A nomogram to predict the progression-free survival of clival chordoma

Zhai, Yixuan; Bai, Jiwei; Li, Mingxuan; Wang, Shuai; Li, Chuzhong; Wei, Xinting; Zhang, Yazhou

doi:10.3171/2019.10.jns192414

Cited by 18 publications

(25 citation statements)

References 22 publications

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“…We found no signi cant difference, which is consistent with several studies [32,2]. Several previous studies showed that dural penetration [37,7] and age [29,5] were associated with long-term outcomes, and we demonstrated that they were not independent risk factors after multivariate analysis [23,36].…”

Section: Other Risk Factors For Outcomesupporting

confidence: 92%

“…To the best of our knowledge, this is the largest series of SBCs surgically treated by single surgical team, and we found that surgery should be the initial treatment for primary SBCs. GTR is the surgical goal and should be applied in both primary and recurrent SBCs [36]. History of surgery, larger tumor volume, and tumor location (lower clivus, extension from the midline to the paramedian region) are independent risk factors for GTR.…”

Section: Discussionmentioning

confidence: 99%

“…The resection rate strongly in uences CSS and PFS [9,38,36]. Maximum resection was traditionally recommended with the goal of marginal resection [24,25,30].…”

Section: Resection Rate and Outcomementioning

confidence: 99%

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Long Follow-up Surgical Results in 284 Cases of Clival Chordomas: The Risk Factors for Outcome and Tumor Recurrence

bai

Shi

et al. 2021

Preprint

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OBJECTIVE: Skull-base chordoma (SBC) is rare and one of the most challenging diseases to treat. We aimed to assess the optimal timing of adjuvant radiation therapy (RT) and evaluate the factors that influence resection and long-term outcomes.METHODS: In total, 284 patients with 382 surgeries were enrolled in this retrospective study. Postsurgically, 64 patients underwent RT before recurrence (pre-recurrence RT), and 47 patients underwent RT after recurrence. During the first attempt to achieve gross-total resection (GTR), when the entire tumor was resected, 268 patients were treated with an endoscopic midline approach, and 16 patients were treated with microscopic lateral approaches. Factors associated with the success of GTR were identified using c2 and logistic regression analyses. Risk factors associated with chordoma-specific survival (CSS) and progression-free survival (PFS) were evaluated with the Cox proportional hazards model.RESULTS: In total, 74.6% of tumors were marginally resected [GTR (40.1%); near-total resection (34.5%)]. History of surgery, large tumor volumes and tumor locations in the lower clivus were associated with a lower GTR rate. The mean follow-up period was 43.9 months. At last follow-up, 181 (63.7%) patients were alive. RT history, histologic subtype (dedifferentiated and sarcomatoid), non-GTR, no postsurgical RT, and the presence of metastasis were associated with poorer CSS. Patients with pre-recurrence RT had the longest PFS and CSS, while patients without postsurgical RT had the worst outcome.CONCLUSION: GTR is the goal of initial surgical treatment. Pre-recurrence RT would improve outcome regardless of GTR.

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Section: Other Risk Factors For Outcomesupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Long Follow-up Surgical Results in 284 Cases of Clival Chordomas: The Risk Factors for Outcome and Tumor Recurrence

bai

Shi

et al. 2021

Preprint

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“…The use of this sequence has resulted in up to a threefold improvement in contrast-to-noise ratio when compared to T1 and T2/fluid-attenuated inversion recovery (FLAIR) MRI sequences [ 60 ]. Hybrid quantitative susceptibility mapping has also been used as a method to visualize the GPi and, similar to FGATIR MRI, it has shown reproducibility across centers [ 61 ]. When utilizing imaging for direct targeting, attention should be directed not only to a target point, but also to the position of the DBS electrode array relative to the optimal target volume.…”

Section: Targeting and Intraoperative Physiology Of The Gpi: Pearls And Pitfallsmentioning

confidence: 99%

“…Our DBS team has implanted over 850 GPi DBS leads over the past 18 years, and many of the previously mentioned aspects of this section of the commentary pertain to observations and insights based on our cumulative experience [ 59 , 61 , 63 ]. Within the sensorimotor territory, positioning the DBS electrode 3 mm lateral to the medial internal capsule–GPi border, and 3–5 mm anterior to the posterior internal capsule–GPi border seems to be, in our experience, the optimal site for chronic therapeutic stimulation when using omnidirectional ring electrodes.…”

Section: Targeting and Intraoperative Physiology Of The Gpi: Pearls And Pitfallsmentioning

confidence: 99%

Globus Pallidus Internus (GPi) Deep Brain Stimulation for Parkinson’s Disease: Expert Review and Commentary

Wong

Tsuboi

et al. 2020

Neurol Ther

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Introduction The globus pallidus internus (GPi) region has evolved as a potential target for deep brain stimulation (DBS) in Parkinson’s disease (PD). DBS of the GPi (GPi DBS) is an established, safe and effective method for addressing many of the motor symptoms associated with advanced PD. It is important that clinicians fully understand this target when considering GPi DBS for individual patients. Methods The literature on GPi DBS in PD has been comprehensively reviewed, including the anatomy, physiology and potential pitfalls that may be encountered during surgical targeting and post-operative management. Here, we review and address the implications of lead location on GPi DBS outcomes. Additionally, we provide a summary of randomized controlled clinical trials conducted on DBS in PD, together with expert commentary on potential applications of the GPi as target. Finally, we highlight future technologies that will likely impact GPi DBS, including closed-loop adaptive approaches (e.g. sensing-stimulating capabilities), advanced methods for image-based targeting and advances in DBS programming, including directional leads and pulse shaping. Results There are important disease characteristics and factors to consider prior to selecting the GPi as the DBS target of PD surgery. Prior to and during implantation of the leads it is critical to consider the neuroanatomy, which can be defined through the combination of image-based targeting and intraoperative microelectrode recording strategies. There is an increasing body of literature on GPi DBS in patients with PD suggesting both short- and long-term benefits. Understanding the GPi target can be useful in choosing between the subthalamic (STN), GPi and ventralis intermedius nucleus as lead locations to address the motor symptoms and complications of PD. Conclusion GPi DBS can be effectively used in select cases of PD. As the ongoing DBS target debate continues (GPi vs. STN as DBS target), clinicians should keep in mind that GPi DBS has been shown to be an effective treatment strategy for a variety of symptoms, including bradykinesia, rigidity and tremor control. GPi DBS also has an important, direct anti-dyskinetic effect. GPi DBS is easier to program in the outpatient setting and will allow for more flexibility in medication adjustments (e.g. levodopa). Emerging technologies, including GPi closed-loop systems, advanced tractography-based targeting and enhanced programming strategies, will likely be future areas of GPi DBS expansion. We conclude that although the GPi as DBS target may not be appropriate for all PD patients, it has specific clinical advantages. Electronic supplementary material The online version of this article (10.1007/s40120-020-00220-5) contains supplementary material, which is available to authorized users.

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