Endoscopic Endonasal Approach for Clival Chordomas in Elderly Patients: Clinical Characteristics, Patient Outcome, and Recurrence Rate

Matteo Zoli; Alessandro Carretta; Arianna Rustici; Federica Guaraldi; Davide Gori; Riccardo Cavicchi; Giacomo Sollini; Sofia Asioli; Marco Faustini-Fustini; Ernesto Pasquini; Diego Mazzatenta

doi:10.1055/a-2181-2787

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2024; 85(S 02): e28-e37
DOI: 10.1055/a-2181-2787

Original Article

Endoscopic Endonasal Approach for Clival Chordomas in Elderly Patients: Clinical Characteristics, Patient Outcome, and Recurrence Rate

Authors

Matteo Zoli

¹Programma Neurochirurgia Ipofisi - Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

²Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
Alessandro Carretta

²Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
Arianna Rustici

²Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

³Neuroradiology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore, Bologna, Italy
Federica Guaraldi

¹Programma Neurochirurgia Ipofisi - Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
Davide Gori

²Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
Riccardo Cavicchi

²Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
Giacomo Sollini

⁴Azienda USL di Bologna, ENT Department, Bellaria Hospital, Bologna, Italy
Sofia Asioli

²Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

⁵IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
Marco Faustini-Fustini

¹Programma Neurochirurgia Ipofisi - Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
Ernesto Pasquini

⁴Azienda USL di Bologna, ENT Department, Bellaria Hospital, Bologna, Italy
Diego Mazzatenta

¹Programma Neurochirurgia Ipofisi - Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

²Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

Abstract

Introduction The endoscopic endonasal route has demonstrated to be the approach of choice for a large majority of clival chordomas (CCs). However, its results in elderly patients are under-evaluated in the literature. The aim of this study is to assess the surgical outcome for these patients, determining the factors associated with a larger tumor resection in this population.

Materials and Methods Our institutional database of CC has been retrospectively reviewed, to identify all cases over 65 years old, operated through an endoscopic endonasal approach (EEA). Preoperative clinical and radiological features were considered, as well as surgical results, morbidity, and patients' outcome at follow-up.

Results Out of our series of 143 endoscopic surgical procedures for CC, 34 (23.8%) were in patients older than 65 and 10 in older than 75 (7.0%). Gross tumor removal was achieved in 22 cases (64.7%). Complications consisted of 2 (5.9%) postoperative cerebrospinal leaks, 1 (2.9%) meningitis, 1 (2.9%) permanent cranial nerve VI palsy, 1 (2.9%) pneumonia, and 2 (5.9%) urinary infections. In 39.1% of cases, the preoperative ophthalmoplegia improved or resolved. Twenty-seven patients (79.4%) underwent radiation therapy. At follow-up (37.7 ± 44.9 months), 13 patients (38.2%) showed a recurrence/progression and 13 (38.3%) deceased.

Conclusion EEA can be a useful approach in elderlies, balancing the large tumor removal with an acceptable morbidity rate, even if higher than that for general CC population. However, patient selection remains crucial. A multidisciplinary evaluation is important to assess not only their medical conditions, but also their social and familiar conditions.

Keywords

chordomas - endoscopic endonasal approach - clivus - skull base - elderly - radiation therapy - outcome - complications - recurrences

Full Text

References

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