Keywords
anterolateral approach - chordoma - craniovertebral junction - endoscopic-assisted
microsurgery - operative video
Publication Comments
This is an excellent video of a relatively uncommon approach to the craniovertebral
junction. This had been initially described by Bernard George and the authors demonstrate
a mastery of it. As with most approaches to chordomas, there are certain blind spots,
such as the ipsilateral side, superiorly above the jugular foramen, and across the
midline onto the opposite side. Since the goal is to drill as much of the surrounding
bone as possible, these blind spots are a limitation. Nevertheless it is an effective
approach in selected cases that the skull base surgeon should be familiar with. I
am not sure how the cement implant at the end of the operation is expected to provide
stability.
Chandra Sen, MD
New York University School of Medicine
New York, NY
The authors present an excellent video of an upper cervical anterior lateral and transmastoid
suboccipital approach for resection of an intra- and extradural chordoma of the inferior
clivus and upper cervical region ventral to the cervical medullary junction. The surgical
technique is excellent and very well displayed in the edited and narrated video along
with appropriate annotations of the important anatomy. This video demonstrates masterful
technique.
Michael Chicoine, MD
Washington University
St. Louis, MO
Fig. 1 Preoperative and postoperative magnetic resonance imaging (MRI). (A) Preoperative sagittal T2-weighted MRI showing a hyperintense lesion (chordoma) centered
on the anterior craniovertebral junction with intradural extension and compression
of neurovascular structures. (B) Postoperative sagittal T2-weighted MRI showing gross total of the tumor.
Fig. 2 Surgical steps of surgery. (A) Incision along the anterior border of the sternocleido mastoid muscle and passing
above the mastoid process. (B) View of the tumor capsule prior to removal and after vertebral transposition and
drilling of the occipital condyle and mastoid tip. (C) Intradural tumor dissection from the nerves of the contralateral jugular foramen.
(D) Closure of the dural defect using free fat graft. (E) Endoscopic intradural exploration showing a tumor remnant on the contralateral jugular
foramen.
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