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Int Arch Otorhinolaryngol 2014; 18(S 02): S157-S172
DOI: 10.1055/s-0034-1395267
Review Article
Thieme Publicações Ltda Rio de Janeiro, Brazil

Nuances in the Treatment of Malignant Tumors of the Clival and Petroclival Region

Ahmed Mohyeldin
1   Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
,
Daniel M. Prevedello
1   Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
2   Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
,
Ali O. Jamshidi
1   Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
,
Leo F.S. Ditzel Filho
1   Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
,
Ricardo L. Carrau
1   Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
2   Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
10 October 2014 (online)

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Abstract

Introduction Malignancies of the clivus and petroclival region are mainly chordomas and chondrosarcomas. Although a spectrum of malignancies may present in this area, a finite group of commonly encountered malignant pathologies will be the focus of this review, as they are recognized to be formidable pathologies due to adjacent critical neurovascular structures and challenging surgical approaches.

Objectives The objective is to review the literature regarding medical and surgical management of malignant tumors of the clival and petroclival region with a focus on clinical presentation, diagnostic identification, and associated adjuvant therapies. We will also discuss our current treatment paradigm using endoscopic, open, and combined approaches to the skull base.

Data Synthesis A literature review was conducted, searching for basic science and clinical evidence from PubMed, Medline, and the Cochrane Database. The selection criteria encompassed original articles including data from both basic science and clinical literature, case series, case reports, and review articles on the etiology, diagnosis, treatment, and management of skull base malignancies in the clival and petroclival region.

Conclusions The management of petroclival malignancies requires a multidisciplinary team to deliver the most complete surgical resection, with minimal morbidity, followed by appropriate adjuvant therapy. We advocate the combination of endoscopic and open approaches (traditional or minimally invasive) as required by the particular tumor followed by radiation therapy to optimize oncologic outcomes.

Keywords

skull base - malignancy - clival - petroclival - endoscopic endonasal - craniotomy - chordoma - chondrosarcoma - plasmacytoma
 

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