{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T07:14:21Z","timestamp":1776755661686,"version":"3.51.2"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Tumors in the ventral craniocervical junction (CCJ) pose unique challenges, particularly in children. The potential constraints with endoscopic approaches to tumors extending inferiorly and laterally and the risk of CSF leakage can be exacerbated in the pediatric population. Here, the authors present their experience with the extreme lateral transodontoid (ELTO) approach in children with large ventral CCJ tumors as an alternative or complement to anterior approaches.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This is a retrospective, single-center study of patients who underwent the ELTO approach from January 2021 to January 2024. Patients with at least 3 months of postoperative follow-up and postoperative MR images were included. Primary outcomes included extent of resection, intraoperative and postoperative complications, and neurological outcome.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Six children underwent 8 ELTO approaches (2 children underwent bilateral ELTO). The median age was 8 years (range 3\u201317 years), with a mean follow-up of 15.8 months. Diagnoses included classic chordoma (n = 3), poorly differentiated chordoma (n = 2), and high-grade undifferentiated sarcoma (n = 1). Gross-total resection (GTR) was achieved in all cases. One patient developed thrombosis of the third segment of the vertebral artery without symptoms or signs of ischemia. One patient with hydrocephalus and significant dysphagia due to bilateral cranial nerve XII palsy at diagnosis and worsening left vocal cord paralysis after the resection required ventriculoperitoneal shunt placement as well as a tracheostomy and gastrostomy after tumor resection. One patient required revision of the occipitocervical fixation due to new onset of dysphagia 4 months after tumor resection, without additional consequences.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The ELTO approach is safe and feasible in children with large tumors of the ventral craniocervical junction. GTR was achieved in all the patients, and there were no significant complications or new neurological deficits due to the approach.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.9.peds24305","type":"journal-article","created":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T02:45:28Z","timestamp":1734749128000},"page":"1-8","source":"Crossref","is-referenced-by-count":1,"title":["The extreme lateral transodontoid approach for large tumors in children in the ventral craniocervical junction"],"prefix":"10.3171","author":[{"given":"Nealen","family":"Laxpati","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Surgery, Texas Children\u2019s Hospital, Houston;"},{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uma","family":"Ramaswamy","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otorhinolaryngology, Department of Surgery, Texas Children\u2019s Hospital,"},{"name":"Department of Otorhinolaryngology, Baylor College of Medicine, Houston; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Lin","sequence":"additional","affiliation":[{"name":"Cancer Center, Department of Pediatrics, Texas Children\u2019s Hospital, Baylor College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William E.","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Surgery, Texas Children\u2019s Hospital, Houston;"},{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard L.","family":"Weiner","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Surgery, Texas Children\u2019s Hospital, Houston;"},{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David F.","family":"Bauer","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Surgery, Texas Children\u2019s Hospital, Houston;"},{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guillermo","family":"Aldave","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Surgery, Texas Children\u2019s Hospital, Houston;"},{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Head Neck","first-page":"892","article-title":"Clival chordomas: a pathological, surgical, and radiotherapeutic review","volume":"36","author":"Fernandez-Miranda JC","year":"2014","unstructured":"Fernandez-Miranda JC, Gardner PA, Snyderman CH,  Clival chordomas: a pathological, surgical, and radiotherapeutic review. 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