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BENİGN KEMİK DIŞI KAYNAKLI KRANYOVERTEBRAL BÖLGE LEZYONLARI VE YAKLAŞIM

Year 2021, Volume: 28 Issue: 4, 579 - 583, 30.12.2021
https://doi.org/10.17343/sdutfd.908347

Abstract

Amaç
Kranyovertebral bileşkede (KVB) birçok farklı patoloji
görülebilmektedir. En sık menengiom olmak üzere,
schwannom, ependimom, hemanjioblastom bu bölgede
yerleşen kemik dışı kaynaklı benign lezyonlardır.
Bu çalışmada, kliniğimize başvuran kranyovertebral
bileşkede kemik dışı kaynaklı lezyonu olup, vertebral
artere hakim olabilmek ve stabilizasyonun korunabilmesi
için posterior yaklaşım yapılan ve enstrüman
kullanılmayan hastaların değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem
Süleyman Demirel Üniversitesi Nöroşirürji kliniğine
2020 yılında başvuran ve opere edilen 3 hastanın verileri
değerlendirildi. Hastaların 2’si erkek, 1’i kadın ve
yaş ortalamaları 47 idi (37-66). Posterior yaklaşımla
hemilaminektomi sonrası intraoperatif nöromonitör
kullanılarak mikrocerrahi ile intradural lezyonlar çıkarıldı.
Bulgular
İki hastada patolojik tanı schwannom, bir hastada
ise menengiom olarak rapor edildi. Hastalarda postoperatif
dönemde nörolojik defisit gelişmedi. Her 3
vakada da başlangıç motor evoked potansiyel (MEP)
değerlerine göre kapanış MEP değerlerinde düzelme
gözlendi (%4,3; %6,7; %9,4 düzelme).
Sonuç
Bu bölge lezyonlarına anterior ve posteriordan farklı
şekillerde yaklaşımlar bildirilmiştir. Cerrahi teknikler
değerlendirilirken mümkün olan en geniş ve en güvenli
tümör rezeksiyonu yapabilmek öncelikli amaç
olmalıdır. Stabilitenin korunduğu dorsal yerleşimli lezyonlarda
enstrümansız posterior yaklaşım tercih edilebilir.

References

  • 1. Ali Özcan B, Fikret B, Murat B, Mehmet Feryat D, Nurcan Ö. Spinal intradural tümörlerin tedavisi. Türk Nöroşir Derg 2007;17(2):132-7.
  • 2. Kang GC, Soo KC, Lim DT. Extracranial non-vestibular head and neck schwannoma: a ten-year experience. Ann Acad Med Singapore 2007; 36(4):233-8.
  • 3. Mullan S, Naunton R, Hekmat-Panah J, Vailati G. The use of an anterior approach to ventrally placed tumors in the foramen magnum and vertebral column. J Neurosurg 1966;24:536-543.
  • 4. Yasuoka S, Okazaki H, Daube JR,MacCarty CS. Foramen magnum tumors: analysis of 57 cases of benign extramedullary tumors. J Neurosurg 1978;49:828-838.
  • 5. Levy Bay J, Dohn D. Spinal cord meningioma. J Neurosurg 1982;57:804-812.
  • 6. Scott EW, Rhoton AL Jr. Foramen magnum meningiomas, in Al-Mefty o (ed): Meningiomas. New York, Raven Press, 1991,pp543.
  • 7. Emel A, Adil Ö, Murat B, Hamza K. İntradural spinal kord basıları: Literatür araştırması ve ilk olgularımız. Harran Tıp Fak Der 2004;1(3):18-25.
  • 8. Ünal F. Spinal tümörler. Kaya A, Selçuk P, Necmettin P, Recai T, editörler. Temel Nöroşirurji. 1. Baskı. Ankara: Buluş Tasarım ve Matbaacılık Hizmetleri; 2005. p.1124-30.
  • 9. Van Goethem JWA, Van den Hauwe L, Özsarlak Ö, De Schepper AM, Parizel PM. Spinal tumors. Eur J Radiol 2004;50(2):159-76.
  • 10. Pait TG, Al-Mefty O, Boop FA et al. Inside-outside technique for posterior occipitocervical spine instrumentation and stabilization: preliminary results. J Neurosurg (Spine) 1999;90:1-7.
  • 11. Foerster O. Die Leitungsbahmen des Schmerzgefuhls und die chirurgischee Behandlung der Schmerzzustande. Berlin: Urbin and Schwarzenberg. 1927.
  • 12. Paun L, Gondar R, Borrelli P, Meling TR. Foramen magnum menengiomas: a systemic review and meta-analysis. Neurosurgical Review. 2021; doi.org/10.1007/s10143-021-01478-5.
  • 13. Goel A, Desai K, Muzumdar D. Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach:a report on an experience with 17 cases. Neurosurgery 2001;49(1):102-107.
  • 14. Elsberg CA, Strauss I. Tumors of the spinal cord which Project into the posterior cranial fossa: report of a case in which a growth was removed from the ventral and lateral aspects of the medulla oblongata and upper cervical cord. Arch Neurol Psychiatry 1929;21:261-273.
  • 15. Aras Y, Kırış T. Foramen magnum menengiomları. Türk Nöroşirürji Dergisi 2011;21(2):158-161.
  • 16. George B. Dematons C, Cophignon J. Lateral approach to the anterior portion of the foramen magnum. Surg Neurol 1988:29:484-490.
  • 17. Samii M, Klekamp J, Carvalho G. Surgical results for meningiomas of the craniocervical junction. Neurosurgery 1996;39:1086- 1095.
  • 18. Sanai N, Mcdermott MW: A modified far-lateral approach for large or giant meningiomas of the posterior fossa. J Neurosurg 2010;112:907–912.
  • 19. Crockard HA, Sen CN. The transoral approach fort he managament of intradural lesions at the craniovertebral junction: review of 7 cases. Neurosurgery 1991:28:88-97.
  • 20. Miller E,Crockard HA. Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum.Neurosurgery 1987:20:966-968.
  • 21. DickmanC, Locantro J, Fessler R. The influence of transoral odontoid resection on stability of the craniovertebral junction. J Neurosurg 1992;77:525-30.
  • 22. Vender JR, McDonnell DE. Management of lesions involving the craniocervical junction. Neurosurgery Querterly. 2001;11(2):151-171.
  • 23. Zbären P, Markwalder R. Schwannoma of the true vocal cord. Otolaryngol Head Neck Surg 1999; 121:837-9.
  • 24. Meling TR, Da Broi M, Scheie D, Helseth E, Smoll NR. Menengioma surgery- are we making progress. World Neurosurg 2019:125:e205-e213.

