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A refined treatment strategy for skull base chordoma: A protocol and management algorithm
Zachary C Gersey1,2, Hussam Abou-Al-Shaar1, David T Fernandes Cabral1
1Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Neurosurgical Review
|October 22, 2025
Summary
Skull base chordomas (SBCs) are rare tumors requiring a multidisciplinary approach. This study synthesizes surgical experience to propose an optimized treatment paradigm for SBCs, integrating surgery, radiation, and novel therapies.
Area of Science:
- Neurosurgery
- Oncology
- Otolaryngology
Background:
- Skull base chordomas (SBCs) are rare, invasive midline tumors.
- Treatment necessitates a multidisciplinary strategy combining surgery, radiation, and emerging therapies.
Purpose of the Study:
- To synthesize clinical experience from 307 resections in 197 patients.
- To propose a cohesive and optimized treatment paradigm for SBCs.
- To highlight the role of the endoscopic endonasal approach (EEA) and novel therapies.
Main Methods:
- Retrospective analysis of 307 surgical resections in 197 patients with SBCs.
- Review of surgical techniques, focusing on the endoscopic endonasal approach (EEA).
- Discussion of postoperative radiation strategies and emerging treatments like immunotherapy.
Main Results:
- The endoscopic endonasal approach (EEA) is a cornerstone for surgical management of SBCs.
- Maximal safe resection and individualized treatment planning are crucial for optimal outcomes.
- Integration of radiation and novel therapies, including immunotherapy, is discussed.
Conclusions:
- A cohesive treatment paradigm for SBCs should integrate maximal safe resection via EEA, tailored radiation, and novel therapeutic options.
- Individualized treatment planning and continuous innovation are key to improving patient outcomes.
- Further research is needed to advance the management of these complex tumors.
