Lateral transcondylar approach for tumors at the anterior aspect of the craniovertebral junction.
BACKGROUND
Tumors at the craniovertebral junction are difficult to remove because of their location and complex anatomic relations. The lateral transcondylar approach is a versatile approach to this area and allows access to a variety of intra- and extradural tumors. The lateral transcondylar approach has been used for a series of chordomas in this location.


OBJECTIVE
The nuances of this operation and its effectiveness in this group of patients are presented.


METHODS
There were 29 chordomas (1991-2007) in this region treated by one of the authors (CS) that were retrospectively reviewed. The imaging studies and medical records were evaluated. The location and extent of the tumor were defined, and the postoperative images were studied to determine the degree of resection.


RESULTS
There were 11 male and 18 female patients; their age range was 7 to 67 years. Headache and neck pain were the predominant presenting symptoms, and hypoglossal nerve palsy was the most common cranial nerve palsy. Twelve patients had previous surgery and 9 had previous radiation. Anterior midline and lateral approaches were used independently or in combination to treat these patients. Dural invasion was found in 27 patients requiring resection of the dura. Surgery was performed in 1 stage in 19 patients, and the tumor resection in the remaining patients was done in 2 stages. The lateral transcondylar approach was used in 19 patients. The occipital condyle was involved in all these patients. Radical tumor resection was achieved in 17 patients. Patients who had complete removal of the occipital condyle required occipitocervical fusion (20 patients) in the immediate postoperative period.


CONCLUSIONS
The lateral transcondylar approach is an effective approach to chordomas in this region. Most of the tumors were large and extended into multiple anatomic compartments. The approach allowed resection of all the involved tissues, intra- and extracranial, and afforded excellent neurovascular control.
Sen
Chandranath
C
Department of Neurosurgery, Roosevelt Hospital, New York, New York 10019, USA. csen@chpnet.org
Shrivastava
Raj
R
Anwar
Shuman
S
Triana
Aymara
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001933:Brain Stem / Q000033:anatomy & histology / Q000601:surgery; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002648:Child; D002817:Chordoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D004388:Dura Mater / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D007796:Laminectomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009777:Occipital Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011300:Preoperative Care; D011859:Radiography; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013116:Spinal Cord / Q000033:anatomy & histology / Q000601:surgery; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000033:anatomy & histology / Q000601:surgery; D055815:Young Adult