Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Clival Chordoma in Children a Rare Condition: Case Report

Ali Al Mashni, Neeraj Salhotra*, Mohammad Hadad, Mohammad Hashim, Tariq Al Saidi, Samit Biniwal

Neurosurgeon Khoula Hospital Muscat Oman

Abstract: A three year child had presented to our OPD with complaints of nasal obstruction, change of voice and difficulty in ingestion. Patient was investigated and was seen having a mass in the nasopharynx. Further investigations revealed on CT and MRI brain a large tumour destroying the clival region with nasopharyngeal and intracranial extension with pressure effect on brain stem and lower cranial nerves. Patient underwent two stage surgery retromastoid craniectomy with excision of intracranial part and later a tracheostomy and transoral excision of the nasopharyngeal extension and part anterior to brain stem. Patient made a remarkable recovery and was discharged home after tracheostomy removal with advice to follow with pediatric oncology for chemotherapy as HPE revealed it to be clival chordoma a rare entity in children.

Keywords: clival chordoma in children

Citation: Ali Al Mashni, Neeraj Salhotra, Mohammad Hadad, Mohammad Hashim, Tariq Al Saidi, Samit Biniwal, Clival Chordoma in Children a Rare Condition: Case Report. American Journal of Medical Case Reports, 6 (2). 21-23. January 2018. doi:10.12691/ajmcr-6-2-2

1. Introduction

Clival chordoma a skull base condition is encountered commonly in adults. But in pediatric age group it is a rare condition. We however in our institution had this 3 year old child presented with nasal obstruction and later found to a clival chordoma and managed successfully with good outcome.

2. Materials and Methods

A 3 year old child had presented to our OPD with complaints of nasal obstruction, recurrent attacks of upper respiratory infections and voice change with difficulty in swallowing leading to episodes of coughing. Patient was seen initially by ENT surgeons and on post rhinoscopy found a mass in nasopharyngeal area. Patient underwent CT scan followed by MRI brain which revealed large mass destroying the clivus occupying the nasopharyngeal area with intracranial extension compressing the brain stem and infiltrating the lower cranial nerves as Figure 1.

3. Results

Patient after a detailed discussion with parents about all possible risks and benefits of surgery, underwent two stage surgery. Patient initially underwent a retromastoid approach with decompression of intracranial part of the tumour which was compressing the brain stem and engulfing the lower cranial nerves as Figure 2. Patient made a remarkable recovery after surgery. Wounds healed well weaning was started but extubation was difficult in view of lower cranial nerve palsy. After a gap of two weeks once patient was still on ventilator a tracheostomy was done and transoral excision of the tumour was done from the nasopharyngeal area and part anterior to brain stem after removing the invaded clival bony tissues as Figure 3. Postoperative period was uneventful. Patient after of ventilator was shifted to the ward and after downsizing the tracheostomy tube and seeing the tolerance of patient to tracheostomy closure, tracheostomy was removed. Patient was sent to pediatric oncology as histopathology report (H1708145) revealed It to be clival chordoma a rare entity.

4. Discussion

In review of literature Yadav YR in 1992 described the cranial chordomas in 1st decade a rare condition and its management [2]. Pediatric chordomas were further illustrated by Beccaria K in 2015 [3]. Vinke RS in 2015 described a prepontine chordoma in an 11 yr old boy [4]. Chang SW in 2008 also gave a detailed account of management protocols adopted for juvenile chordomas [5]. Warnick RE gave in 1991 gave a detailed account of chordomas in tentorium cerebella [6]. Hazarika D in 1995 gave details of diagnosis of oropharyngeal lesion diagnosed to be chordoma after fine needle aspiration biopsy [1].

Figure 1. Pre op MRI pictures of the lesion

Figure 2. Post op picture after 1st stage retromastoid excision of the tumour

Figure 3. CT picture after 2nd stage transoral excision of the tumour

Figure 4. Pre and post op MRI of the patient

5. Conclusion

To conclude clival chordomas in children are a rare entity. Presentation can be due to local symptoms due to invasion of pharynx or intracranial due to lower cranial nerve involvement or brain stem compression. Diagnosis remains by imaging viz CT/MRI and surgical excision or decompression. Chemotherapy is required to delay the recurrence and for a fair outcome.

References

[1]   | Diagnosis of clival chordoma by fine needle aspiration of an oropharyngeal mass. A case report Hazarika D, Kumar RV, Muniyappa GD, Mukherjee G, Rao CR, Narasimhamurthy NK, Shenoy AM, Nanjundappa. Acta Cytol. 1995 May-Jun; 39(3): 507-10.
[2]   | Cranial chordoma in the first decade. Yadav YR, Kak VK, Khosla VK, Khandelwal N, Radotra BD.Clin Neurol Neurosurg. 1992; 94(3): 241-6.
[3]   | Paediatric Chordomas. Beccaria K, Sainte-Rose C, Zerah M, Puget S Orphanet J Rare Dis. 2015 Sep 22; 10: 116.
[4]   | Intradural prepontine chordoma in an 11-year-old boy. A case report.Vinke RS, Lamers EC, Kusters B, van Lindert EJ. Childs Nerv Syst. 2016 Jan; 32(1): 169-73.
[5]   | Juvenile intradural chordoma: case report.Chang SW, Gore PA, Nakaji P, Rekate HL. Neurosurgery. 2008 Feb; 62(2): E525-6.
[6]   | Intradural chordoma of the tentorium cerebelli. Case report. Warnick RE, Raisanen J, Kaczmar T Jr, Davis RL, Prados MD J Neurosurg. 1991 Mar; 74(3): 508-11.