Clivus ependymoma

Summary An 8-month-old girl had an ependymoma in the clivus, 2x6 cm in size, connected with the fourth ventricle by a cord of tissue 0.5 cm thick. There were no indications to make us suspect the origin of the tumour in the fourth ventricle, or that it was a case of ependymoma.     

成人单纯Arnold-Chiari畸形颅颈交界区CT参数测量

目的探讨不合并颅底凹陷的单纯Arnold-Chiari畸形(Arnold-Chiari malformation,ACM)颅颈交界区CT参数的变化。方法对40例成人单纯ACM和20例正常成人对照组头颈CT原始数据行正中矢状位重建,研究颅颈交界区CT线性及角度参数的变化。结果单纯ACM患者的斜坡长[(40.66±3.11)mm vs(43.44±3.34)mm,P<0.01]、齿突Chamberlain线间距[(1.23±2.41)mm vs.(1.25±2.29)mm,P<(0.001)]、齿突McRae线间距[(4.04±1.39)mm vs.(4.95±1.29)mm,P(<0.05)]、斜坡椎管角(147.93°±7.84°vs.157.33°±8.51°,P<0.001)、减压枕骨角(139.11°±10.14°vs.144.49°±8.03°,P<0.05)明显小于对照组,而斜坡McRae线角(130.82°±7.85°vs.124.60°±7.35°,P<0.01)、减压枕骨椎管角(127.71°±11.75°vs.118.86°±11.33±,P<0.01)明显大于对照组,差异具有统计学意义。结论成人单纯ACM斜坡长度较正常人明显缩短,枕骨大孔区附近枕骨倾斜角度明显增加。     

颅底外面枕骨基底部及周边骨性结构的测量和临床意义

目的为斜坡区肿瘤手术提供解剖资料。方法20例整颅,10例行水平切面,10例行正中矢状切面。测量切牙孔、前鼻棘、后鼻棘、枕骨大孔前端、枕髁前端、卵圆孔、破裂孔、颈动脉管外口及舌下神经管外口的内侧缘至咽结节的距离;测量卵圆孔、破裂孔、颈动脉管外口及舌下神经管外口的内侧缘至正中线的距离;测量枕骨基底部颅底外面的长径、枕骨大孔纵径(FML)、枕骨大孔前正中点与枕髁后缘连线垂直距离(AOCP)、枕髁轴径(OCA)、枕髁间距。结果切牙孔后缘、前鼻棘、后鼻棘、枕骨大孔前端、枕髁前端、卵圆孔、破裂孔、颈动脉管外口及舌下神经管外口的内侧缘至咽结节的距离分别为(mm):72.12±4.25、77.77±3.89、33.73±2.07、13.14±1.91、15.71±1.74、27.51±2.12、15.98±1.98、25.93±2.23、19.15±1.49。卵圆孔、破裂孔、颈动脉管及舌下神经管外口的内侧缘至中线的距离分别为:25.55±1.63、11.72±1.70、25.75±1.98、17.41±1.41。枕骨基底部颅底外面长径、FML、AOCP、OCA、枕髁间距分别为(mm):28.80±2.67、35.84±2.59、17.10±1.13、24.55±2.35、21.07±1.92。结论经口咽至斜坡区的手术入路中,开骨窗时安全范围是以咽结节为中心,以15mm为半径做斜坡磨除;也可以做矩形骨窗,即以咽结节为中心开一长(高)25mm×宽20mm的骨窗。     

乙状窦前入路处理斜坡凹陷区病变的量化研究

目的量化研究乙状窦前入路中每一步岩骨切除及血管神经牵拉完成后获得的斜坡中央凹陷区显露范围及手术自由度。方法对20例头颅标本采用乙状窦前入路,骨切除分4步进行：迷路后骨质切除,上、后半规管切除,切除岩尖并打开Meckel＇s腔游离三叉神经,全切迷路及耳蜗并后移面神经。每一步完成后分别测量斜坡中央凹陷区的显露范围和手术自由度。结果岩尖切除、打开Meckel＇s腔游离三叉神经后,斜坡中央凹陷区显露面积为（190±32）mm^2,占整个入路完成后的95％,与磨除上、后半规管后的显露范围相比差异显著,手术自由度亦显著增加。结论乙状窦前联合部分迷路岩尖切除手术入路能够较好的显露斜坡中央凹陷区。岩尖的切除和打开Meckel＇s腔游离三叉神经是充分显露斜坡中央凹陷区并提供足够手术自由度的关键步骤。     

