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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
 

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