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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

Neil C-W Tan
1   Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, South Australia, Australia
,
Yuresh Naidoo
1   Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, South Australia, Australia
,
Sakiko Oue
1   Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, South Australia, Australia
,
Hamish Alexander
2   Department of Endoscopic Skull Base Surgery and Neurosurgery, Wakefield and Wellington Hospitals, Wellington, New Zealand
,
Simon Robinson
2   Department of Endoscopic Skull Base Surgery and Neurosurgery, Wakefield and Wellington Hospitals, Wellington, New Zealand
,
Agadha Wickremesekera
2   Department of Endoscopic Skull Base Surgery and Neurosurgery, Wakefield and Wellington Hospitals, Wellington, New Zealand
,
Steve Floreani
1   Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, South Australia, Australia
,
Nick Vrodos
3   Department of Neurosurgery, Flinders University, Adelaide, South Australia, Australia
,
Steve Santoreneos
4   Department of Neurosurgery, University of Adelaide, South Australia, Australia
,
Eng Ooi
5   Department of Otolaryngology - Head and Neck Surgery, Flinders University, Adelaide, South Australia, Australia
,
Matthew Mcdonald
3   Department of Neurosurgery, Flinders University, Adelaide, South Australia, Australia
,
Peter-John Wormald
1   Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, South Australia, Australia
› Author Affiliations
Further Information

Publication History

06 January 2012

28 March 2012

Publication Date:
29 August 2012 (online)

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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
 

  • 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
    CrossrefPubMedGoogle Scholar
  • 2 Unni KK. Dahlin's bone tumors: general aspects and data on 11,087 cases. 5th ed. Philadelphia, PA: Lippincott-Raven; 1996
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 7 Ogi H, Kiryu H, Hori Y, Fukui M. Cutaneous metastasis of CNS chordoma. Am J Dermatopathol 1995; 17: 599-602
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Stippler M, Gardner PA, Snyderman CH , et al. Endoscopic endonasal approach for clival chordomas. Neurosurgery 2009; 64: 268-277 ; discussion 277–268
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 18 Choo YS, Joo SW, Noh SJ, Lee SI. Intradural retroclival chordoma. J Korean Neurosurg Soc 2009; 46: 152-155
    CrossrefPubMedGoogle Scholar
  • 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.
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 23 Colli BO, Al-Mefty O. Chordomas of the skull base: follow-up review and prognostic factors. Neurosurg Focus 2001; 10: E1
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 28 Valentine R, Wormald PJ. Controlling the surgical field during a large endoscopic vascular injury. Laryngoscope 2011; 121: 562-566
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar