[Multidisciplinary management of skull base and craniocervical chordoma]

Craniocervical chordomas often only become manifest in an advanced stage. The localisation and locally-destructive growth require a multidisciplinary diagnostic and therapeutic concept early on. The goal of the present study was to present a reproducible strategy for quality assurance.

We retrospectively analysed the hospital records of 10 consecutive patients (4 women and 6 men) whom we had treated during a period of 7 years.

The first step in therapy was tumour resection in 9 cases. One patient initially underwent stereotactic radiation. Postoperative radiation was not included a priori, but discussed individually depending on the degree of resection, the patient's age and physical condition. After an average 5 years follow up, 100 % of patients are alive. In all patients, tumour control was achieved.

The prognosis for patients with chordomas of the skull base has improved considerably in recent years. New technologies like intraoperative navigation and improved radiation procedures have contributed to this improvement. The basis for treatment remains, however, the greatest possible surgical exstirpation with minimal surgical morbidity. Special attention should be paid in this connection to the stability of the cervical spine and the craniocervical transition border. In advanced tumour growth, complete resection is often not possible. Proton and heavy-ion radiation are promising new forms of therapy, which can also be applied after conventional radiation has been performed. A directed multidisciplinary procedure guarantees years of survival with good quality of life in many cases.