Endoscopic endonasal approach for loco-regional recurrent clivus chordomas

Zoli, Matteo; Guaraldi, Federica; Gori, Davide; Cavicchi, Riccardo; Sollini, Giacomo; Asioli, Sofia; Faustini‐Fustini, Marco; Agati, R.; Lodi, Raffaele; Tonon, Caterina; Pasquini, Ernesto; Mazzatenta, Diego

doi:10.1016/j.bas.2022.100918

Cited by 1 publication

(15 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We have also observed that the prognostic factors, affecting the tumor resection rate in elderly patients, are the same that we had already observed in the general population of CC, namely the primary surgery (p < 0.001) and the size of the tumor (p:0.004) 1,11,12 . The better surgical outcome that we have observed for naive patients, confirms that the first surgery has the better odds to achieve the GTR, while the followings are usually negatively affected by the presence of the surgical scars and post-operative or postactinic fibrous tissue 10,11 . In elderly patients, we have not observed that resection rate is related to tumor location in the clivus, or its intradural extension, as reported for general CC population probably for low numerosity of the study sample.…”

Section: Discussionsupporting

confidence: 72%

“…Comparing the GTR rate of elderly population with younger patients, we found no statistical relevant differences. We argue that this could be due both to the good tolerability of such approach (which allows the surgeon to extend as much as possible the tumor resection also in this cohort of patients), and to a careful multidisciplinary patients selection 3,[5][6][7][8][9][10][11][12][13][14][15] . We have also observed that the prognostic factors, affecting the tumor resection rate in elderly patients, are the same that we had already observed in the general population of CC, namely the primary surgery (p < 0.001) and the size of the tumor (p:0.004) 1,11,12 .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, infective complications were more frequent than in younger patients, with 1 (2.9%) case of meningitis, 1 (2.9%) of pneumonia and 2 (5.8%) of urinary infection, treated with antibiotic therapies and resolved with no consequences or subsequent neurological deficit. Indeed, one of the advantages of EEA is its minimally invasiveness with prompt patients recovery 3,5,[9][10][11][13][14][15] . In comparison to other transcranial or transfacial (including the transoral for the lower clivus) approaches for the clival region, EEA would allow patients to restore spontaneous breathing immediately after awakening from anesthesia and the oral feeding after 6 hours from surgery, usually not needing of a preventive tracheostomy or prolonged intubation 15,16 .…”

Section: Discussionmentioning

confidence: 99%

“…Our surgical technique has been already described elsewhere 10,11 . Surgical complications were retrieved from medical records.…”

Section: Methodsmentioning

confidence: 99%

“…However, the impact of comorbidities and of the fragilities typical of the elderly population on the current treatment paradigm for CC has been poorly considered in literature, as well as the results and the risk of complications of the endoscopic endonasal approach (EEA). Indeed, most of the studies are focusing on adult patients with CC with a mean age between 40 and 58 years, not specifically considering the elderly patients 10 . Moreover, also the clinical manifestations of this subgroup of CC, their most common symptoms, biological behavior or response to adjuvant treatment have not been specifically analyzed.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Endoscopic Endonasal Approach for Clival Chordomas in Elderly Patients: Clinical Characteristics, Patient Outcome, and Recurrence Rate

Zoli,

Carretta,

Rustici

et al. 2023

J Neurol Surg B Skull Base

Self Cite

View full text Add to dashboard Cite

Introduction. The endoscopic endonasal route has demonstrated to be the approach of choice for a large majority of clival chordomas (CC). However, its results in elderly patients are under-evaluated in literature. Aim of this study is to assess the surgical outcome for these patients, determining the factors associated with a larger tumor resection in this population. Materials and Methods. Our institutional database of CC has been retrospectively reviewed, to identify all cases over 65 years old, operated through an endoscopic endonasal approach (EEA). Pre-operative clinical and radiological features were considered, as well as surgical results, morbidity and patients outcome at follow-up. Results. Out of our series of 143 endoscopic surgical procedures for CC, 34 (23.8%) were in patients older than 65 and 10 in older than 75 (7.0%). Gross tumor removal was achieved in 22 cases (64.7%). Complications consisted in 2 (5.9%) post-operative CSF leaks, 1 (2.9%) meningitis, 1 (2.9%) permanent CN VI palsy, 1 (2.9%) pneumonia and 2 (5.9%) urinary infections. In 39.1% of cases, the pre-operative ophthalmoplegia improved or resolved. Twenty-seven patients (79.4%) underwent radiation therapy. At follow-up (37.7 ± 44.9 months), 13 patients (38.2%) showed a recurrence/progression and 13 (38.3%) deceased. Conclusion. EEA can be a useful approach in elderlies, balancing the large tumor removal with an acceptable morbidity rate, even if higher than for general CC population. However, patients selection remains crucial. A multidisciplinary evaluation is important to assess not only their medical conditions, but also their social and familiar conditions.

show abstract