SURGICAL VIDEO Management of Complex Pediatric Chordoma: Transnasal and Bilateral Far-Lateral Approach for Resection With O-C4 Fusion: 3-Dimensional Operative Video Jayson A. Neil, MD, Sarah T. Garber, MD, Andrew T. Dailey, MD, William T. Couldwell, MD, PhD Watch now at http://links.lww.com/NEU/A898 Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah The 3-D video can be viewed at http://links.lww.com/NEU/A898. Because the natural history of chordomas is one of persistent local Disclosure recurrence with tumor growth, treatment of chordomas in both The authors have no personal, financial, or institutional interest in any of the drugs, adults and children consists of an effort at complete resection materials, or devices described in this article. whenever possible followed by stereotactic proton beam radio- Acknowledgments therapy. The authors present the 3-D video of a case of a large We thank Vance Mortimer for helping with the video production and Kristin pediatric skull base chordoma demonstrating that multiple Kraus, MSc, for editorial assistance. approaches may be combined to allow for complete resection and that surgical judgment must be based on the patient’s COMMENTS particular anatomy and deficits. An 8-year-old girl presented with 1 week of progressive upper extremity weakness and a 1-year his is a beautiful video detailing a multistage, multidisciplinary ap- history of neck pain. Magnetic resonance imaging demonstrated T proach to management of a complex skull base tumor in a young a very large skull base lesion involving the clivus and upper child. It will be viewed and studied by the neurosurgical community with cervical spine. The initial resection was performed via an pleasure. endonasal endoscopic and microscopic transclival approach. Sunit Das Because of the fibrous nature of the tumor, gross total resection Toronto, Canada could not be achieved, and left and right far-lateral approaches with transposition of both vertebral arteries and an occipital xcellent video demonstration of the multiple surgical corridors of cervical fusion were necessary for complete resection of this E access often required for complete resection of complex skull base tumor. This patient’s good outcome emphasizes that manage- chordomas. ment of a complex chordoma often requires multiple approaches to attain a gross total resection providing the patient with James P. Chandler improved prognosis. Toronto, Canada 392 | VOLUME 12 | NUMBER 4 | DECEMBER 2016 www.operativeneurosurgery-online.com Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited.
Operative Neurosurgery – Oxford University Press
Published: Dec 1, 2016
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