Clival Tumor Surgery in New Jersey

A clival tumor is a growth on the clivus, which is a portion of bone at the base of the skull. As a clival tumor grows, it can invade and damage the nearby structures, including:

• Cranial nerves, nerves that control, eye movements, facial sensation and movement, hearing and balance, tongue movement, and swallowing
• Internal carotid arteries, the main arteries supplying blood to the brain
• Brainstem

A clival tumor happens mostly in adults between the ages of 40 and 60. This type of tumor grows slowly and can be hard to treat because of its location. Clival tumors also are considered locally invasive and tend to recur after treatment.

Two types of tumors can grow in the clivus: Chordomas and chondrosarcomas.

Chordomas

A chordoma is a rare, slow-growing but malignant tumor. It forms from cells that were once part of an embryonic structure called a notochord. Normally, notochord remnants form part of intervertebral discs. When the notochord cells are enclosed by developing bones, a chordoma is formed. Chordomas are slow-growing, but their mild behavior can still cause significant damage when they invade nearby bone structures due to the pressure they inflict.

Chondrosarcoma

A chondrosarcoma is a very rare, slow-growing tumor that happens in the cartilage of the skull. They are usually malignant but rarely spread to other areas of the brain. Like chordomas, chondrosarcomas can recur after treatment and spread to nearby bone structures.

Symptoms of a Clival Tumor

The symptoms of a clival tumor can vary depending on the tumor’s location in the brain. Warning signs of clival tumors can include:

• Coordination problems
• Dizziness and vertigo
• Facial pain, numbness, or paralysis
• Headaches
• Hearing difficulty
• Neck pain
• Speech problems
• Swallowing difficulty
• Vision problems

Because the symptoms of a clival tumor are very similar to those of other brain and spine conditions, it can be difficult to diagnose. Sometimes, the symptoms of a clival tumor do not appear until the tumor has grown very large. That is why the medical team at Centers for Neurosurgery, Spine & Orthopedics recommends seeking a diagnosis from a neurosurgeon or similar specialist if a patient is experiencing these symptoms.

Diagnosing a Clival Tumor

At Centers for Neurosurgery, Spine & Orthopedics, the diagnosis begins with the neurosurgeon completing a neurological examination. A neurological examination includes:

• Testing eye movements
• Coordination
• Balance
• Testing other sensations, like touch and taste

Other diagnostic testing may include:

• Magnetic resonance imaging (MRI) scan: An MRI is one of the most common and preferred ways to scan for a clival tumor. An MRI uses magnets and radio waves to create detailed images of the spinal cord and brain.
• Computed tomography (CT) scan: A CT scan is another form of diagnostic imaging that uses X-rays and a computer to create pictures of the brain so doctors can check for a clival tumor and examine its surrounding structures.
• Biopsy: A doctor can remove a small number of tumor cells for examination. A biopsy can determine the type of clival tumor.

Treatment for Clival Tumors

Treatment for clival tumors depends on their size and location in the brain. Below are some of the treatment options available for removing or resecting these tumors

Endoscopic Transsphenoidal Surgery

An endoscopic transsphenoidal surgery is a scarless procedure that uses an endoscope to remove clival tumors. A neurosurgeon will insert the endoscope through the nose, to get a direct view of the area of tumor growth. Surgeons then use very small instruments to remove the tumor via the patient’s nose.

Craniotomy

Traditionally, clival tumors are removed through complex skull base procedures including a craniotomy, which involves temporarily removing the top portion of the skull to directly visualize the brain and tumor. After the tumor is removed, the skull bone that was initially removed, otherwise known as the bone flap, is reconnected and secured back onto the patient’s skull. Surgeons will use this procedure if less invasive surgery methods will not provide adequate visualization of the necessary anatomical structures.

Radiation Therapy

Radiation therapy is typically prescribed following clival tumor resection, due to the high recurrence rate and the fact that these tumors may be slow-growing but are malignancies. The neurosurgeon and radiation oncologist devise the best strategy using evidence-based medicine. Radiation therapy helps clear any remaining cancerous growth cells that might multiply. If these cells multiply, it can cause additional tumors to appear, referred to as a recurrence.

Proton Beam Therapy

Proton beam therapy is an alternative treatment option to radiation therapy. It eliminates cancerous cells to avoid their re-growth. Proton beam therapy has been shown to be more effective in treating clival tumors than traditional radiation. If a tumor is deemed inoperable, proton beam therapy may be used as the primary form of the treatment.

Developing a Treatment Plan

As part of the treatment decision process, a neurosurgeon at CNSO will first consider the patient’s medical history and the size, type, and location of the tumor. Together with the patient and their family, they can decide which method would be most beneficial to the patient’s health and well-being during and after the treatment.

Treating a Clival Tumor with Minimally Invasive Surgery

Neurosurgeons at CNSO, leaders in brain surgery and spine surgery, prefer to perform minimally invasive surgery whenever possible. This technique of brain surgery and spine surgery can be used to access and treat many brain and spine malformations.

Using advanced techniques and state-of-the-art minimally invasive equipment, neurosurgeons can access the affected area of the brain or spine through small incisions under direct visualization. During a minimally invasive procedure, surgeons use small and narrow surgical tools designed for accuracy and precision.

CNSO neurosurgeons also can perform endoscopic surgery, another form of minimally invasive surgery, which uses a small endoscopic camera to see past the skull and into the brain A narrow, high-resolution camera displays the surgical field on a monitor allowing the neurosurgeon to work through a smaller incision site with the visualization equal in quality to direct visualization.

Other advantages of a minimally invasive brain surgery are:

• Faster recovery times
• Shorter hospital stays
• Less discomfort during recovery
• Lowered risk of complications and side effects

Other benefits include significantly less post-operative pain and minimal scarring.  Both help the patient have a quicker recovery.

Need a Second Opinion?

The doctors at Centers for Neurosurgery, Spine & Orthopedics understand patients may want a second opinion on their diagnosis. CNSO’s brain and spine specialists know a second opinion can help patients feel at ease with their diagnosis and even help them understand their condition more.

When a patient schedules a consultation with CNSO, the doctors review every part of a diagnosis and plan. The compassionate group of doctors and surgeons, educate patients on their diagnosis, explains the most effective treatment option, and ensures patients understand their expected course towards wellness, including:

• Symptoms
• Medical conditions
• Previous testing
• Diagnosis
• Treatment options
• Recovery process

At CNSO, one-hour consultations are booked to give enough time for the patient and doctor to go through a complete diagnosis and care plan.

See a Specialist for Clival Tumor Diagnosis at CNSO

The dedicated surgical and non-surgical team at Centers for Neurosurgery, Spine & Orthopedics understands how any type of brain tumor can impact daily life. At CNSO, patients will receive comprehensive and coordinated care so they can resume a healthy, less painful lifestyle free from disability by working with leading board-certified neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists.

CNSO also ensures language is not a barrier for patients to receive the care they need. Members of the medical staff are fluent in the following languages: English, Hebrew, Korean, Mandarin Chinese, Russian, Serbo-Croatian, and Spanish.

CNSO offers multiple convenient locations spanning across northern New Jersey, including in Bergen, Passaic, Essex, Morris, and Hudson counties. Northern New Jersey patients can learn more about effective treatment for a clival tumor by contacting the doctors at CNSO today.