دورية أكاديمية
Anatomical determinants of occipitocervical fusion in skull base chordoma resection: a systematic review of the literature with illustrative cases.
| العنوان: | Anatomical determinants of occipitocervical fusion in skull base chordoma resection: a systematic review of the literature with illustrative cases. |
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| المؤلفون: | Golub D; 1Department of Neurosurgery, Northwell Health, Manhasset, New York., Küffer AF; 1Department of Neurosurgery, Northwell Health, Manhasset, New York., Garrel S; 2SUNY Downstate College of Medicine, Brooklyn, New York., Zandpazandi S; 3Department of Neurological Surgery, Medical University of South Carolina, Charleston, South Carolina., McBriar JD; 4Zucker School of Medicine at Hofstra University/Northwell Health, Hempstead, New York., Modi S; 5New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York; and., Papadimitriou K; 1Department of Neurosurgery, Northwell Health, Manhasset, New York., Costantino PD; 6Department of Otolaryngology, Northwell Health, New Hyde Park, New York., Sciubba DM; 1Department of Neurosurgery, Northwell Health, Manhasset, New York., Dehdashti AR; 1Department of Neurosurgery, Northwell Health, Manhasset, New York.; 6Department of Otolaryngology, Northwell Health, New Hyde Park, New York. |
| المصدر: | Neurosurgical focus [Neurosurg Focus] 2024 May; Vol. 56 (5), pp. E8. |
| نوع المنشور: | Journal Article; Systematic Review; Case Reports |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 100896471 Publication Model: Print Cited Medium: Internet ISSN: 1092-0684 (Electronic) Linking ISSN: 10920684 NLM ISO Abbreviation: Neurosurg Focus Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Charlottesville, VA : American Association of Neurological Surgeons, c1996- |
| مواضيع طبية MeSH: | Chordoma*/surgery , Chordoma*/diagnostic imaging , Skull Base Neoplasms*/surgery , Skull Base Neoplasms*/diagnostic imaging , Occipital Bone*/surgery , Occipital Bone*/diagnostic imaging , Spinal Fusion*/methods , Cervical Vertebrae*/surgery , Cervical Vertebrae*/diagnostic imaging, Humans ; Female ; Atlanto-Occipital Joint/surgery ; Atlanto-Occipital Joint/diagnostic imaging ; Male ; Adult ; Middle Aged |
| مستخلص: | Objective: Skull base chordomas are rare, locally osseo-destructive lesions that present unique surgical challenges due to their involvement of critical neurovascular and bony structures at the craniovertebral junction (CVJ). Radical cytoreductive surgery improves survival but also carries significant morbidity, including the potential for occipitocervical (OC) destabilization requiring instrumented fusion. The published experience on OC fusion after CVJ chordoma resection is limited, and the anatomical predictors of OC instability in this context remain unclear. Methods: PubMed and Embase were systematically searched according to the PRISMA guidelines for studies describing skull base chordoma resection and OC fusion. The search strategy was predefined in the authors' PROSPERO protocol (CRD42024496158). Results: The systematic review identified 11 surgical case series describing 209 skull base chordoma patients and 116 (55.5%) who underwent OC instrumented fusion. Most patients underwent lateral approaches (n = 82) for chordoma resection, followed by midline (n = 48) and combined (n = 6) approaches. OC fusion was most often performed as a second-stage procedure (n = 53), followed by single-stage resection and fusion (n = 38). The degree of occipital condyle resection associated with OC fusion was described in 9 studies: total unilateral condylectomy reliably predicted OC fusion regardless of surgical approach. After lateral transcranial approaches, 4 studies cited at least 50%-70% unilateral condylectomy as necessitating OC fusion. After midline approaches-most frequently the endoscopic endonasal approach (EEA)-at least 75% unilateral condylectomy (or 50% bilateral condylectomy) led to OC fusion. Additionally, resection of the medial atlantoaxial joint elements (the C1 anterior arch and tip of the dens), usually via EEA, reliably necessitated OC fusion. Two illustrative cases are subsequently presented, further exemplifying how the extent of CVJ bony elements removed via EEA to achieve complete chordoma resection predicts the need for OC fusion. Conclusions: Unilateral total condylectomy, 50% bilateral condylectomy, and resection of the medial atlantoaxial joint elements were the most frequently described independent predictors of OC fusion in skull base chordoma resection. Additionally, consistent with the occipital condyle harboring a significantly thicker joint capsule at its posterolateral aspect, an anterior midline approach seems to tolerate a greater degree of condylar resection (75%) than a lateral transcranial approach (50%-70%) prior to generating OC instability. |
| فهرسة مساهمة: | Keywords: atlanto-occipital instability; chordoma; craniovertebral junction; occipitocervical fusion; skull base |
| تواريخ الأحداث: | Date Created: 20240501 Date Completed: 20240501 Latest Revision: 20240628 |
| رمز التحديث: | 20240629 |
| DOI: | 10.3171/2024.3.FOCUS248 |
| PMID: | 38691866 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1092-0684 |
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| DOI: | 10.3171/2024.3.FOCUS248 |