Endoscopic Surgery of Skull Base Chordomas

Neil C-W Tan; Yuresh Naidoo; Sakiko Oue; Hamish Alexander; Simon Robinson; Agadha Wickremesekera; Steve Floreani; Nick Vrodos; Steve Santoreneos; Eng Ooi; Matthew Mcdonald; Peter-John Wormald

doi:10.1055/s-0032-1321508

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

J Neurol Surg B Skull Base 2012; 73(06): 379-386
DOI: 10.1055/s-0032-1321508

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Surgery of Skull Base Chordomas

Authors

Neil C-W Tan

¹Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, South Australia, Australia
Yuresh Naidoo

¹Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, South Australia, Australia
Sakiko Oue

¹Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, South Australia, Australia
Hamish Alexander

²Department of Endoscopic Skull Base Surgery and Neurosurgery, Wakefield and Wellington Hospitals, Wellington, New Zealand
Simon Robinson

²Department of Endoscopic Skull Base Surgery and Neurosurgery, Wakefield and Wellington Hospitals, Wellington, New Zealand
Agadha Wickremesekera

²Department of Endoscopic Skull Base Surgery and Neurosurgery, Wakefield and Wellington Hospitals, Wellington, New Zealand
Steve Floreani

¹Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, South Australia, Australia
Nick Vrodos

³Department of Neurosurgery, Flinders University, Adelaide, South Australia, Australia
Steve Santoreneos

⁴Department of Neurosurgery, University of Adelaide, South Australia, Australia
Eng Ooi

⁵Department of Otolaryngology - Head and Neck Surgery, Flinders University, Adelaide, South Australia, Australia
Matthew Mcdonald

³Department of Neurosurgery, Flinders University, Adelaide, South Australia, Australia
Peter-John Wormald

¹Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, South Australia, Australia

Abstract

Objective To assess our clinical experience in treating midline intracranial pathology using minimally invasive surgical techniques.

Design Retrospective chart review of patients undergoing endoscopic endonasal resection of clival chordomas.

Setting Two tertiary referral centers in Australia and New Zealand.

Main Outcome Measures Patients were assessed by intraoperative findings (macroscopic resection rate, tumor size, and operative complications) and clinical outcomes (residual disease, postoperative complications, recurrence rate, and mortality).

Results Fourteen patients underwent endoscopic resection of clival chordomas (seven primary, seven revision) with a mean follow-up of 41.45 months (3 to 104 months). Macroscopic resection rates were 71% and 29%, respectively. Mean operative time was 386 minutes. Overall cerebrospinal fluid (CSF) leak rate was 3/14 (21%) and, using the nasoseptal flap, it was 0/5 (0%). Two patients developed late recurrence; one died of disease and one was treated with intensity modulated radiation therapy. Overall mortality was 2/14 (14%).

Conclusion Endoscopic resection of clival chordomas is a safe and viable alternative to the traditional open approach. The nasoseptal flap is an excellent method of obtaining a watertight skull base closure. Furthermore, this series highlighted the fact that the primary attempt at surgery offers the best chance to achieve a total resection.

