alexa
Reach Us +44-7447-215064
Cranio-Spinal Junction Tumours: Role of Transoral Approach Followed by Stereotactic Radiotherapy | OMICS International
ISSN: 2165-7939
Journal of Spine
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on Medical, Pharma, Engineering, Science, Technology and Business

Cranio-Spinal Junction Tumours: Role of Transoral Approach Followed by Stereotactic Radiotherapy

Mario Francesco Fraioli1*, Pierpaolo Lunardi1, Giuseppe Giovinazzo2 and Bernardo Fraioli3
1Neurosurgery, Department of Neurosciences, University of Rome Tor Vergata, Italy
2Department of Radiotherapy, IFO Regina Elena Institute of Tumors, Italy
3Department of Radiotherapy and Radiosurgery, CIRAD of Rome, Italy
Corresponding Author : Mario Francesco Fraioli
Neurosurgery, Department of Neurosciences
University of Rome Tor Vergata
Tel: +39 06 723 1941
E-mail: [email protected]
Received July 27, 2015; Accepted July 29, 2015; Published July 31, 2015
Citation:Fraioli MF, Lunardi P, Giovinazzo G, Fraioli B (2015) Cranio-Spinal Junction Tumours: Role of Transoral Approach Followed by Stereotactic Radiotherapy. J Spine 4: e117
Copyright: ©2015 Fraioli MF, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Related article at Pubmed, Scholar Google

Visit for more related articles at Journal of Spine

Abstract

Cranio-spinal junction tumors are usually approached through posterior, postero-lateral and far lateral approaches but, in case of prevalently anterior extension, with posterior and postero-lateral displacement of brainstem, anterior transoral approach should be considered to achieve a satisfactory tumor removal. Anterior transoral approach allows a direct exposition of the tumor without necessity of nervous/vascular structures manipulation. Postoperative instability is not frequent, and usually posterior stabilization is rarely required. Although transoral approach allows removing only the median part of the tumor’s and in few cases radical removal can be performed, it presents an extremely low rate of new neurological deficit and a rapid resumption of vital activities. Postoperative tumor remnant can be treated, in our experience, with hypofractionated stereotactic radiotherapy with very satisfactory results concerning tumor regrow and recurrence. We believe that in the modern era its capital to deal with this extremely challenging tumor’s with a different goal: to achieve the maximal clinical result, not the maximal surgical resection at all costs.

Keywords
Cranio-spinal tumors; Transoral approach; Conservative surgery; Stereotactic radiotherapy
Editorial
Most frequent tumors of cranio-spinal junction are represented by meningiomas and chordomas. Usually, the classical approaches employed are the posterior, postero-lateral and far lateral ones [1-5] but, in case of prevalently anterior extension, with posterior and postero-lateral displacement of brain stem, vertebro-basilar complex and cranial nerves, these approaches don’t allow a satisfactory tumor exposition and removal and are burdened by relevant compliances. For these tumors (Figure 1), in our opinion and experience, anterior transoral approach should be considered to achieve a satisfactory tumor removal. Only few authors report the utility of this approach [6].
Anterior transoral approach, removing anterior tuberculum of atlas, dens of C2 and transverse ligament of atlas (Figure 2), presents several advantages: a direct exposition of the tumor is achieved in case of chordomas, while a direct access to the dura mater is achieved in case of meningiomas which can be exposed opening the dura mater itself. No necessity of nervous/vascular structures manipulation is needed to remove the tumors. Chordomas were removed in our experience by aspiration with standard aspirator, while for meningiomas ultrasonic aspirator was necessary to remove the typical hard-fibrous tissue; microsurgery with the aid of angulate endoscope was performed in all our patients.
Postoperative instability is not frequent, and usually posterior stabilization is rarely required. In our yet unpublished experience with transoral approach for cranio-spinal tumors (14 cases), no postoperative instability was observed in any patients but one, based on postoperative dynamic cervical x-ray and symptoms referred by the patients, as nucal pain; in the patient with instability, posterior stabilization was performed (Figure 2).
Although transoral approach allows removing only the median part of the tumors and in few cases radical removal can be performed, it presents an extremely low rate of new neurological deficit and a rapid resumption of vital activities, obviously in relation with preoperative clinical status. It should be underlined that for these particular tumors, located forward to brainstem, lateral and far lateral approaches present very high risks of neuro-vascular injuries; moreover, radical removal for chordomas is usually an illusion, because these tumors present a very high degree of bone infiltration which limit/avoid in most cases the possibility of radical removal with any approach.
Postoperative tumor remnant can be treated, in our experience, with hypo fractionated stereotactic radiotherapy with very satisfactory results concerning tumor regrow and recurrence, delivering a total dose of 40 Gy through 10 fractions twice a week (Figure 3).
We believe that in the modern era it’s capital to deal with these extremely challenging tumors with a different goal: to achieve the maximal clinical result, not the maximal surgical resection at all costs
References
 






 
Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Article Usage

  • Total views: 12290
  • [From(publication date):
    August-2015 - Feb 23, 2020]
  • Breakdown by view type
  • HTML page views : 8493
  • PDF downloads : 3797
Top