Surgical Pathway Seeding of Clivo-Cervical Chordomas

Abstract

Objective Clival chordomas are slow-growing aggressive tumors that originate from the extra-axial remnants of the notochord. Current management of these tumors use surgical resection combined with radiation therapy. Given the location and invasive nature of these tumors, complete resection is difficult. A variety of both open and endoscopic therapeutic approaches have evolved and combined with the improvements in proton therapy, long-term control of these tumors appears to be improving. However, in recent literature the relatively rare complication of surgical seeding or surgical pathway recurrence has been reported. We report a case of surgical seeding following primary resection and review the world literature regarding surgical pathway recurrence.

Study Design Retrospective chart review and review of current literature.

Methods We report a case of a patient with a large chordoma that required treatment with a staged endoscopic endonasal and external transcervical approach. The patient subsequently developed recurrent disease along the cervical skin incision due to surgical seeding. Literature review and case reports were identified by a comprehensive search of Medline for the years 1950 to 2012.

Results The overall surgical pathway recurrence rate for clival chordoma resection based on analysis of the open nonendoscopic published case studies was 14 of 497 (2.8%).

Conclusion Tumor seeding can occur anywhere along the operative route and is often outside the field of radiotherapy. Increased awareness of this rare occurrence is necessary. The use of novel techniques to minimize exposure to tumor including primary endoscopic resection and so-called clean oncologic technique may help limit tumor seeding. Level of evidence: 4.

Keywords

skull base - surgical seeding - endoscopic surgery - chordoma - clivus

• References

• 1 Austin JP, Urie MM, Cardenosa G, Munzenrider JE. Probable causes of recurrence in patients with chordoma and chondrosarcoma of the base of skull and cervical spine. Int J Radiat Oncol Biol Phys 1993; 25 (3) 439-444
• 2 Fagundes MA, Hug EB, Liebsch NJ, Daly W, Efird J, Munzenrider JE. Radiation therapy for chordomas of the base of skull and cervical spine: patterns of failure and outcome after relapse. Int J Radiat Oncol Biol Phys 1995; 33 (3) 579-584
• 3 Fischbein NJ, Kaplan MJ, Holliday RA, Dillon WP. Recurrence of clival chordoma along the surgical pathway. AJNR Am J Neuroradiol 2000; 21 (3) 578-583
• 4 Arnautović KI, Al-Mefty O. Surgical seeding of chordomas. J Neurosurg 2001; 95 (5) 798-803
• 5 van Lierop AC, Fagan JJ, Taylor KL. Recurrent chordoma of the palate occurring in the surgical pathway: a case report. Auris Nasus Larynx 2008; 35 (3) 447-450
• 6 Chambers PW, Schwinn CP. Chordoma. A clinicopathologic study of metastasis. Am J Clin Pathol 1979; 72 (5) 765-776
• 7 Sen C, Triana AI, Berglind N, Godbold J, Shrivastava RK. Clival chordomas: clinical management, results, and complications in 71 patients. J Neurosurg 2010; 113 (5) 1059-1071
• 8 Camara O, Kavallaris A, Nöschel H, Rengsberger M, Jörke C, Pachmann K. Seeding of epithelial cells into circulation during surgery for breast cancer: the fate of malignant and benign mobilized cells. World J Surg Oncol 2006; 4: 67
• 9 Ploumidis A, Panoskaltsis T, Gavresea T, Yiannou P, Yiannakou N, Pavlakis K. Tumor seeding incidentally found two years after robotic-assisted radical nephrectomy for papillary renal cell carcinoma. A case report and review of the literature. Int J Surg Case Rep 2013; 4 (6) 561-564
• 10 Rolle A, Günzel R, Pachmann U, Willen B, Höffken K, Pachmann K. Increase in number of circulating disseminated epithelial cells after surgery for non-small cell lung cancer monitored by MAINTRAC(R) is a predictor for relapse: a preliminary report. World J Surg Oncol 2005; 3 (1) 18
• 11 Castelnuovo PG, Delù G, Sberze F , et al. Esthesioneuroblastoma: endonasal endoscopic treatment. Skull Base 2006; 16 (1) 25-30
• 12 de Almeida JR, Witterick IJ, Gullane PJ , et al. Physical morbidity by surgical approach and tumor location in skull base surgery. Head Neck 2013; 35 (4) 493-499
• 13 Lombardi D, Tomenzoli D, Buttà L , et al. Limitations and complications of endoscopic surgery for treatment for sinonasal inverted papilloma: a reassessment after 212 cases. Head Neck 2011; 33 (8) 1154-1161
• 14 Zemmoura I, Ben Ismail M, Travers N, Jan M, François P. Maxillary surgical seeding of a clival chordoma. Br J Neurosurg 2012; 26 (1) 102-103
• 15 Boyette JR, Seibert JW, Fan CY, Stack Jr BC. The etiology of recurrent chordoma presenting as a neck mass: metastasis vs. surgical pathway seeding. Ear Nose Throat J 2008; 87 (2) 106-109