title: Transmandibular, circumglossal, retropharyngeal approach for chordomas of the clivus and upper cervical spine. Technical note.
abstract: Extensive clival tumors that involve both the midline and lateral skull base compartments, or those that extend inferiorly to the anterior cervical spine, are difficult to expose in a wide fashion using any of the transmaxillary, transoral, or transcervical routes. In the transmandibular, circumglossal, retropharyngeal (TCR) approach wide access of this region can be obtained, thus allowing for a more complete resection of tumor and infiltrated bone. It also provides for an improved ability to perform dural reconstruction, should it be necessary. Over the past 4 years four patients with extensive clival chordomas underwent resection via the TCR approach. Gross-total resection was achieved in two patients, a greater than 98% resection in one patient, and a greater than 95% resection in the fourth patient. The surgical technique, all approach-related complications and morbidity, and patient outcome are discussed. If an expanded exposure of the clivus is necessary, the TCR approach is a good choice as well as a useful surgical technique to have available.
authors.affiliation: Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. fdemonte@mdanderson.org
authors.forename: F
authors.initials: F
authors.lastname: DeMonte
authors.forename: E
authors.initials: E
authors.lastname: Diaz
authors.forename: D
authors.initials: D
authors.lastname: Callender
authors.forename: I
authors.initials: I
authors.lastname: Suk
mesh_terms: D000328:Adult; D000368:Aged; D002817:Chordoma / Q000601:surgery*; D003388:Cranial Fossa, Posterior; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D010614:Pharynx / Q000601:surgery; D019292:Skull Base Neoplasms / Q000601:surgery*; D013125:Spinal Neoplasms / Q000601:surgery*