CRANIOSPINAL TUMORS

1
CRANIOSPINAL TUMORS

• B.GEORGE
• HOPITAL LARIBOISIERE
• PARIS FRANCE
• Bernard.george_at_lrb.aphp.fr

2
FM ANATOMY
3
FM ANATOMY
4
ANATOMY
5
ANATOMY

• OSSIFICATION OR
• CALCIFICATION OF THE
• ATLANTO-OCCIPITAL MB
• TURNING THE GROOVE
• INTO A TUNNEL

6
CCJA PATHOLOGY

• LARIBOISIERE SERIES
• Extradural N144
• Meningioma 3
• Neurinoma.34
• Chordoma..43
• Sarcoma .19
• Metastasis.17
• Osteoid Osteoma..7 Others
  .21

• LARIBOISIERE SERIES
• Intradural N133
• Meningioma.92
• Neurinoma...27
• Others14
• Pseudotumors N29

LARIB 2004
7
CCJA PATHOLOGY

• MENINGIOMA
• LOCALIZATION
• Intradural .91 (86)
• Extradural .4 (4)
• Intra-Extradural .11 (10)

FRENCH COOPERATIVE STUDY 1993
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MENINGIOMA

9

• MENINGIOMA

ED
ID-ED
EN PLAQUE
10
CCJA PATHOLOGY

• NEURINOMA
• LOCALIZATION
• Intradural ..14
• Extradural .37
• Intra-Extradural ...49
• Neurofibromatosis ..17

FRENCH COOPERATIVE STUDY 1993
11

• NEURINOMA

12

• NEURINOMA

BILATERAL
CN XII
CN XI
13

• EPIDERMOID K

HBLASTOMA
MELANOMA
14

• CHORDOMA

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SURGICAL TECHNIQUE

• ANTERIOR APPROACH TRANSORAL
• POSTERIOR APPROACH MIDLINE POSTERIOR
• LATERAL APPROACH ANTERO and POSTEROLAT
• KEY-POINT VERTEBRAL ARTERY
• LIMITED DRILLING
• PRESERVED STABILITY

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CCJA SURGERY

• APPROACHES
• POSTEROLATERAL AP.
• INTRADURAL ANTEROLATERAL TUMORS
  (MENINGIOMAS)
• EXTRADURAL POSTEROLATERAL TUMORS
• ANTEROLATERAL AP.
• EXTRADURAL ANTEROLATERAL TUMORS
  (CHORDOMAS)

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CCJA FM
18
FM PosteroLateral approach
19
FM PosteroLateral approach
J
O

A
2
20
POSTEROLATERAL APPROACH
21
FM PosteroLateral Ap.
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SURGICAL TECHNIQUE
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CCJA SURGERY

• Anterior Meningioma

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CCJA SURGERY

• Lateral Meningioma

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CCJA SURGERYPOSTEROLATERAL APPROACH
1
3
Anterior M
2
26
CCJA SURGERYPOSTEROLATERAL APPROACH
1
2
27
CCJA SURGERY

• Relation to the VA ABOVE

28
CCJA SURGERY

• Relation to the VA BELOW

29
CCJA SURGERY

• Relation to the VA BOTH SIDES

30
CCJA SURGERY

• Relation to the DURA

Extradural
No dural attachment
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CCJA SURGERYPOSTEROLATERAL APPROACH
32
CCJA SURGERYPOSTEROLATERAL APPROACH
33
CCJA SURGERYPOSTEROLATERAL APPROACH
34
RECURRENT MENINGIOMA
35
RECURRENT MENINGIOMA
36
CCJA SURGERYPOSTEROLATERAL APPROACH
ID-ED NEURINOMA
BONE MALFORMATION
37
FM AnteroLateral Approach
38
JF JuxtaCondylar Approach
V
S
G
39
CCJA SURGERYANTEROLATERAL APPROACH
CHORDOMA
40
CCJA SURGERYCOMBINED APPROACHES
TRANSORAL
BILATERAL ANTLAT
41
CCJA SURGERY
TRANSBASAL
TRANSORAL
42
CCJA SURGERY

• GREAT VARIETY OF TUMORS
• M AND CH MOST COMMON
• PSEUDOTUMOR
• PREOP PLANNING
• SURGERY
• -respect the lateral wall
• -key point VA
• . COMPLETE RESECTION
• . LIMITED MORBIDITY