasal septum, sphenoid sinus, and clivus. Gross total resection was achieved using an expanded endonasal endoscopic transethmoidal, transsphenoidal, transpterygoid, and transclival approach...
August 20, 2016: World Neurosurgery
Wei Ji, Xiang Liu, Wenhan Huang, Zucheng Huang, Jianting Chen, Qingan Zhu, Zenghui Wu
Clival screw and plate fixation technique is an alternative or supplement to the occipitocervical instrumentation. However, no report has clarified the applied anatomy of clivus in patients with atlas assimilation (C1A), especially for clival screw fixation. Therefore, we measured the parameters of clival lengths, widths, putative screw lengths, clival-cervical angel and foramen magnum diameters on CT images in a cohort of 81 C1A patients and patients without C1A. The clivus showed a rectangular shape in 96...
2016: Scientific Reports
Chuanyuan Tao, Xiaowei Liu, Yuekang Zhang, Fan Liu, Chao You
INTRODUCTION: Anterior and anterolateral tumors in foramen magnum region are rare and surgically challenging although most of them are benign. The optimal approach is debatable and prognostic factors affecting surgical outcome remains unclear. We aimed to identify factors including surgical approach determining postoperative outcome. METHODS: The data of 49 patients diagnosed benign tumors involving the anterior and anterolateral foramen magnum were retrospectively analyzed in our institution from January 2009 to January 2015...
September 2016: International Journal of Surgery
P Wu, Z Y Yang, Y Liu, Y Li, Y H Tan
OBJECTIVE: To analyze the impact of maxillofacial injury on skull base. METHODS: A three-dimensional(3D)finite-element model of cranio-maxillofacial bone was established by CT scan data. A lead cylinder in base diameter of 3 cm was designed as an impactor. There regions(upper right maxilla, left infraorbital margin and left zygomatic body)subjected to an impact at the speed of 8.6 m/s(about 30 km/h)was simulated. Thirteen landmarks at the skull base were selected...
August 2016: Zhonghua Kou Qiang Yi Xue za Zhi, Zhonghua Kouqiang Yixue Zazhi, Chinese Journal of Stomatology
Jun Won Kim, Chang-Ok Suh, Chang-Ki Hong, Eui Hyun Kim, Ik Jae Lee, Jaeho Cho, Kyu-Sung Lee
BACKGROUND: Local recurrence is common after surgical resection of clivus chordoma. We report the results of maximum surgical resection followed by intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB). METHODS: We reviewed 14 consecutive clivus chordoma cases undergoing postoperative IMRT-SIB using the institutional protocol between 2005 and 2013. Total and near-total resections were achieved in 11 patients (78.6 %), partial in 2 patients (14...
August 9, 2016: Acta Neurochirurgica
Jian Yang, Xinghai Yang, Wujun Miao, Qi Jia, Wei Wan, Tong Meng, Zhipeng Wu, Xiaopan Cai, Dianwen Song, Jianru Xiao
BACKGROUND: For a long time, chordoma has been known as an osseous tumor mainly found at the clivus and sacrococcygeal region. However, spine extra-osseous chordoma (SEC) with a better prognosis than the classic type has been neglected. According to our literature review, only several case reports have been published in English literatures. Here in this article, three cases of SEC, plus a literature review, are presented. CASE PRESENTATION: Three cases of SEC were presented from our center...
2016: World Journal of Surgical Oncology
Aanchal Kakkar, Aruna Nambirajan, Vaishali Suri, Chitra Sarkar, Shashank S Kale, Manmohan Singh, Mehar Chand Sharma
AIMS: Primary skull bone tumors, benign or malignant, are rare, and include a vast repertoire of lesions. These tumors are not reported systematically in the literature, with most studies being on individual entities or as single case reports. METHODS: Primary bone tumors diagnosed over a period of 12 years were retrieved, histological diagnoses reviewed, and clinical parameters noted. RESULTS: We identified 125 primary skull bone tumors. The mean age at diagnosis was 32 years (range: 2-65 years)...
August 2016: Journal of Neurological Surgery. Part B, Skull Base
Walter C Jean, Daniel R Felbaum, Amjad Anaizi, Timothy R DeKlotz
The endoscopic endonasal transclival approach has been widely described for its use to resect clivus chordomas, but there have only been isolated reports of its use for petroclival meningiomas. These tumors are most often resected utilizing open transpetrosal approaches, but these operations, difficult even in the hands of dedicated skull base surgeons, are particularly challenging if the meningiomas are medially-situated and positioned mainly behind the clivus. For this subset of petroclival meningiomas, a transclival approach may be preferable...
2016: Curēus
Mazda K Turel, Christopher J Chin, Allan D Vescan, Fred Gentili
With the use and efficacy of the vascularized nasoseptal flap, its indications are also expanding. Due to its relative ease of harvesting and no significant impairment in the long-term sinonasal quality of life, the flap has been used for a number of other purposes apart from its originally proposed use in reconstruction of the anterior cranial fossa, sella, and the clivus. Its use may negate the need of another incision to obtain fat or fascia. The authors describe the case of a 47-year-old lady who underwent endoscopic excision of a medially placed orbital intraconal hemangioma who presented to us with very poor vision in the left eye...
September 2016: Journal of Craniofacial Surgery
Manish Bhartiya, Aditya Pachisia, Rajan Kapoor, Vasu Vardhan
No abstract text is available yet for this article.
June 2016: Indian Journal of Hematology & Blood Transfusion
Mark Calayag, Reid Hoshide, David D Gonda, Hal S Meltzer, Takanori Fukushima, Michael L Levy
INTRODUCTION: Hemorrhagic cavernous malformations involving the lateral pontine region require complex surgical considerations to maximize complete resection of the cavernoma and associated hemorrhage while minimizing morbidity. We describe our experience through the middle fossa rhomboid approach in 8 children with cavernomas involving the pons, with lateralized hemorrhages extending through the pontine parenchyma. METHODS: Eight children underwent this approach over a 10-year period at Rady Children's Hospital of San Diego...
August 2016: Neurosurgery
Aurel Hasanbelliu, Norberto O Andaluz, Alberto Di Somma, Jeffrey T Keller, Lee Zimmer, Myles L Pensak, Ravi Samy, Mario Zuccarello
INTRODUCTION: Petroclival tumors and ventrolateral lesions of the pons present a unique surgical challenge. We aimed to provide qualitative and quantitative anatomic analyses of anterior petrous apicectomy through the transcranial middle fossa (TMF) and the extended endoscopic transphenoidal-transclival (EETT) approaches. METHODS: Ten cadaveric silicon-injected cadaver heads were used for this study. The petrous apex and the clivus were drilled extradurally through both middle fossa and endonasal approaches...
August 2016: Neurosurgery
Wei Ji, Jie Tong, Zhiping Huang, Minghui Zheng, Xiuhua Wu, Jianting Chen, Qingan Zhu
BACKGROUND: Ventral defect caused by resection of the lesions involving the upper cervical spine was commonly reconstructed with a fabricated mesh cage. Recently, a clival screw and plate fitted to the osseous anatomy of the craniovertebral junction was developed for this pathological state. OBJECTIVE: To evaluate the stability a clivus plate system fixation (CPSF) for the craniovertebral junction and compared with a conventional fashioned mesh cage fixation (FMCF)...
June 30, 2016: World Neurosurgery
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