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

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

› Author Affiliations

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

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