Endoscopic surgery of skull base chordomas

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• Clival chordomas are rare bone tumors requiring complex surgical management.
• Minimally invasive endoscopic endonasal techniques are emerging as alternatives to traditional open approaches.
• Assessing clinical experience with these techniques is crucial for refining treatment strategies.

Purpose of the Study:

• To evaluate the clinical outcomes of endoscopic endonasal resection for midline intracranial pathology, specifically clival chordomas.
• To determine the safety and efficacy of minimally invasive surgical techniques in this patient cohort.
• To compare resection rates and complications between primary and revision surgeries.

Main Methods:

• Retrospective chart review of 14 patients undergoing endoscopic endonasal resection of clival chordomas across two centers.
• Assessment of intraoperative findings including macroscopic resection rate, tumor size, and operative complications.
• Evaluation of clinical outcomes such as residual disease, postoperative complications, recurrence, and mortality.

Main Results:

• Macroscopic resection rates were 71% for primary and 29% for revision surgeries.
• The overall cerebrospinal fluid (CSF) leak rate was 21%, reduced to 0% with the use of a nasoseptal flap.
• Late recurrence occurred in two patients, with an overall mortality rate of 14%.

Conclusions:

• Endoscopic resection is a safe and viable alternative for clival chordomas compared to open surgery.
• The nasoseptal flap is effective for achieving watertight skull base closure.
• Primary surgical intervention offers the highest probability of achieving a total tumor resection.