ABSTRACT
Lesions of the lower clivus represent a technically challenging subset of skull base disease that requires careful treatment. A 75-year-old woman with tongue atrophy was referred for resection of a presumed clival chordoma. The lesion was resected via an endoscopic transnasal transclival approach with no complications. Pathology revealed only chronic inflammatory tissue consistent with a degenerative pannus. Degenerative pannus should be included in the differential diagnosis of lower clival extradural lesions. The endoscopic transnasal transclival corridor should be considered for resection of such lesions as an alternative to larger, more morbid, traditional skull base approaches.
KEYWORDS
Clivus - endoscopic - chordoma - pannus - degenerative
REFERENCES
-
1 Rhoton A L. Congress of Neurological Surgeons .Cranial Anatomy and Surgical Approaches. Hagerstown, MD: Lippincott Williams & Wilkins; 2003
-
2
Kelley T F, Stankiewicz J A, Chow J M, Origitano T C.
Endoscopic transsphenoidal biopsy of the sphenoid and clival mass.
Am J Rhinol.
1999;
13
17-21
-
3
Solares C A, Fakhri S, Batra P S, Lee J, Lanza D C.
Transnasal endoscopic resection of lesions of the clivus: a preliminary report.
Laryngoscope.
2005;
115
1917-1922
-
4
Laws Jr E R.
Transsphenoidal surgery for tumors of the clivus.
Otolaryngol Head Neck Surg.
1984;
92
100-101
-
5
Maira G, Pallini R, Anile C et al..
Surgical treatment of clival chordomas: the transsphenoidal approach revisited.
J Neurosurg.
1996;
85
784-792
-
6
Kassam A B, Gardner P, Snyderman C, Mintz A, Carrau R.
Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa.
Neurosurg Focus.
2005;
19
E6
-
7
Shen F H, Samartzis D, Jenis L G, An H S.
Rheumatoid arthritis: evaluation and surgical management of the cervical spine.
Spine J.
2004;
4
689-700
-
8
Nguyen H V, Ludwig S C, Silber J et al..
Rheumatoid arthritis of the cervical spine.
Spine J.
2004;
4
329-334
-
9
de Almeida J R, Zanation A M, Snyderman C H et al..
Defining the nasopalatine line: the limit for endonasal surgery of the spine.
Laryngoscope.
2009;
119
239-244
-
10
Jho H D.
Endoscopic pituitary surgery.
Pituitary.
1999;
2
139-154
-
11
de Divitiis E, Cappabianca P, Cavallo L M.
Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions.
Neurosurgery.
2002;
51
699-705
discussion 705-707
-
12
Frank G, Sciarretta V, Calbucci F et al..
The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas.
Neurosurgery.
2006;
59
(Suppl 1)
ONS50-ONS57
discussion ONS50-ONS57
-
13
Stippler M, Gardner P A, Snyderman C H et al..
Endoscopic endonasal approach for clival chordomas.
Neurosurgery.
2009;
64
268-277
discussion 277-278
-
14
Dehdashti A R, Karabatsou K, Ganna A, Witterick I, Gentili F.
Expanded endoscopic endonasal approach for treatment of clival chordomas: early results in 12 patients.
Neurosurgery.
2008;
63
299-307
discussion 307-309
-
15
Sekhar L N, Nanda A, Sen C N, Snyderman C N, Janecka I P.
The extended frontal approach to tumors of the anterior, middle, and posterior skull base.
J Neurosurg.
1992;
76
198-206
-
16
Crockard H A, Sen C N.
The transoral approach for the management of intradural lesions at the craniovertebral junction: review of 7 cases.
Neurosurgery.
1991;
28
88-97
discussion 97-98
-
17
Price J C.
The midfacial degloving approach to the central skull-base.
Ear Nose Throat J.
1986;
65
174-180
-
18
Froelich S, Aziz K A, Levine N B et al..
Extension of the one-piece orbitozygomatic frontotemporal approach to the glenoid fossa: cadaveric study.
Neurosurgery.
2008;
62
(Suppl 2)
ONS312-ONS316
discussion ONS316-ONS317
-
19
Aziz K M, van Loveren H R, Tew Jr J M, Chicoine M R.
The Kawase approach to retrosellar and upper clival basilar aneurysms.
Neurosurgery.
1999;
44
1225-1234
discussion 1234-1236
-
20
Tanriover N, Sanus G Z, Ulu M O et al..
Middle fossa approach: microsurgical anatomy and surgical technique from the neurosurgical perspective.
