Contemporary management of clival chordomas

Campbell, Raewyn; Prevedello, Daniel M.; Filho, Leo F. Ditzel; Otto, Brad; Carrau, Ricardo L.

doi:10.1097/moo.0000000000000140

Cited by 35 publications

(25 citation statements)

References 94 publications

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“…Our understanding of the present consensus is that most specialists agree on three points: (1) “safe” microsurgery is indicated for all patients, although small, histopathologically verified tumours can be treated with only stereotactic radiosurgery (SRS) [ 19 , 26 , 27 , 53 ], (2) despite extensive surgical removal and adjuvant treatment, tumour recurrence/progression is common, and (3) chordomas require adjuvant treatment following initial therapy, often in close proximity to the index surgery [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary management of clival chordomas; long-term clinical outcome in a single-institution consecutive series

et al. 2017

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ObjectiveChordomas of the skull base have high recurrence rates even after radical resection and adjuvant radiotherapy. We evaluate the long-term clinical outcome using multidisciplinary management in the treatment of clival chordomas.MethodsBetween 1984 and 2015, 22 patients diagnosed with an intracranial chordoma were treated at the Karolinska University Hospital, Stockholm, Sweden. Sixteen of 22 were treated with Gamma Knife radiosurgery (GKRS) for tumour residual or progression during the disease course. Seven of 22 received adjuvant fractionated radiotherapy and 5 of these also received proton beam radiotherapy.ResultsFifteen of 22 (68%) patients were alive at follow-up after a median of 80 months (range 22–370 months) from the time of diagnosis. Six were considered disease free after >10-year follow-up. The median tumour volume at the time of GKRS was 4.7 cm3, range 0.8–24.3 cm3. Median prescription dose was 16 Gy, range 12–20 Gy to the 40–50% isodose curve. Five patients received a second treatment with GKRS while one received three treatments. After GKRS patients were followed with serial imaging for a median of 34 months (range 6–180 months). Four of 16 patients treated with GKRS were in need of a salvage microsurgical procedure compared to 5/7 treated with conventional or proton therapy.ConclusionAfter surgery, 7/22 patients received conventional and/or photon therapy, while 15/22 were treated with GKRS for tumour residual or followed with serial imaging with GKRS as needed upon tumour progression. With this multidisciplinary management, 5- and 10-year survivals of 82% and 50% were achieved, respectively.

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Section: Introductionmentioning

confidence: 99%

Multidisciplinary management of clival chordomas; long-term clinical outcome in a single-institution consecutive series

et al. 2017

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“…The majority of chordomas involve the sacrococcygeal region but the spheno‐occipital region is implicated in 25%‐35% of cases . The differential diagnosis of these lesions includes chondrosarcoma and ecchordosis physaliphora, a benign lesion also of notochord origin . Definitive diagnosis of clival chordomas requires histological evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…Although several stains are used in the diagnostic process, brachyury has become a mainstay of pathological evaluation of these lesions (Figure ). Brachyury is a transcription factor in notochord development and has a 98% sensitivity and 100% specificity for the diagnosis of chordomas when combined with cytokeratin staining . In addition to its diagnostic utility, brachyury has been targeted in emerging immunotherapy for unresectable chordomas .…”

Section: Discussionmentioning

confidence: 99%

A novel transpalatal‐transoral robotic surgery approach to clival chordomas extending into the nasopharynx

et al. 2019

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Background In this paper, we present three cases where a novel transoral robotic surgery (TORS) approach was used to resect clival chordomas extending into the nasopharynx to demonstrate progress in the evolution of robotic surgery of the head and neck. Methods The first patient had a history of metastatic chordoma resection and presented with trismus and dysphagia; the second and third patients had first presentation with nasal congestion and facial numbness, respectively. All patients underwent a novel transpalatal‐TORS resection. Results Total resection was achieved in the first patient and near‐total resections were achieved in the second and third patients. All patients had minimal postoperative morbidity and no patients experienced significant adverse events. Conclusion Clival chordomas are rare, potentially dangerous lesions with a high rate of recurrence. The novel transpalatal‐TORS approach to these tumors presented in this series represents advancement in the realm of minimally invasive surgery of the head and neck. This approach offers patients total or near‐total control of these lesions with minimal intraoperative and postoperative side effects.

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“…Chordomas are diagnosed on contrast-enhanced MRI and bone CT, with an intermediate-low signal on T1- and a high signal on T2-weighted images, and a moderate to high contrast enhancement. Bone CT is useful for ascertaining bone erosion due to the lytic nature of the lesion 1415 .…”

Section: Introductionmentioning

confidence: 99%

Surgery of the lateral skull base: a 50-year endeavour

Zanoletti¹,

Mazzoni²,

Martini³

et al. 2019

Acta Otorhinolaryngol Ital

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SUMMARY Disregarding the widely used division of skull base into anterior and lateral, since the skull base should be conceived as a single anatomic structure, it was to our convenience to group all those approaches that run from the antero-lateral, pure lateral and postero-lateral side of the skull base as “Surgery of the lateral skull base”. “50 years of endeavour” points to the great effort which has been made over the last decades, when more and more difficult surgeries were performed by reducing morbidity. The principle of lateral skull base surgery, “remove skull base bone to approach the base itself and the adjacent sites of the endo-esocranium”, was then combined with function preservation and with tailoring surgery to the pathology. The concept that histology dictates the extent of resection, balancing the intrinsic morbidity of each approach was the object of the first section of the present report. The main surgical approaches were described in the second section and were conceived not as a step-by-step description of technique, but as the highlighthening of the surgical principles. The third section was centered on open issues related to the tumor and its treatment. The topic of vestibular schwannoma was investigated with the current debate on observation, hearing preservation surgery, hearing rehabilitation, radiotherapy and the recent efforts to detect biological markers able to predict tumor growth. Jugular foramen paragangliomas were treated in the frame of radical or partial surgery, radiotherapy, partial “tailored” surgery and observation. Surgery on meningioma was debated from the point of view of the neurosurgeon and of the otologist. Endolymphatic sac tumors and malignant tumors of the external auditory canal were also treated, as well as chordomas, chondrosarcomas and petrous bone cholesteatomas. Finally, the fourth section focused on free-choice topics which were assigned to aknowledged experts. The aim of this work was attempting to report the state of the art of the lateral skull base surgery after 50 years of hard work and, above all, to raise questions on those issues which still need an answer, as to allow progress in knowledge through sharing of various experiences. At the end of the reading, if more doubts remain rather than certainties, the aim of this work will probably be achieved.

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Contemporary management of clival chordomas

Cited by 35 publications

References 94 publications

Multidisciplinary management of clival chordomas; long-term clinical outcome in a single-institution consecutive series

Multidisciplinary management of clival chordomas; long-term clinical outcome in a single-institution consecutive series

A novel transpalatal‐transoral robotic surgery approach to clival chordomas extending into the nasopharynx

Surgery of the lateral skull base: a 50-year endeavour

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