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Endoscopic Endonasal Approaches for Treatment of Craniovertebral Junction Tumours

  • Davide Locatelli
  • Apostolos Karligkiotis
  • Mario Turri-Zanoni
  • Frank Rikki Canevari
  • Fabio Pozzi
  • Paolo Castelnuovo
Chapter
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 125)

Abstract

Tumours involving the craniovertebral junction (CVJ) are challenging because of their local invasiveness and high recurrence rates, as well as their proximity to critical neurovascular structures and the difficulty of reconstructing the resulting skull base defect at this site. Several surgical techniques are currently available to access these lesions, including the far lateral, extreme lateral, direct lateral, transcervical, transoral and transnasal approaches. In this paper, application of the endoscopic endonasal approach (EEA) in the treatment of CVJ tumours is analysed. The indications, contraindications, preoperative workup, step-by-step surgical technique, skull base reconstruction options and postoperative management are described. The advantages and limitations of the EEA are also discussed. Finally, a systematic review of the literature is provided to elucidate the levels of evidence supporting the use of the EEA in this field. Employment of this approach to the CVJ has contributed to high success rates in achieving gross total resection of tumours and improvement in neurological symptoms. Intraoperative and postoperative complication rates are acceptable, with cerebrospinal fluid leakage being the major concern (with a 17–25% incidence). Moreover, in comparison with traditional approaches to the CVJ, the EEA provides lower rates of postoperative dysphagia and respiratory complications. Use of the EEA for treatment of CVJ tumours appears to be a rational alternative to the conventional transoral, transcranial and transcervical approaches in selected cases. Multidisciplinary teamwork including different specialists—such as medical and radiation oncologists, radiologists, otorhinolaryngologists and neurosurgeons—is strongly recommended for the purpose of offering the best treatment strategy for the patient.

Keywords

Chordomas Meningiomas Craniovertebral junction Clivus Posterior cranial fossa Endoscopic transnasal approaches Multiportal endoscopic approaches Radiotherapy 

Notes

Competing Interests

The authors declare that they have no competing interests.

Compliance with Ethical Standards

 No financial support was received for this work.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Davide Locatelli
    • 1
    • 2
  • Apostolos Karligkiotis
    • 2
    • 3
  • Mario Turri-Zanoni
    • 2
    • 3
  • Frank Rikki Canevari
    • 4
  • Fabio Pozzi
    • 1
    • 2
  • Paolo Castelnuovo
    • 2
    • 3
  1. 1.Division of Neurological Surgery, Department of Biotechnology and Life SciencesUniversity of Insubria–Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione MacchiVareseItaly
  2. 2.Head and Neck Surgery & Forensic Dissection Research Centre, Department of Biotechnology and Life SciencesUniversity of Insubria–Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione MacchiVareseItaly
  3. 3.Division of Otorhinolaryngology, Department of Biotechnology and Life SciencesUniversity of Insubria–Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione MacchiVareseItaly
  4. 4.Department of OtorhinolaryngologyAzienda Ospedaliera SS Antonio e Biagio e Cesare ArrigoAlessandriaItaly

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