Introduction Malignancies of the clivus and petroclival region are mainly chordomas and chondrosarcomas. Although a spectrum of malignancies may present in this area, a finite group of commonly encountered malignant pathologies will be the focus of this review, as they are recognized to be formidable pathologies due to adjacent critical neurovascular structures and challenging surgical approaches. Objectives The objective is to review the literature regarding medical and surgical management of malignant tumors of the clival and petroclival region with a focus on clinical presentation, diagnostic identification, and associated adjuvant therapies. We will also discuss our current treatment paradigm using endoscopic, open, and combined approaches to the skull base. Data Synthesis A literature review was conducted, searching for basic science and clinical evidence from PubMed, Medline, and the Cochrane Database. The selection criteria encompassed original articles including data from both basic science and clinical literature, case series, case reports, and review articles on the etiology, diagnosis, treatment, and management of skull base malignancies in the clival and petroclival region. Conclusions The management of petroclival malignancies requires a multidisciplinary team to deliver the most complete surgical resection, with minimal morbidity, followed by appropriate adjuvant therapy. We advocate the combination of endoscopic and open approaches (traditional or minimally invasive) as required by the particular tumor followed by radiation therapy to optimize oncologic outcomes.

Oitenta e quatro pacientes submetidos a lobectomia temporal anterior foram avaliados retrospectivamente com o intuito de correlacionar os diferentes tipos de crises parcias simples (CPS) e suas implicações prognósticas nos pacientes com esclerose mesial temporal. Os pacientes foram divididos em dois grupos de acordo com a classificação de Engel: o Grupo 1 (53 pacientes) englobando os pacientes Classe I (sem crises ou de boa evolução) e o Grupo 2 (31 pacientes) abrangendo as Classes II, III, IV (com crises ou de má evolução). Os grupos foram comparados e os resultados mostraram não haver diferença estatística, quanto aos aspectos demográficos como sexo, lado da cirurgia, idade de início das crises e tempo de acompanhamento pós-operatório dos pacientes. A análise estatística não mostrou relação entre evolução clínica e o tipo de CPS, assim como não mostraram as CPS ter um valor na localização do lado acometido. No entanto, quando os dois grupos foram comparados estatisticamente com relação às idades dos pacientes na ocasião da cirurgia e ao tempo decorrido a partir do início das crises até a intervenção cirúrgica, observou-se que o Grupo 1 (de melhor evolução) conviveu com as crises por intervalo de tempo menor (p<0,05) e realizou as cirurgias em idades mais precoces (p<0,02) do que as correspondentes do Grupo 2 (de pior evolução). A presença ou o tipo de CPS não pode ser um fator usado na determinação prognóstica; a cirurgia deve ser considerada tão breve seja demonstrada resistência ao tratamento clínico.

Eighty-four patients submitted to anterior temporal lobectomy were evaluated retrospectively in order to correlate the different type of simple partial seizure (SPS) and their prognostic implications in patients with mesial temporal sclerosis. The patients were divided in two groups following the classification of Engel; Group 1 (53 patients) included patients Class I (without seizures or of good outcome) and Group 2 (31 patients) included Classes II, III and IV (with seizures or of bad outcome). The two groups were compared and results showed no statistical difference in relation to the demographic aspects as sex, side of surgery, age at onset of seizures and time of the patients' postoperative follow-up. Statistical analysis revealed no relationship between type of SPS and outcome. SPS did not show a statistical value in localizing the side of pathology. However, when the two groups were compared statistically in terms of patients' ages at the time of surgery, and the time elapsed from the onset of the seizures to the surgical intervention, it was observed that Group 1 (of good outcome) had seizures for smaller interval (p <0.05) and was operated at an earlier age (p<0.02) than Group 2 (of bad outcome). The presence or the type of SPS can not be used as a prognostic measure; surgical therapy must be considered as soon as clinical resistance is demonstrated.