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Objective To conduct a comparative analysis of 2 groups of patients with skull base chordomas extending onto the craniovertebral junction, who underwent surgical treatment using extracranial approaches with and without craniocervical fusion. Methods The study group included 29 patients with skull base chordomas, extending to the craniovertebral junction, who were operated on from 2000 to 2015. The patients underwent the following surgical treatment: posterior craniocervical fusion followed by tumor removal using transoral and combined transoral and transnasal approaches. The reference group included 21 patients with the same disease, who underwent tumor removal surgery using the transoral approach without craniocervical fusion. Results In the study group, in 27.5% of all cases (8 patients), the tumors were removed radically; in 65.5% of all cases (19 patients), the tumors were removed subtotally; and in 7% of all cases (2 patients), the tumors were removed partially. In the reference group, the extent of surgical radicality was as follows: radical, 0%; subtotal, 19% (4 cases); partial, 81% (17 cases). Conclusions Use of the proposed surgical technique in clinical practice may help increase the radicality of tumor excisions, decrease the number of postoperative complications, accelerate the rehabilitation process, and increase the quality of life in patients with skull base tumors extending to the craniovertebral junction. [ABSTRACT FROM AUTHOR]

Introduction With the introduction into the neurosurgical practice of minimally invasive methods using endoscopic techniques, it became possible to effectively remove hard-to-reach tumors, including central tumors of the anterior region of the posterior cranial fossa. Objective To analyze the results of surgical treatment of patients with various centrally located tumors of the base of the skull that extend into the anterior region of the posterior cranial fossa using the endoscopic endonasal transclival approach. Methods The personal surgical experience of the first author is 136 patients with various tumors (e.g., chordomas, meningiomas, pituitary adenomas, and fibrous dysplasia). Results Radicality of tumor removal was total 61.03%; subtotal 25%; partial 13.23%; and insufficient removal 0.74%. Postoperative cerebrospinal fluid leaks occurred in 9 cases (6.62%) and meningitis in 13 cases (9.56%). In 2 cases, surgical treatment had a lethal outcome (1.47%). Conclusions The endoscopic endonasal transclival approach can be used to obtain access to centrally located skull base tumors. This approach allows for a radical and low-risk removal of various skull base tumors of central localization that, until recently, were considered to be almost inoperable. Highlights • We present our experience of endoscopic endonasal transclival removal of mid located skull base tumors. • Personal surgical experience of the first author is 136 patients with various tumors (chordomas, meningiomas, etc.). • This approach allows for a radical and low-risk removal of various skull base tumors of central localization. [ABSTRACT FROM AUTHOR]

Introduction Intraoperative identification of cranial nerves is crucial for safe surgery of skull base tumors. Currently, only a small number of published papers describe the technique of trigger electromyography (t-EMG) in endoscopic endonasal removal of such tumors. Objective To assess the effectiveness of t-EMG in preventing intraoperative cranial nerve damage in endoscopic endonasal surgery of skull base tumors. Materials and Methods Nine patients were operated on using the endoscopic endonasal approach within a 1-year period. The tumors included large skull base chordomas and trigeminal neurinomas localized in the cavernous sinus. During the surgical process, cranial nerve identification was carried out using monopolar and bipolar t-EMG methods. Assessment of cranial nerve functional activity was conducted both before and after tumor removal. Results We mapped 17 nerves in 9 patients. Third, fifth, and sixth cranial nerves were identified intraoperatively. There were no cases of postoperative functional impairment of the mapped cranial nerves. In one case we were unable to get an intraoperative response from the fourth cranial nerve and observed its postoperative transient plegia (the function was normal before surgery). Conclusion t-EMG allows surgeons to control the safety of cranial nerves both during and after skull base tumor removal. [ABSTRACT FROM AUTHOR]