Superior And Posterior Spread

Chordomas are cancerous tumors that occur anywhere on the spine. They grow slowly and can metastasize to other areas of the body. Other names for this disorder include CHDM, chordocarcinoma, chordoepithelioma, notochordal sarcoma, and notochordoma. Chordomas are rare and most often occur in people ages 40 to 70. Males are affected twice as often as females. About half of all chordoma cases appear at the base of the spine, while about a third occur at the base of the skull, and the rest appear in the kneck, upper back, or lower back vertebrae of the spine. Chordomas in the spine can cause the back, arms, or legs of the affected individual to feal weak or numb. Chordomas occurring at the base of the skull can cause double vision or headaches. Chordomas on the tailbone result in a large lump and can affect the function of the bladder or bowel..

The nasal septum divides the medially into the right and left portion. The nasal septum separates the cranial cavity by the cribriform plate of the ethmoid bone and by the oral cavity by the hand palate. Passageways called the superior, middle and inferior meatuses are the nasal conchae or turbinate bone that curl out from the lateral walls of the nasal cavity on each side. Nasal conchae support the mucous membranes that line the nasal cavity that help increase the surface area. The upper posterior portion of the nasal cavity is slit like and lines and contains the factory receptors that give use the sense of smell. The rest of the cavity conducts air to and from the nasopharynx.

A. Protrusion of the disk material may impinge on nerve roots that exit through intervertebral foramina.

Remove the dorsal portion of the carapace to observe other organs in the head and thorax.

Chordomas are considered rare neoplasms with an incidence of 0.08/100 000.(1) chordomas arise from remnant notochord cells found mainly within the clivus and sacrococcygeal regions . But also, can be found at any site along the vertebral column (2). The presentation of clival chordomas tend to be late, associated neurological impairment due to involvement of the lower cranial nerves (3). Clival chordomas are also challenging to treat due to their site , anterior to the brainstem, and their aggressive locally invasive nature (4,5) and they are radioresistant lesions . clival chordomas have relatively poor survival of 0.9 years without treatment (6). Extended open skull base approaches to the clival region are traditionally the mainstay for achieving gross total resection in chordoma. Extended subfrontal transbasal, anterior transfacial, and lateral transtemporal or far-lateral approaches have been described, as well as staged surgical approaches. (7-9) . These approaches to the anterior midline skull base often require extensive removal of skull base bone and brain retraction, and they put critical neurovascular structures between the operating surgeon and the pathology. With the advent and incorporation of the rigid endoscope into neurosurgical practice and the active collaboration between ENT surgeons and neurosurgeons, extended endonasal endoscopic approaches have become well-accepted, minimally invasive routes to the midline and paramedian skull base. The endoscopic

Imagine a football player is tackled and hits the back of his head. As a result, his brain has hit the back of the cranium, then the front.

A Pancoast tumor is a carcinoma in the apex of the lung that involves the brachial plexus, subclavian, sympathetic chain, upper ribs, or vertebral body.1 Involvement of these structures causes pain or tingling in the arm, and possible paralysis. A Pancoast tumor is most commonly a non-small cell lung carcinoma. 2 In the case where the tumor involves the sympathetic pathway leading to the eye, the patient can present with constriction of the pupil (miosis), drooping of the eyelid (ptosis), and diminished sweating (anhydrosis).3 These symptoms will present on the ipsilateral side of the face as the tumor. Interestingly, although Horner’s syndrome suggests there is more invasion, there is no correlation to prognosis.4 In treatment of a Pancoast

