Bernard George

This study aims to contribute to the collective experience with the treatment of those skull base tumors exceptionally arising in children and adolescents. We retrospectively reviewed 42 patients younger than 19 years and operated on for a skull base tumor between 1992 and 2002. We analyzed data regarding patient age, histology, tumor location, extent of resection, postoperative complications, and adjuvant therapies. Long-term outcomes were also tracked (functional sequelae, recurrence, mortality). The median age was 13.75 years. Twenty-two patients harbored a malignant tumor. Gross total resection was achieved for 78% of cases. Transient postoperative cerebrospinal fluid leak or infection affected ten patients, suggesting the need for reconstructive techniques. Nineteen patients received adjuvant therapy. Recurrence rate was 47%. At the end of the follow-up (median = 63 months), 14% of patients had a neurological deficit and 30% were dead. Middle cranial base tumors were associated with a poor prognosis.

Background. Bone tumors located at the cranio-cervical junction (CCJ)are rare. Tumoral involvement of the neighbouring structures including bone, nerves and vertebral artery and the dynamic aspects of the bone structures raise technical difficulties in the surgical approach. The surgical management includes tumoral resection and stabilization of the CCJ. Methods. Forty-one patients presenting a bone tumor (26 benign and 15 malignant tumors), excluding chordomas, located at the CCJ (including lower third of the clivus, C1 and C2) were observed over 20 years from 1981 to 2001. Imaging work-up included CT scanner with bone windows sequences and reconstruction in the coronal and sagittal plane; since 1984 most of the patients (N = 35) underwent a MRI and angioMR scanning. Vertebral angiography was rarely performed (N = 9) and mostly when the diagnosis was doubtful. In some cases the diagnosis was clear but in others, imaging studies showed destructive lesions suggesting a malignancy, which sometimes required a biopsy (N = 4). The surgical resection was only performed through a lateral approach. Findings. Complete resection was achieved in 38 cases while in 3 cases a small remnant was left behind. A complementary stabilization procedure was necessary in 18 cases using either bone grafting during the same procedure and through the same approach (N = 5) or a craniocervical plating and bone grafting (N = 13). No recurrence in the group of benign tumors was seen during an average follow-up of 6 years (from 2 to 11 years). The pre-operative symptoms of pain and neck stiffness, improved or disappeared in most patients. Three patients with lower cranial nerves (N = 2) or sphincter disturbances (N = 1) remained unchanged. One patient with tetraplegia eventually died. Conclusions. Various types of bone tumors may be found at the CCJ. Confusion between benign and malignant tumor or pseudo tumors must be avoided, sometimes requiring a biopsy. Surgery using a lateral approach, usually permits the surgeon to achieve a complete resection either preserving the stability of the CCJ whenever intact or associated with a stabilization procedure.

OBJECTIVE. Invasive tumors involving the cavernous sinus, such as recurrent benign meningiomas or sarcomas, raise therapeutic problems that may be reso

Object: Radical resection of chordomas seems to improve a patient's long-term prognosis. At the suboccipital and cervical levels, the vertebral artery (VA) is often considered as a limit in surgical possibilities. The authors report on the management of the VA in a series of 36 patients with chordomas located in the cervical region. Methods: Over an 11-year period, 36 patients with chordomas located at the suboccipital (28 patients) or cervical (eight patients) level were treated in the authors' neurosurgical department. In 30 patients, the tumors extended laterally toward the VA and required surgical control of the VA. Sixteen of these 30 patients harbored primary tumor, whereas 14 were treated for recurrent disease. The VA was encased in the tumor in 23 patients, with stenosis in six cases. A balloon occlusion test was performed in seven patients and the VA was resected in four. Extensive resection, via a lateral approach on one (22 cases) or on both (eight cases) sides, did not cause any permanent postoperative deficits. In five patients a complementary approach was performed: posterolateral in one and transoral in four. Spinal fixation was performed via the lateral approach (eight cases) or via a complementary posterior approach (five cases). All but two patients underwent radiotherapy, including 10 who underwent proton-beam radiotherapy. Conclusions: Chordomas extending laterally to the VA can be radically resected via a lateral approach without causing significant morbidity. A complementary approach is often necessary. The best results are achieved in patients with primary compared with recurrent tumor.