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DOI: 10.1055/s-0030-1249570
© Thieme Medical Publishers
Staged Transcrusal and Transsphenoidal Endoscopic Resection of an Atypical Clival Melanoma: A Case Report and Literature Review
Publikationsverlauf
Publikationsdatum:
11. März 2010 (online)
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ABSTRACT
We present a case of an atypical clival meningeal melanoma treated with a multidisciplinary staged transcrusal and transsphenoidal endoscopic surgical approach. A 45-year-old woman presented with a 15-month history of visual symptoms, neck pain, and unsteadiness. Magnetic resonance imaging of the head revealed a clival mass with both intracranial and extracranial involvement. Endoscopic clival biopsy suggested a melanocytic tumor. Extensive imaging and dermatological workup did not demonstrate a primary source. A multidisciplinary staged surgical resection included a transcrusal approach to resect the intracranial component, followed by transsphenoidal endoscopic resection of the extracranial component. Postoperatively, she received adjuvant radiation. At 1 year following surgery, the patient retains full preservation of hearing, facial nerve function, and extraocular movements. To our knowledge, this is the first case report of a combined surgical approach for a primary clival meningitic melanoma.
KEYWORDS
Melanoma - clival lesion - transcrusal - transsphenoidal - endoscopic
REFERENCES
- 1 Stamm A C, Pignatari S S, Vellutini E. Transnasal endoscopic surgical approaches to the clivus. Otolaryngol Clin North Am. 2006; 39 639-656, xi
- 2 Bailey B J, Johnson J T. Head & Neck Surgery – Otolaryngology. 4th ed. Philadelphia, PA; Lippincott Williams & Wilkins 2006
- 3 Davis M DP, Harris K R, Earnest IV F, Gibson L E. Malignant blue nevus. Eur J Dermatol. 1997; 7 53-55
- 4 Hirsch B E, Cass S P, Sekhar L N, Wright D C. Translabyrinthine approach to skull base tumors with hearing preservation. Am J Otol. 1993; 14 533-543
- 5 Horgan M A, Delashaw J B, Schwartz M S, Kellogg J X, Spektor S, McMenomey S O. Transcrusal approach to the petroclival region with hearing preservation. Technical note and illustrative cases. J Neurosurg. 2001; 94 660-666
- 6 Kaylie D M, Horgan M A, Delashaw J B, McMenomey S O. Hearing preservation with the transcrusal approach to the petroclival region. Otol Neurotol. 2004; 25 594-598, discussion 598
- 7 Sekhar L N, Schessel D A, Bucur S D, Raso J L, Wright D C. Partial labyrinthectomy petrous apicectomy approach to neoplastic and vascular lesions of the petroclival area. Neurosurgery. 1999; 44 537-550, discussion 550–552
- 8 Horgan M A, Anderson G J, Kellogg J X et al.. Classification and quantification of the petrosal approach to the petroclival region. J Neurosurg. 2000; 93 108-112
-
9 Weiss M.
The transnasal transsphenoidal approach . In: Apuzzo MLF Surgery of the Third Ventricle. Baltimore, MD; Williams & Wilkins 1987: 476-494 -
10 Cappabianca P, Cavallo L M, Esposito F, De Divitis O, Messina A, De Divitis E.
Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery . In: Pickard JD Advances and Technical Standards in Neurosurgery. New York; Springer 2008: 151-199 - 11 Buchmann L, Larsen C, Pollack A, Tawfik O, Sykes K, Hoover L A. Endoscopic techniques in resection of anterior skull base/paranasal sinus malignancies. Laryngoscope. 2006; 116 1749-1754
- 12 Zak F G, Lawson W. The presence of melanocytes in the nasal cavity. Ann Otol Rhinol Laryngol. 1974; 83 515-519
- 13 Batsakis J G, Regezi J A, Solomon A R, Rice D H. The pathology of head and neck tumors: mucosal melanomas, part 13. Head Neck Surg. 1982; 4 404-418
- 14 Busaba N Y. Primary melanoma of the sphenoid sinus. Otolaryngol Head Neck Surg. 2000; 123 748-749
- 15 Batra K, Chhabra A, Rampure J, Tang S, Koenigsberg R, Gonzales C CT. CT and MRI appearances of primary sphenoid melanoma: a rare case. AJNR Am J Neuroradiol. 2005; 26 2642-2644
- 16 Lynch S C, Lee A G, Graham S M, Kirby P A. Primary melanoma of the sphenoid sinus presenting with a third cranial nerve palsy. J Neuroophthalmol. 2005; 25 289-292
- 17 Solares C A, Fakhri S, Batra P S, Lee J, Lanza D C. Transnasal endoscopic resection of lesions of the clivus: a preliminary report. Laryngoscope. 2005; 115 1917-1922
- 18 Fatemi N, Dusick J R, Gorgulho A A et al.. Endonasal microscopic removal of clival chordomas. Surg Neurol. 2008; 69 331-338
- 19 Cha S T, Jarrahy R, Yong W H, Eby T, Shahinian H K. A rare symptomatic presentation of ecchordosis physaliphora and unique endoscope-assisted surgical management. Minim Invasive Neurosurg. 2002; 45 36-40
- 20 Carrau R L, Kassam A B, Snyderman C H. Pituitary surgery. Otolaryngol Clin North Am. 2001; 34 1143-1155, ix
- 21 Presentation abstracts. 16th Annual Meeting of the North American Skull Base Society. Skull Base. 2005; 15(Suppl 1)
- 22 Presentation abstracts. 7th European Skull Base Society Congress. Skull Base. 2005; 15:(Suppl 2)
- 23 Kassam A, Snyderman C H, Mintz A et al.. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus. 2005; 19 E3
- 24 Kassam A, Snyderman C H, Mintz A, Gardner P, Carrau R L. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus. 2005; 19 E4
- 25 Kassam A, Gardner P, Snyderman C H, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus. 2005; 19 E6
Dr. Brian W RotenbergM.D. F.R.C.S.C.
Assistant Professor, Department of Otolaryngology – Head & Neck Surgery
St. Joseph's Health Centre, 268 Grosvenor Street, Rm. E3-104, London, Ontario, Canada N6A 4V2
eMail: brian.rotenberg@sjhc.london.on.ca