The extreme lateral transodontoid approach for large tumors in children in the ventral craniocervical junction.

IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Journal of neurosurgery. Pediatrics Pub Date : 2024-12-20 DOI:10.3171/2024.9.PEDS24305
Nealen Laxpati, Uma Ramaswamy, Frank Lin, William E Whitehead, Howard L Weiner, David F Bauer, Guillermo Aldave
{"title":"The extreme lateral transodontoid approach for large tumors in children in the ventral craniocervical junction.","authors":"Nealen Laxpati, Uma Ramaswamy, Frank Lin, William E Whitehead, Howard L Weiner, David F Bauer, Guillermo Aldave","doi":"10.3171/2024.9.PEDS24305","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Tumors in the ventral craniocervical junction (CCJ) pose unique challenges, particularly in children. The potential constraints with endoscopic approaches to tumors extending inferiorly and laterally and the risk of CSF leakage can be exacerbated in the pediatric population. Here, the authors present their experience with the extreme lateral transodontoid (ELTO) approach in children with large ventral CCJ tumors as an alternative or complement to anterior approaches.</p><p><strong>Methods: </strong>This is a retrospective, single-center study of patients who underwent the ELTO approach from January 2021 to January 2024. Patients with at least 3 months of postoperative follow-up and postoperative MR images were included. Primary outcomes included extent of resection, intraoperative and postoperative complications, and neurological outcome.</p><p><strong>Results: </strong>Six children underwent 8 ELTO approaches (2 children underwent bilateral ELTO). The median age was 8 years (range 3-17 years), with a mean follow-up of 15.8 months. Diagnoses included classic chordoma (n = 3), poorly differentiated chordoma (n = 2), and high-grade undifferentiated sarcoma (n = 1). Gross-total resection (GTR) was achieved in all cases. One patient developed thrombosis of the third segment of the vertebral artery without symptoms or signs of ischemia. One patient with hydrocephalus and significant dysphagia due to bilateral cranial nerve XII palsy at diagnosis and worsening left vocal cord paralysis after the resection required ventriculoperitoneal shunt placement as well as a tracheostomy and gastrostomy after tumor resection. One patient required revision of the occipitocervical fixation due to new onset of dysphagia 4 months after tumor resection, without additional consequences.</p><p><strong>Conclusions: </strong>The ELTO approach is safe and feasible in children with large tumors of the ventral craniocervical junction. GTR was achieved in all the patients, and there were no significant complications or new neurological deficits due to the approach.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1000,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neurosurgery. Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3171/2024.9.PEDS24305","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Objective: Tumors in the ventral craniocervical junction (CCJ) pose unique challenges, particularly in children. The potential constraints with endoscopic approaches to tumors extending inferiorly and laterally and the risk of CSF leakage can be exacerbated in the pediatric population. Here, the authors present their experience with the extreme lateral transodontoid (ELTO) approach in children with large ventral CCJ tumors as an alternative or complement to anterior approaches.

Methods: This is a retrospective, single-center study of patients who underwent the ELTO approach from January 2021 to January 2024. Patients with at least 3 months of postoperative follow-up and postoperative MR images were included. Primary outcomes included extent of resection, intraoperative and postoperative complications, and neurological outcome.

Results: Six children underwent 8 ELTO approaches (2 children underwent bilateral ELTO). The median age was 8 years (range 3-17 years), with a mean follow-up of 15.8 months. Diagnoses included classic chordoma (n = 3), poorly differentiated chordoma (n = 2), and high-grade undifferentiated sarcoma (n = 1). Gross-total resection (GTR) was achieved in all cases. One patient developed thrombosis of the third segment of the vertebral artery without symptoms or signs of ischemia. One patient with hydrocephalus and significant dysphagia due to bilateral cranial nerve XII palsy at diagnosis and worsening left vocal cord paralysis after the resection required ventriculoperitoneal shunt placement as well as a tracheostomy and gastrostomy after tumor resection. One patient required revision of the occipitocervical fixation due to new onset of dysphagia 4 months after tumor resection, without additional consequences.

Conclusions: The ELTO approach is safe and feasible in children with large tumors of the ventral craniocervical junction. GTR was achieved in all the patients, and there were no significant complications or new neurological deficits due to the approach.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
求助全文
约1分钟内获得全文 去求助
来源期刊
Journal of neurosurgery. Pediatrics
Journal of neurosurgery. Pediatrics 医学-临床神经学
CiteScore
3.40
自引率
10.50%
发文量
307
审稿时长
2 months
期刊介绍: Information not localiced
期刊最新文献
The extreme lateral transodontoid approach for large tumors in children in the ventral craniocervical junction. Tubular single-port endoscope-assisted surgery for fetal myelomeningocele repair. False alarms and the burden of shunt failure in pediatric patients with hydrocephalus: a longitudinal study. The epidemiology and management of spontaneous spinal epidural abscesses in children: a single-center experience. Corpus callosotomy for intractable epilepsy: a contemporary series of operative factors and the overall complication rate.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1