Advertisement

Endoscopic Endonasal Surgery of Clival Chordomas: Preliminary Results

  • Davide Soloperto
  • Cristoforo FabbrisEmail author
  • Stefano De Rossi
  • Angelo Musumeci
  • Daniele Marchioni
Original Article
  • 14 Downloads

Abstract

Chordomas are rare malignant tumors, often affecting the clival region. Traditionally, they are removed via craniotomic approach but the introduction of the endoscopic endonasal technique (EEA) allowed to control this area. This article shows a series of patients affected by clival chordomas treated with endoscopic approach. Patients who underwent EEA or transoral approach (TO) for clival chordomas at our Skull Base Referral Center, have been retrospectively examined. Clinical symptoms, preoperative neuroradiological evaluation, surgical approach, complications and postoperative results were evaluated. Nine patients (4 females and 5 males; age range 45–82 years, mean 61 years) were included. Chordomas involved upper clivus in 4/9 cases, with (2) or without (2) extension to the middle clivus, middle clivus alone in 2/9, lower clivus in 2/9, and the whole clivus in 1/9. Tumors were totally (4/9) or subtotally (5/9) removed. Skull base reconstruction was performed with a multilayer technique (6/9) or a gasket-seal closure (1/9), using pedicled nasoseptal flaps, middle turbinate and mucoperichondrial grafts, fascia lata and synthetic fascia. No reconstruction was performed in 2 cases. Recurrence occurred in 4 cases, who underwent a new operation. All the other patients underwent proton-beam radiotherapy with no documented tumor growth at the last follow-up (median: 24.9 months; range: 7–36 months). EEA and TO resulted to be safe procedures for treatment of clival chordomas. These approaches may be used as an alternative to the traditional approaches, according to the extension of the pathology.

Keywords

Chordomas Clivus Endoscopic approach Pedicled flaps Radiotherapy 

Notes

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Human and Animal Rights

This research involved human participants, who all signed an informed consent before any further treatment.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Anagiotos A, Preuss SF, Drebber U, Jumah MD (2013) Multiple craniocervical chordomas presenting as a parapharyngeal mass. Head Neck 35(11):E325–E327CrossRefGoogle Scholar
  2. 2.
    Arnautović KI, Al-Mefty O (2001) Surgical seeding of chordomas. J Neurosurg 95:798–803CrossRefGoogle Scholar
  3. 3.
    Carrabba G, Dehdashti AR, Gentili F (2008) Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach. Neurosurg Focus 25(6):E7CrossRefGoogle Scholar
  4. 4.
    Dehdashti AR, Karabatsou K, Ganna A, Witterick I, Gentili F (2008) Expanded endoscopic endonasal approach for treatment of clival chordomas: early results in 12 patients. Neurosurgery 63:299–309CrossRefGoogle Scholar
  5. 5.
    Eriksson B, Gunterberg B, Kindblom LG (1981) Chordoma: a clinicopathologic and prognostic study of a Swedish national series. Acta Orthop Scand 52:49–58CrossRefGoogle Scholar
  6. 6.
    Forsyth PA, Cascino TL, Shaw EG, Scheithauer BW, O’Fallon JR, Dozier JC, Piepgras DG (1993) Intracranial chordomas: a clinicopathological and prognostic study of 51 cases. J Neurosurg 78:741–747CrossRefGoogle Scholar
  7. 7.
    Gay E, Sekhar LN, Rubinstein E, Wright DC, Sen C, Janecka IP, Snyderman CH (1995) Chordomas and chondrosarcomas of the cranial base: results and follow-up of 60 patients. Neurosurgery 36:887–897CrossRefGoogle Scholar
  8. 8.
    Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116(10):1882–1886CrossRefGoogle Scholar
  9. 9.
    Heffelnger MJ, Dahlin DC, MacCarty CS, Beabout J (1973) Chordomas and cartilaginous tumors at the skull base. Cancer 32:410–420CrossRefGoogle Scholar
  10. 10.
    Hug EB, Loredo LN, Slater JD, DeVries A, Grove RI, Schaefer RA, Rosenberg AE, Slater JM (1999) Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg 91:432–439CrossRefGoogle Scholar
  11. 11.
    Koutourousiou M, Gardner PA, Tormenti MJ, Henry SL, Stefko ST, Kassam AB, Fernandez-Miranda JC, Snyderman CH (2012) Endoscopic endonasal approach for resection of cranial base chordomas: outcomes and learning curve. Neurosurgery 71:614–624 (discussion 624–625)CrossRefGoogle Scholar
  12. 12.
    Leng LZ, Brown S, Anand VK, Schwartz TH (2008) “Gasket-seal” watertight closure in minimal access endoscopic cranial base surgery. Neurosurgery 62(ONS Suppl 2):ONSE342–ONSE343PubMedGoogle Scholar
  13. 13.
    Lobo BC, Baumanis MM, Nelson RF (2017) Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: a systematic review. Laryngoscope Investig Otolaryngol 2(5):215–224CrossRefGoogle Scholar
  14. 14.
    Marchioni D, Musumeci A, Fabbris C, De Rossi S, Soloperto D (2018) Endoscopic transnasal surgery of clival lesions: our experience. Eur Arch Otorhinolaryngol 275:1149–1156CrossRefGoogle Scholar
  15. 15.
    Menezes AH (2008) Craniovertebral junction neoplasms in the pediatric population. Childs Nerv Syst 10:1173–1186CrossRefGoogle Scholar
  16. 16.
    Patibandla MR, Thotakura AK, Rao MN, Addagada GC, Nukavarapu MC, Panigrahi MK, Uppin S, Challa S, Dandamudi S (2017) Clival giant cell tumor: a rare case report and review of literature with respect to current line of management. Asian J Neurosurg 12(1):78–81CrossRefGoogle Scholar
  17. 17.
    Roberti F, Sekhar LN, Jones RV, Wright DC (2007) Intradural cranial chordoma: a rare presentation of an uncommon tumor. Surgical experience and review of the literature. J Neurosurg 106:270–274CrossRefGoogle Scholar
  18. 18.
    Vellutini EA, Balsalobre L, Hermann DR, Stamm AC (2014) The endoscopic endonasal approach for extradural and intradural clivus lesions. World Neurosurg 82(6 Suppl):S106–115, 201CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Department of OtolaryngologyUniversity Hospital of VeronaVeronaItaly
  2. 2.Department of NeurosurgeryUniversity Hospital of VeronaVeronaItaly

Personalised recommendations