Surg Neurol.
2009;
71
586-596
discussion 596
-
21
Lanzino G, Dumont A S, Lopes M B, Laws Jr E R.
Skull base chordomas: overview of disease, management options, and outcome.
Neurosurg Focus.
2001;
10
E12
-
22
Frempong-Boadu A K, Faunce W A, Fessler R G.
Endoscopically assisted transoral-transpharyngeal approach to the craniovertebral junction.
Neurosurgery.
2002;
51
(Suppl)
S60-S66
-
23
Baird C J, Conway J E, Sciubba D M, Prevedello D M, Quiñones-Hinojosa A, Kassam A B.
Radiographic and anatomic basis of endoscopic anterior craniocervical decompression: a comparison of endonasal, transoral, and transcervical approaches.
Neurosurgery.
2009;
65
(Suppl)
158-163
discussion 63-64
-
24
Menezes A H.
Surgical approaches: postoperative care and complications “transoral-transpalatopharyngeal approach to the craniocervical junction”.
Childs Nerv Syst.
2008;
24
1187-1193
-
25
Yang S Y, Gao Y Z.
Clinical results of the transoral operation for lesions of the craniovertebral junction and its abnormalities.
Surg Neurol.
1999;
51
16-20
-
26
Reijnierse M, Dijkmans B A, Hansen B et al..
Neurologic dysfunction in patients with rheumatoid arthritis of the cervical spine. Predictive value of clinical, radiographic and MR imaging parameters.
Eur Radiol.
2001;
11
467-473
-
27
Pallini R, Maira G, Pierconti F et al..
Chordoma of the skull base: predictors of tumor recurrence.
J Neurosurg.
2003;
98
812-822
-
28
Park L, Delaney T F, Liebsch N J et al..
Sacral chordomas: impact of high-dose proton/photon-beam radiation therapy combined with or without surgery for primary versus recurrent tumor.
Int J Radiat Oncol Biol Phys.
2006;
65
1514-1521
-
29
Hug E B, Loredo L N, Slater J D et al..
Proton radiation therapy for chordomas and chondrosarcomas of the skull base.
J Neurosurg.
1999;
91
432-439
-
30
Mendenhall W M, Mendenhall C M, Lewis S B, Villaret D B, Mendenhall N P.
Skull base chordoma.
Head Neck.
2005;
27
159-165
-
31
Colli B, Al-Mefty O.
Chordomas of the craniocervical junction: follow-up review and prognostic factors.
J Neurosurg.
2001;
95
933-943
-
32
Forsyth P A, Cascino T L, Shaw E G et al..
Intracranial chordomas: a clinicopathological and prognostic study of 51 cases.
J Neurosurg.
1993;
78
741-747
-
33
Fagundes M A, Hug E B, Liebsch N J, Daly W, Efird J, Munzenrider J E.
Radiation therapy for chordomas of the base of skull and cervical spine: patterns of failure and outcome after relapse.
Int J Radiat Oncol Biol Phys.
1995;
33
579-584
-
34
Rosenberg A E, Nielsen G P, Keel S B et al..
Chondrosarcoma of the base of the skull: a clinicopathologic study of 200 cases with emphasis on its distinction from chordoma.
Am J Surg Pathol.
1999;
23
1370-1378
-
35
Korten A G, ter Berg H J, Spincemaille G H, van der Laan R T, Van de Wel A M.
Intracranial chondrosarcoma: review of the literature and report of 15 cases.
J Neurol Neurosurg Psychiatry.
1998;
65
88-92
-
36
Goel A, Phalke U, Cacciola F, Muzumdar D P.
Giant pituitary adenoma invading the clivus.
Neurol India.
2005;
53
105-107
-
37
Quarta L, Corrado A, Melillo N et al..
Cervical myelopathy caused by periodontoid synovial pannus in a patient with psoriatic arthritis: a case report.
Clin Rheumatol.
2007;
26
1380-1382
-
38
Chugh R, Tawbi H, Lucas D R, Biermann J S, Schuetze S M, Baker L H.
Chordoma: the nonsarcoma primary bone tumor.
Oncologist.
2007;
12
1344-1350
Edward A.M DuckworthM.D.
Assistant Professor, Director of Cerebrovascular and Skull Base Neurosurgery, Department of Neurosurgery, Baylor College of Medicine
1709 Dryden Road, Suite 750, Houston, TX 77030
eMail: edward.duckworth@bcm.edu