American Cancer Society says, “The term neuro refers to nerves, while blastoma refers to a cancer that affects immature or developing cells.” It is usually found in the small glands on top of the kidneys. The glands are called adrenal glands. Places where it can develop are the belly, chest, neck, pelvis, and bones. Possible symptoms can include fatigue (a feeling of tiredness or exhaustion or a need to rest because of lack of energy or strength), loss of appetite, and fever. Mayo Clinic says, “There may be a lump or compression of tissues in the affected area.” Treatments for the cancer include surgery or chemotherapy. For smaller tumors that have not spread, surgery is usually the only treatment needed. American Cancer Society, “If the tumor is in the abdomen (belly), the surgeon may do the biopsy with the aid of a laparoscope. This is a long, thin tube with a tiny video camera on the end. It is put into the abdomen through a small incision to allow the surgeon to see inside. The surgeon then makes a second small incision to reach inside the abdomen with long, thin instruments and remove pieces of tumor.” Alex’s original tumor of Neuroblastoma was in her adrenal gland. They did a similar process to Alex for the surgery, except for that they had to make an incision near the kidney to remove the tumor from her

There has been a case of SqCc that has impacted the parietal bone. An 80 year old Australian man was admitted with a rare form of metastatic carcinoma of the lung. After a physical examination, it was conclude that there was an extensive amount of bone destruction. The authors were unable to find a past case with this same problem. It is an unusual disease with very limited resources and background knowledge.

Chordomas of the skull base represent significant challenges due to their midline position and their ability to engulf critical neurovascular structures located around them. In addition to these location issues, their biology represents significant challenges, as notocordal rests located throughout the clivus, often remote from the visible lesion, have the propensity to grow and recur. Both of these features are critical for the skull base surgeon, the former in determining the surgical approach and trajectory and the latter in deciding on the surgical goals and intentions of treatment. For more than a decade, lateral and paramedian approaches have been traditionally the mainstay for surgical access and have provided valuable corridors. These have included transbasal (12), trans-septal trans-sphenoidal (13), transmaxillary (14), facial translocation, (15), transoral with or without mandible split (16), transcervical-transclival, and anterior cervical approaches. These anterior and lateral approaches toward a centrally located chordoma carry the potential morbidity of manipulating neurovascular structures in the way to lesion. The cited data report gross total resection rates that vary widely, ranging from 44 to 83%. The corresponding neurological morbidity rates are equally variable, ranging from 0 to 80%, and vascular injuries are reported at 9 to 12%. CSF leak rates are reported to range from 8.3 to 30% (17-19).

Normally, the onconeural antigens are expressed only in immunologically privileged sites, such as brain and testis(, which may explain that the immune system identifies these antigens as foreign following expression by the systemic tumor.Tumors in patients with PNS are often heavily infiltrated with inflammatory cells (in contrast to histologic features of tumors in non-PNS patients).The immune hypothesis of PNS is further supported by the following facts: The target onconeural antigens are expressed both in the tumor and in the affected parts of the nervous system; examination of the CSF frequently shows moderate lymphocytic pleocytosis, intrathecal synthesis of IgG and CSF-specific oligoclonal bands; pathological examination of the nervous system shows loss of neurons in affected areas with inflammatory infiltration by CD4+ T cells and B cells in the perivacular spaces and by CD8+ T cells in the interstitial spaces; control of tumor growth by the immune response is suggested by well documented regression or even obliteration of the underlying tumor (usually SCLC) at the time when PNS developed(Horino et al. 2006); finally, SCLC patients with low titers of anti-Hu antibodies (no PNS) a have more limited disease distribution and better

Patients with a tumor that has spread to the spinal bones possibly will build up nerve damage that can lead to paralysis or loss of the use of the legs and/or arms (Fischer and Quinn, 2011).

For AP-PA fields the lateral borders extended to cover pelvic sidewalls, i.e. 1.5 cm outside pelvic inlet. The superior border was at the L5-S1 inter-vertebral space, and the lower border was kept at 3-5 cm below tumor volume. Anterior border of lateral fields was 3-5 cm anterior to sacral promontory and posterior border was behind bony sacrum to cover presacral tissues. All ethical issues

Look at the photo of a Pacinian corpuscle. Notice the onion-like bulb of connective tissue. Describe briefly —

Label the Mid Sagittal View of the brain below using the table from the Procedures.