A refined treatment strategy for skull base chordoma: A protocol and management algorithm

Skull base chordomas (SBCs) are rare and challenging tumors due to their midline location and invasive behavior, requiring a multidisciplinary approach that integrates advancements in surgical techniques, radiation therapy, and emerging therapies. This paper synthesizes clinical experience with 307 surgical resections performed on 197 patients to propose a cohesive treatment paradigm for SBCs. The endoscopic endonasal approach (EEA) is highlighted as a cornerstone of surgical management, with key considerations for postoperative radiation strategies and novel therapeutic options, such as immunotherapy, discussed. By emphasizing the importance of maximal safe resection, individualized treatment planning, and ongoing innovation, this paper aims to provide a framework for optimizing outcomes in patients with SBCs while highlighting areas for future research in this complex field.