Chordoma radicular metastasis following cerebrospinal fluid dissemination

INTRODUCTION: Chordoma metastases are usually found at advanced stages of the disease. The metastases occur generally in lung, bones, liver and lymph nodes. We report a rare case of radicular chordoma metastasis. CLINICAL CASE: A 59-year-old man, operated for a clival chordoma six years ago, was admitted for atypical S1 radiculopathy. The MRI showed lumbar intradural tumor compressing the cauda equina. Surgery was performed. RESULTS: After opening of the dura mater, the tumor was seen tightly attached to the nerve roots and was totally removed. The histological examination confirmed a metastasis of the known chordoma without local recurrence. CONCLUSION: Chordomas are slowly growing, aggressive malignancies. Mostly complete microsurgical resection reduces local and distant recurrences. Intradural metastases are rare and follow cerebrospinal fluid dissemination from tumor cells. These metastases must be actively cured to achieve longer survival and better quality of life.     

Cirugía endoscópica endonasal extendida para cordomas y condrosarcomas de clivus: nuestra experiencia en 14 casos

Objective

To report our experience in the management of chordoma and chondrosarcoma with extended endoscopic endonasal surgery.

Entrapment of the basilar artery within a clivus fracture: Case report and literature review

A review of the literature revealed that basilar artery (BA) entrapment is a very rare (17 cases published) and severe pathological condition, which often leads to death. We report the case of a 72-year-old man who presented with a longitudinal clivus fracture associated with a basilar artery entrapment. This entrapment was responsible for a basilar artery dissection, which led to an ischemic stroke in the pons. The patient was managed with medical treatment, mainly to avoid a progression towards an ischemic stroke. It consisted of heparin therapy followed by antiplatelet therapy, which finally resulted in a successful outcome. In BA entrapment most of the patients who had a favorable outcome received antithrombotic therapy. This suggests that antithrombotic therapy might be useful in the first line treatment of post-traumatic BA entrapment.     

经鼻蝶入路神经内镜手术治疗斜坡区肿瘤的应用解剖

目的 探讨经鼻蝶入路神经内镜手术治疗斜坡区肿瘤的应用解剖特征。方法 利用10具（20侧）成人尸头标本，模拟经鼻蝶入路神经内镜手术，从颅底内、外两面观察，测量斜坡及相关毗邻骨性结构。结果 ①斜坡外表面呈凸状向下倾斜，长度为28.12 mm，由外展神经硬膜孔和舌咽神经水平将斜坡分为上、中、下三段:舌下神经管外口到颈静脉结节距离，左侧（5.80±0.82）mm，右侧（5.91±0.79）mm；到枕骨大孔前缘中点距离，左侧（19.54±1.72）mm，右侧（18.42±1.69）mm；到中线距离，左侧（17.08±2.25）mm；咽结节到枕骨大孔前缘中点距离（12.12±1.63）mm；斜坡可切除面积（805.92±5.24）mm2，枕髁可切除面积（144.47±4.76）mm2。②斜坡内面观，斜坡由枕骨大孔向前上方宽而浅的倾斜而成，两侧以岩斜裂与岩骨相毗邻:舌下神经管内口到枕骨大孔前缘，左侧（15.12±1.59）mm，右侧（14.25±1.63）mm；到枕髁前缘距离，左侧（12.77±1.47）mm，右侧（11.16±1.44）mm。结论 熟悉斜坡的重要解剖标记对经鼻蝶入路神经内镜手术中切除范围有重要指导作用。