Keywords

chordoma - endoscopic - endonasal - surgery - minimally invasive - skull base

Full Text

References

References
1 McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM. Chordoma: incidence and survival patterns in the United States, 1973-1995. Cancer Causes Control 2001; 12: 1-11
2 Unni KK. Dahlin's bone tumors: general aspects and data on 11,087 cases. 5th ed. Philadelphia, PA: Lippincott-Raven; 1996
3 Volpe NJ, Liebsch NJ, Munzenrider JE, Lessell S. Neuro-ophthalmologic findings in chordoma and chondrosarcoma of the skull base. Am J Ophthalmol 1993; 115: 97-104
4 Forsyth PA, Cascino TL, Shaw EG , et al. Intracranial chordomas: a clinicopathological and prognostic study of 51 cases. J Neurosurg 1993; 78: 741-747
5 Sopta J, Tulic G, Mijucic V, Mamontov P, Mandic N. Solitary lymph node metastasis without local recurrence of primary chordoma. Eur Spine J 2009; 18 (Suppl. 02) 191-195
6 Tavernaraki A, Andriotis E, Moutaftsis E, Attard A, Liodantonaki P, Stasinopoulou M. Isolated liver metastasis from sacral chordoma. Case report and review of the literature. J BUON 2003; 8: 381-383
7 Ogi H, Kiryu H, Hori Y, Fukui M. Cutaneous metastasis of CNS chordoma. Am J Dermatopathol 1995; 17: 599-602
8 Jho HD, Carrau RL, McLaughlin MR, Somaza SC. Endoscopic transsphenoidal resection of a large chordoma in the posterior fossa. Acta Neurochir (Wien) 1997; 139: 343-347 , discussion 347–348
9 Jho HD, Carrau RL, McLaughlin ML, Somaza SC. Endoscopic transsphenoidal resection of a large chordoma in the posterior fossa. Case report. Neurosurg Focus 1996; 1: e3 , discussion 1p, e3
10 Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH. Endoscopic endonasal transclival resection of chordomas: operative technique, clinical outcome, and review of the literature. J Neurosurg 2010; 112: 1061-1069
11 Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH. Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. Neurosurg 2010; 67 (3 Suppl Operative) ons150-ons158 ; discussion ons158
12 Stippler M, Gardner PA, Snyderman CH , et al. Endoscopic endonasal approach for clival chordomas. Neurosurgery 2009; 64: 268-277 ; discussion 277–268
13 Kassam A, Thomas AJ, Snyderman C , et al. Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg 2007; 106 (2, Suppl) 75-86
14 Kassam AB, Snyderman C, Gardner P, Carrau R, Spiro R. The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery 2005; 57 (1, Suppl) E213 ; discussion E213
15 Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 2005; 19: E6
16 Snyderman CH, Pant H, Carrau RL, Prevedello D, Gardner P, Kassam AB. What are the limits of endoscopic sinus surgery?: the expanded endonasal approach to the skull base. Keio J Med 2009; 58: 152-160
17 Hadad G, Bassagasteguy L, Carrau RL , et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116: 1882-1886
18 Choo YS, Joo SW, Noh SJ, Lee SI. Intradural retroclival chordoma. J Korean Neurosurg Soc 2009; 46: 152-155
19 Morisako H, Goto T, Nagata T , et al. Middle skull base approach with postero-lateral mobilization of the geniculate ganglion to access the clival regions. Neurosurgery 2011; 69 (1 Suppl Operative) :ons88–94; discussion ons94.
20 Bozbuğa M, Turan Süslü H, Güler I, Bilgi B, Bayindir C. Removal of clival chordoma in an adolescent thorough combned pterional transsylvian and anterior temporal approach. Turk Neurosurg 2007; 17: 55-59
21 Yoneoka Y, Tsumanuma I, Fukuda M , et al. Cranial base chordoma—long term outcome and review of the literature. Acta Neurochir (Wien) 2008; 150: 773-778 , discussion 778
22 Tzortzidis F, Elahi F, Wright DC, Temkin N, Natarajan SK, Sekhar LN. Patient outcome at long-term follow-up after aggressive microsurgical resection of cranial base chondrosarcomas. Neurosurgery 2006; 58: 1090-1098 , discussion 1090–1098
23 Colli BO, Al-Mefty O. Chordomas of the skull base: follow-up review and prognostic factors. Neurosurg Focus 2001; 10: E1
24 Gay E, Sekhar LN, Rubinstein E , et al. Chordomas and chondrosarcomas of the cranial base: results and follow-up of 60 patients. Neurosurgery 1995; 36: 887-896 ; discussion 896–887
25 Park L, Delaney TF, Liebsch NJ , et al. Sacral chordomas: Impact of high-dose proton/photon-beam radiation therapy combined with or without surgery for primary versus recurrent tumor. Int J Radiat Oncol Biol Phys 2006; 65: 1514-1521
26 Leng LZ, Brown S, Anand VK, Schwartz TH. “Gasket-seal” watertight closure in minimal-access endoscopic cranial base surgery. Neurosurgery 2008; 62 (5 Suppl 2) :ONSE342-3; discussion ONSE343
27 Jardeleza C, Seiberling K, Floreani S, Wormald PJ. Surgical outcomes of endoscopic management of adenocarcinoma of the sinonasal cavity. Rhinology 2009; 47: 354-361
28 Valentine R, Wormald PJ. Controlling the surgical field during a large endoscopic vascular injury. Laryngoscope 2011; 121: 562-566
29 Valentine R, Boase S, Jervis-Bardy J, Dones Cabral JD, Robinson S, Wormald PJ. The efficacy of hemostatic techniques in the sheep model of carotid artery injury. Int Forum Allergy Rhinol 2011; 1: 118-122