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
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引用次数: 0

摘要

目的:腹侧颅颈交界处(CCJ)的肿瘤带来了独特的挑战,尤其是对儿童而言。内窥镜方法治疗向下部和侧面延伸的肿瘤的潜在限制以及 CSF 渗漏的风险在儿童群体中会更加严重。在此,作者介绍了他们采用极外侧经蝶骨(ELTO)方法治疗儿童腹侧CCJ巨大肿瘤的经验,作为前路方法的替代或补充:这是一项回顾性单中心研究,研究对象是2021年1月至2024年1月期间接受ELTO方法治疗的患者。研究纳入了术后随访至少 3 个月并获得术后 MR 图像的患者。主要结果包括切除范围、术中和术后并发症以及神经功能结果:6名儿童接受了8种ELTO方法(2名儿童接受了双侧ELTO)。中位年龄为8岁(3-17岁),平均随访时间为15.8个月。诊断结果包括典型脊索瘤(3例)、分化不良脊索瘤(2例)和高分化未分化肉瘤(1例)。所有病例均实现了大体全切除(GTR)。一名患者出现椎动脉第三段血栓形成,但无缺血症状或体征。一名患者在确诊时因双侧颅神经XII麻痹导致脑积水和明显的吞咽困难,切除术后左侧声带麻痹加重,需要进行脑室腹腔分流术,肿瘤切除术后还需要进行气管造口术和胃造口术。一名患者在肿瘤切除术后 4 个月因吞咽困难再次发作而需要重新进行枕颈固定,但未造成其他后果:结论:ELTO方法对患有腹侧颅颈交界处巨大肿瘤的儿童是安全可行的。结论:ELTO方法对腹侧颅颈交界处巨大肿瘤患儿是安全可行的,所有患者都实现了GTR,并且没有出现明显的并发症或新的神经功能障碍。
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The extreme lateral transodontoid approach for large tumors in children in the ventral craniocervical junction.

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.

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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
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