Ricardo L. Carrau

Diagnostic Imaging Dilemma of a Clival Lesion and Its Clinical Management Implications

Backgroundu2003A retroclival lesion can represent a notochordal remnant-derived mass. The differential diagnoses includes benign lesions such as ecchordosis physaliphora (EP) and neuroenteric cyst or malignant ones such as chordomas. In the case of EP and chordoma, although both types arise from remnants of fetal notochord tissues, they represent two separate entities with different radiographic and biologic behaviors. Case Descriptionu2003We present a case of an incidental finding of a retroclival lesion. The magnetic resonance imaging (MRI) characteristics of the lesion match the neuroimaging profile of a benign lesion and are suggestive of an EP. There was no enhancement noted with the addition of gadolinium. Nonetheless, pathology determined the lesion to be a malignant chordoma. Conclusionu2003The differential diagnosis of a retroclival lesion includes benign and malignant notochordal lesions. Here we present a case of a patient with an incidental finding of a retroclival lesion. Radiographic findings were suggestive of a benign lesion, possibly EP, yet the pathology revealed a chordoma. This report suggests that despite benign imaging, chordoma cannot be excluded and the implications for treatment can be significant. It is important to achieve the correct diagnosis because the prognostic and therapeutic implications are different.

Endoscopic Approaches to the Skull Base: The Coronal Plane

Background: Endoscopic endonasal skull base surgery has become an important part of the arsenal of contemporary skull base surgery. The coronal or paramedian plane is defined as the

Endoscopic Endonasal Approach for Olfactory Groove Meningiomas

Background: Endoscopic endonasal approaches (EEAs) have been applied for pathologies across the entire anterior skull base. Olfactory groove meningiomas are tumors of the anterior b

The Learning Curve for Endonasal Surgery of the Cranial Base: A Systematic Approach to Training

Proper training in endoscopic endonasal surgery of the cranial base is essential to avoid unnecessary morbidity and mortality. An incremental program for the training of skull base surgeons is describ

Management of complications of endonasal cranial base surgery

Endoscopic endonasal surgery of the cranial base is maximally invasive surgery and poses many of the same risks as traditional skull base approaches. Preliminary data demonstrates that serious complications can be avoided through a strong foundation in endoscopic skull base anatomy, adherence to principles of surgical dissection, and a dedicated surgical team with proper training and experience. Surgical complications may be categorized by severity, location, organ system or tissue type, and time period. Advances in reconstruction have decreased the incidence of CSF leaks to less than 5%. Major complications such as vascular injury are rare and can be managed using endoscopic techniques. Nasal morbidity is acceptable.

Endoscopic Endonasal Approach to the Odontoid and Craniocervical Junction

Background: Endoscopic endonasal approaches (EEAs) have been applied for skull base pathologies from the christa galli to the clivus. This approach also provides a natural corridor

How I do it: modification of the posterior pedicled nasoseptal flap for clival and nasopharyngeal surgery

The posterior pedicle nasoseptal flap, also named the Hadad-Bassagaisteguy flap, was developed at the University of Rosario, Argentina by Hadad and Bassagaisteguy, and modified by Carrau with the aim to design a better intranasal vascular pedicled flap for skull base reconstruction (1,2). The posterior pedicle nasoseptal flap provides an ample surface area with a superior arc of rotation and is therefore a reliable flap, especially for the reconstruction of large skull base defects.