title: Extended maxillotomy for skull base access in contemporary management of chordomas: Rationale and technical aspect.
abstract: Minimally invasive approaches to the central skull base have been popularized over the last decade and have to a large extent displaced 'open' procedures. However, traditional skull base surgery still has its role especially when dealing with a large clival chordoma where maximal surgical resection is the principal goal to maximize patient survival. In this paper, we present a case of a 25year-old male patient with chordoma in the inferior clivus which was initially debulked via a transnasal endoscopic approach. He unfortunately had a large recurrence of tumor requiring re-do resection. With the aim to achieve maximal surgical resection, we then chose the technique of a transoral approach with Le Fort 1 maxillotomy and midline palatal split. Post-operative course for the patient was uneventful and post-operative MRI confirmed significant debulking of the clival lesion. The technique employed for the surgical procedure is presented here in detail as is our experience over two decades using this technique for tumors, inflammatory lesions and congenital abnormalities at the cranio-cervical junction.
authors.affiliation: Department of Neurosurgery, Austin Hospital, Heidelberg, Victoria 3084, Australia. Electronic address: fahmi.abduljalil@gmail.com.
authors.forename: Muhammad Fahmi
authors.initials: MF
authors.lastname: Abdul Jalil
authors.affiliation: Department of Maxillofacial Surgery, Austin Hospital, Heidelberg, Victoria 3084, Australia.
authors.forename: Rowan D
authors.initials: RD
authors.lastname: Story
authors.affiliation: Department of Neurosurgery, Austin Hospital, Heidelberg, Victoria 3084, Australia.
authors.forename: Myron
authors.initials: M
authors.lastname: Rogers
mesh_terms: D000328:Adult; D002817:Chordoma / Q000000981:diagnostic imaging / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging / Q000601:surgery; D019468:Disease Management; D004724:Endoscopy / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Chordoma; Extended maxillotomy; Skull base