Endoscopic Endonasal Approach for Resection of Chordoma

Background: Skull base chordomas are difficult lesions to treat. The endoscopic endonasal approach (EEA) takes advantage of the natural sinus corridor and may provide a less invasive approach for these midline tumors.

Methods: Patients undergoing EEA for chordomas were selected from a database of over 800 consecutive patients undergoing EEA at the University of Pittsburgh Medical Center and retrospectively evaluated. Additionally, a systematic review of the literature of endoscopic endonasally resected chordomas was performed and compared to our personal experience.

Results: Twenty patients (8 female and 12 male) underwent 26 endoscopic EEAs for skull base chordomas. Eight (40 %) were recurrent. In the 12 newly diagnosed chordomas, 8 (66.7%) underwent total, 2 (16.7%) near-total, and 2 (16.7%) subtotal resection. In the eight recurrent chordomas, one (12.5%) underwent gross total, two (25.0%) near-total and five (62.5%) subtotal resections were achieved. Two patients (10%) recurred and five (25%) progressed during the mean follow-up period of 13 months (1 to 45 months). Five (25 %) underwent re-resection, one was lost to follow-up, and one died secondary to progression of disease. There was one intraoperative vascular complication with no sequelae. The CSF leak rate was 25%. The permanent neurological complication rate was 5%.

Conclusions: Endoscopic endonasal resection of skull base chordomas is safe. This approach provides the potential for, at the least, similar resections compared with traditional skull base approaches while potentially limiting morbidity.