BENIGN EXTRA-OSSEOUS LESIONS IN CRANIOVERTEBRAL JUNCTION AND APPROACH

Year 2021, Volume: 28 Issue: 4, 579 - 583, 30.12.2021
https://doi.org/10.17343/sdutfd.908347

Abstract

Objective
Various pathologies can be seen in craniovertebral
junction. Menengiomas, the most frequent, and
schwannoma, ependimoma, hemangioblastoma are
the benign extra-osseous lesions localized in this
region. In this study, we aimed to evaluate the patients
admitted to our clinic with an extra-osseous lesion in
craniovertebral junction, and operated via posterior
approach to dominate vertebral artery and preserve
stabilisation, without an instrument.
Material and Methods
The data of 3 patients, admitted and operated in
the neurosurgery department of Süleyman Demirel
University, were evaluated. Two of the patients
were male, and one of them was female, and the
mean age was 47 (37-66). Microsurgical intradural
lesion excision was done with posterior approach
via using intraoperative neuromonitoring after
hemilaminectomy.
Results
The pathological diagnosis was schwannoma in 2
patients and meningioma in 1 patient. No neurological
deficit was observed in the patients during postoperative
period. Improvement was observed in closure motor
evoked potansiyel (MEP) values (4.3%; 6.7%; 9.4%
improvement) compared with initial values in all patients.
Conclusion
Various approaches from anterior and posterior were
reported in this region lesions. Performing the most
possible extensive and reliable tumor resection should
be the initial aim during the evaluation of surgical
techniques. In the lesions localized dorsally posterior
approach without instrumentation can be preferred
with the protection of the stability.

