+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Endoscopic Approach to Clival Chordomas: The Northwestern Experience

Endoscopic Approach to Clival Chordomas: The Northwestern Experience

World Neurosurgery 110: E231-E238

Chordomas are rare primary bone tumors with a low-grade histology but an aggressive clinical behavior characterized by local invasion and recurrence. When occurring in the skull base, their treatment is limited by proximity to critical neurovascular structures. Open surgical approaches can carry high morbidity, making the development of alternative approaches desirable. We describe our experience with endoscopic endonasal approaches to clival chordomas over 13 years. We performed a retrospective chart review of patients diagnosed with clival chordomas and treated with an endoscopic endonasal approach between 2003 and 2015 at Northwestern Memorial Hospital. We reviewed presenting symptoms, tumor location and size, extent of resection, complications, recurrence, adjuvant treatment, retreatment, and follow-up duration. A total of 23 charts were reviewed, with 17 included in our final review. Mean age was approximately 48 years. The most common presenting symptom was diplopia present in 70.6% of patients. Mean tumor volume was 20.2 cm3. Gross total resection was achieved in 52.9% of patients. With a mean follow-up period of 63.4 months, 5 patients had a recurrence. The most common complication was cerebrospinal fluid (CSF) leak, which was noted in 6 patients. Tumor volume was significantly higher in patients with CSF leak. No correlation between intradural extension and postoperative CSF leak was noted. Clival chordoma are challenging entities to treat. The best outcomes are achieved with gross total resection followed by adjuvant radiotherapy treatment. We show that the endonasal endoscopic corridor is a viable alternative approach to these lesions.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 059680331

Download citation: RISBibTeXText

PMID: 29104156

DOI: 10.1016/j.wneu.2017.10.146

Related references

Endoscopic endonasal approach for clival chordomas. Neurosurgery 64(2): 268-77; Discussion 277-8, 2009

Surgical results of an endoscopic endonasal approach for clival chordomas. Acta Neurochirurgica 154(5): 879-886, 2012

Endonasal endoscopic approach to clival and posterior fossa chordomas. Operative Techniques in Otolaryngology-Head and Neck Surgery 22(4): 274-280, 2011

Neuronavigation using an image-guided endoscopic transnasal-sphenoethmoidal approach to clival chordomas. Neurosurgery 61(5 Suppl 2): 212-7; Discussion 217-8, 2008

Expanded endoscopic endonasal approach for treatment of clival chordomas: early results in 12 patients. Neurosurgery 63(2): 299-307; Discussion 307-9, 2008

Endoscopic endonasal surgery for Clival Chordomas - a single institution experience and short term outcomes. British Journal of Neurosurgery 2019: 1-6, 2019

Endoscopic transnasal approach for surgical treatment of skull base clival area chordomas (Report of 2 cases). Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 32(3): 230-232, 2018

Endoscopic resection of chordomas in different clival regions. Acta Oto-Laryngologica 129(1): 71-83, 2008

Three-dimensional endoscopy in transnasal transsphenoidal approach to clival chordomas. Head and Neck 38 Suppl 1: E1814-9, 2018

Surgical treatment of clival chordomas: the transsphenoidal approach revisited. Journal of Neurosurgery 85(5): 784-792, 1996

Transmaxillary approach for surgical removal of clival chordomas: study of 10 cases. Zhonghua Yi Xue Za Zhi 85(20): 1379-1381, 2005

Atlanto-occipital Instability Following Endoscopic Endonasal Approach for Lower Clival Lesions: Experience With 212 Cases. Neurosurgery 77(6): 888-97; Discussion 897, 2016

A novel transpalatal-transoral robotic surgery approach to clival chordomas extending into the nasopharynx. Head and Neck 2019, 2019

Tailored surgical strategy in clival chordomas: an extraordinary selection bias that limits approach comparison. Journal of Neurosurgical Sciences 62(4): 519-521, 2017

Endoscopic endonasal approach in the management of skull base chordomas--clinical experience on a large series, technique, outcome, and pitfalls. Neurosurgical Review 37(2): 217-24; Discussion 224-5, 2014