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J Neurol Surg B Skull Base 2022; 83(S 02): e113-e125
DOI: 10.1055/s-0041-1722933
Original Article

Systematic Review Comparing Open versus Endoscopic Surgery in Clival Chordomas and a 10-Year Single-Center Experience

Asfand Baig Mirza  ‡   *
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Visagan Ravindran  ‡   *
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Mohamed Okasha
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Timothy Martyn Boardman
2   GKT School of Medical Education, King's College London, London, United Kingdom
,
Eleni Maratos
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Barazi Sinan
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Nick Thomas
1   Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
› Author Affiliations Funding None.
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Abstract

Objectives Chordomas are rare, slow-growing, and osteo-destructive tumors of the primitive notochord. There is still contention in the literature as to the optimal management of chordoma. We conducted a systematic review of the surgical management of chordoma along with our 10-year institutional experience.

Design A systematic search of the literature was performed in October 2020 by using MEDLINE and EMBASE for articles relating to the surgical management of clival chordomas. We also searched for all adult patients surgically treated for primary clival chordomas at our institute between 2009 and 2019.

Participants Only articles describing chordomas arising from the clivus were included in the analysis. For our institution experience, only adult primary clival chordoma cases were included.

Main Outcome Measures Patients were divided into endoscopic or open surgery. Rate of gross total resection (GTR), recurrence, and complications were measured.

Results Our literature search yielded 24 articles to include in the study. Mean GTR rate among endoscopic cases was 51.9% versus 41.7% for open surgery. Among the eight cases in our institutional experience, we found similar GTR rates between endoscopic and open surgery.

Conclusion Although there is clear evidence in the literature that endoscopic approaches provide better rates of GTR with fewer overall complications compared to open surgery. However, there are still situations where endoscopy is not viable, and thus, open surgery should still be considered if required.

Keywords

Chordoma - clivus - endoscopic skull base - proton beam therapy

Note

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


* Authors contributed equally to the manuscript.




Publication History

Received: 20 July 2020

Accepted: 27 November 2020

Article published online:
22 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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