References

  • 1. Ali Özcan B, Fikret B, Murat B, Mehmet Feryat D, Nurcan Ö. Spinal intradural tümörlerin tedavisi. Türk Nöroşir Derg 2007;17(2):132-7.
  • 2. Kang GC, Soo KC, Lim DT. Extracranial non-vestibular head and neck schwannoma: a ten-year experience. Ann Acad Med Singapore 2007; 36(4):233-8.
  • 3. Mullan S, Naunton R, Hekmat-Panah J, Vailati G. The use of an anterior approach to ventrally placed tumors in the foramen magnum and vertebral column. J Neurosurg 1966;24:536-543.
  • 4. Yasuoka S, Okazaki H, Daube JR,MacCarty CS. Foramen magnum tumors: analysis of 57 cases of benign extramedullary tumors. J Neurosurg 1978;49:828-838.
  • 5. Levy Bay J, Dohn D. Spinal cord meningioma. J Neurosurg 1982;57:804-812.
  • 6. Scott EW, Rhoton AL Jr. Foramen magnum meningiomas, in Al-Mefty o (ed): Meningiomas. New York, Raven Press, 1991,pp543.
  • 7. Emel A, Adil Ö, Murat B, Hamza K. İntradural spinal kord basıları: Literatür araştırması ve ilk olgularımız. Harran Tıp Fak Der 2004;1(3):18-25.
  • 8. Ünal F. Spinal tümörler. Kaya A, Selçuk P, Necmettin P, Recai T, editörler. Temel Nöroşirurji. 1. Baskı. Ankara: Buluş Tasarım ve Matbaacılık Hizmetleri; 2005. p.1124-30.
  • 9. Van Goethem JWA, Van den Hauwe L, Özsarlak Ö, De Schepper AM, Parizel PM. Spinal tumors. Eur J Radiol 2004;50(2):159-76.
  • 10. Pait TG, Al-Mefty O, Boop FA et al. Inside-outside technique for posterior occipitocervical spine instrumentation and stabilization: preliminary results. J Neurosurg (Spine) 1999;90:1-7.
  • 11. Foerster O. Die Leitungsbahmen des Schmerzgefuhls und die chirurgischee Behandlung der Schmerzzustande. Berlin: Urbin and Schwarzenberg. 1927.
  • 12. Paun L, Gondar R, Borrelli P, Meling TR. Foramen magnum menengiomas: a systemic review and meta-analysis. Neurosurgical Review. 2021; doi.org/10.1007/s10143-021-01478-5.
  • 13. Goel A, Desai K, Muzumdar D. Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach:a report on an experience with 17 cases. Neurosurgery 2001;49(1):102-107.
  • 14. Elsberg CA, Strauss I. Tumors of the spinal cord which Project into the posterior cranial fossa: report of a case in which a growth was removed from the ventral and lateral aspects of the medulla oblongata and upper cervical cord. Arch Neurol Psychiatry 1929;21:261-273.
  • 15. Aras Y, Kırış T. Foramen magnum menengiomları. Türk Nöroşirürji Dergisi 2011;21(2):158-161.
  • 16. George B. Dematons C, Cophignon J. Lateral approach to the anterior portion of the foramen magnum. Surg Neurol 1988:29:484-490.
  • 17. Samii M, Klekamp J, Carvalho G. Surgical results for meningiomas of the craniocervical junction. Neurosurgery 1996;39:1086- 1095.
  • 18. Sanai N, Mcdermott MW: A modified far-lateral approach for large or giant meningiomas of the posterior fossa. J Neurosurg 2010;112:907–912.
  • 19. Crockard HA, Sen CN. The transoral approach fort he managament of intradural lesions at the craniovertebral junction: review of 7 cases. Neurosurgery 1991:28:88-97.
  • 20. Miller E,Crockard HA. Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum.Neurosurgery 1987:20:966-968.
  • 21. DickmanC, Locantro J, Fessler R. The influence of transoral odontoid resection on stability of the craniovertebral junction. J Neurosurg 1992;77:525-30.
  • 22. Vender JR, McDonnell DE. Management of lesions involving the craniocervical junction. Neurosurgery Querterly. 2001;11(2):151-171.
  • 23. Zbären P, Markwalder R. Schwannoma of the true vocal cord. Otolaryngol Head Neck Surg 1999; 121:837-9.
  • 24. Meling TR, Da Broi M, Scheie D, Helseth E, Smoll NR. Menengioma surgery- are we making progress. World Neurosurg 2019:125:e205-e213.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Surgery
Journal Section Research Articles
Authors

Ali Serdar Oğuzoğlu 0000-0002-1735-4062

Nilgün Şenol 0000-0002-1714-3150

Mustafa Sadef This is me 0000-0001-9002-5591

Murat Goksel 0000-0002-9417-0857

Publication Date December 30, 2021
Submission Date April 2, 2021
Acceptance Date June 17, 2021
Published in Issue Year 2021 Volume: 28 Issue: 4

Cite

Vancouver Oğuzoğlu AS, Şenol N, Sadef M, Goksel M. BENİGN KEMİK DIŞI KAYNAKLI KRANYOVERTEBRAL BÖLGE LEZYONLARI VE YAKLAŞIM. Med J SDU. 2021;28(4):579-83.

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