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Anatomy of the head and neck
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The brainstem comprises the medulla oblongata, itself an upward continuation of the spinal cord, the pons and the midbrain; it is continuous with the diencephalon component of the forebrain. It is related to the basiocciput or clivus and is connected to and overlaid by the posterior and lateral aspects by the cerebellum.
Spinal Cord Disease
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Extradural (only 10% in this category are primary tumors with 90% being of metastatic origin): Myeloma (i.e. solitary plasmacytoma).Primary bone tumors.Hemangioma of bone.Osteosarcoma.Chordoma (commonly sacral or clivus).Chondrosarcoma.
Common otology viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
The infection can spread from skin of the external ear canal along the fissures of Santorini within the lateral ear cartilage to the lateral skull base. Osteomyelitis can spread anteriorly to the temporo-mandibular joint and masseter space and cause trismus or along the skull base medially and irritate the CN either through neurotoxin release or direct compression by inflammatory tissue. Medially infection spreads to the central skull base by tracking from the petrous bone to the clivus.
Important aspect of hypoglossal nerve injury following gunshot wound; Can the clivus has a role? A case report
Published in British Journal of Neurosurgery, 2023
Bulent Ozdemir, Ayhan Kanat, Cihangir Erturk, Osman Ersegun Batcik, Fatma Beyazal Celiker, Metin Celiker, Engin Dursun
We suggest that the effect of human skull anatomy with clivus is important. The thick clivus protects the structure of the brainstem and posterior cranial fossa. It measures about 4 to 5.5 cm long and about 3 cm wide at its midpoint.2 In this case, the bullet had entered from the nasal cavity (Figure 1(A), traversed to (Figure 1(B,C)) to the occipital condyle (Figure 1(D)). Hypoglossal nerve injury following gunshot injury is not a common event. In maxillofacial gunshot injury, the bullet may predilect the hypoglossal nerve, but we proposed that the Clivus is hard enough that bullets tend to bounce off it rather than penetrate it. Thats quite a bold claim, particularly if one of their cases was 74 years old and therefore presumably had some degree of osteoporosis. This case was injured with a low-velocity bullet. In the high-velocity bullet, this situation may not be credible. We suggest that the clivus protects the structures behind it from injury from incoming bullets, but at the expense of deflecting the bullets laterally. This bullet goes to injure the hypoglossal nerve, which is vulnerable to anything reflecting laterally off the clivus. This is the third reported isolated hypoglossal nerve injury case following gunshot wound in the world medical literature, previous cases were published by Ozdemir et al.1 and Hageman et al.3 What about other structures: such as the jugular, vagus, and accessory? The difference of three cases from other gunshot wound cases is that, all of these cases have had isolated hypoglossal nerve palsy without injured adjacent neurovascular structures.
An unusual presentation of clival chordoma: a case report and review of the literature
Published in British Journal of Neurosurgery, 2020
Monther Andijani, Aimun Jamjoom, Antonia Togersen, Bhashkar Ram, Peter Bodkin, Mahmoud Kamel
Spontaneous non-traumatic CSF rhinorrhoea is a rare condition. A recent systematic review showed that only 5% of non-traumatic CSF fistulae are caused by tumours.8 The typical clinical presentation of chordoma is dependent on its location and what structures it is pressing on. CSF rhinorrhoea as a presentation of clival chordoma has been reported in five cases in the literature.3,7,9–11 In our presented case, neither CT nor MRI imaging demonstrated a tumour mass being present. Of the five cases in the literature, only one case had a similar radiologically occult chordoma which was only diagnosed when samples were taken from eroded clival bone.10 This case report highlights that patient can present with the sequelae of clival chordoma even without clear radiological evidence of a tumour mass within the clivus. Importantly, it holds the lesson that a biopsy should be considered in cases of non-traumatic spontaneous CSF rhinorrhoea even in absence of any radiological evidence of tumour on imaging.
Endoscopic endonasal surgery for Clival Chordomas – a single institution experience and short term outcomes
Published in British Journal of Neurosurgery, 2019
Jawad Yousaf, Fardad T. Afshari, Shahzada K. Ahmed, Swarupsinh V. Chavda, Paul Sanghera, Alessandro Paluzzi
The aim of surgery is maximal tumour resection. The procedures are performed using two surgeons, four hands, binostril endoscopic endonasal approach with a Karl Storz® 2D endoscope and intraoperative BrainLab® image guidance. This is a well documented set-up and technique described by the Pittsburg group.3 A vascularised nasoseptal flap is raised in all cases. A septostostomy and large sphenoidotomy then provides access to the sella and clival access. Further surgical approach is tailored depending on tumour location in the clivus and its superior and lateral extent. The adjacent dura is excised in all cases to maximise surgical resection. All patients undergo a multilayered closure with inlay dural substitute, fat graft (where necessary) and a vascularised nasoseptal flap. A lumbar CSF drain in inserted in all cases postoperatively and is removed within 5 days postoperatively.