Surgery for chordomas of the craniocervical junction: lessons learned

We investigated the outcomes of chordomas of the craniocervical junction after surgery including complication rates, survival, associated adverse factors, and quality of life. We present our results and lessons learned from surgeries performed between 1982 and 2007 in the National Hospital for Neurology and Neurosurgery, London. Patients undergoing transfacial, transoral, and transmandibular surgeries for chordomas of the craniocervical junction were enrolled in this study. Chi-square, Fisher exact tests, and log-rank survival analysis were used to determine significant adverse factors (p < 0.05). In our series, 80 operations were performed in 66 patients; 37 patients were male, 29 female. Age at presentation was commonly 40 to 60 years. After surgery, pain was the same or better in 98.1% of patients; 18.6% of patients presented with myelopathy, of whom 27.8% improved, 44.4% remained unchanged, 27.8% deteriorated. Complication rates were as follows: velopharyngeal incompetence 2%, dysphagia 3%, failure of fixation 2%, sepsis 5%, meningitis 5%, wound infection 3%, chest infection 6%, cerebrospinal fluid leakage 5%. Five- and 10-year overall survivals were 62% and 39%, respectively. Complication rates for these major operations can be minimized in specialist centers, with careful patient selection and counseling. Quality of life and survival are significantly improved after surgery.