Mayo Clinic Clival Chordoma Case Series: Impact of Endoscopic Training on Clinical Care

Abstract

The management of clival chordoma in our group shifted around 2013 to mostly endoscopic, and proton beam was introduced for our multidisciplinary team. Consecutive patients who had surgical resection from 1987 to 2021 were reviewed. A total of 58 patients (39 patients after 2013) were analyzed. The mean tumor size was 3.7 cm, and the most common location was the upper clivus (43%). Compared to before 2013, after 2013, the endoscopic endonasal approach was more common (90%, p < 0.001), and more gross or near total resections (64%, p = 0.002) were attained. Ten cases (17%) were revision surgeries referred from elsewhere, and three cases (5%) underwent additional surgery elsewhere before adjuvant radiation. The postoperative cerebrospinal fluid leak occurred in 7%. Post-operative new cranial nerve deficits occurred in 32% before 2013, compared to 2.6% after 2013 (p = 0.004). For cases before 2013, 10 patients (53%) recurred during the median follow-up of 144 months (mean, 142 months), whereas for cases after 2013, seven patients (18%) recurred with a median follow-up of 35 months (mean, 42 months). 5-year progression-free survival was 58%, and 5-year overall survival was 87%. A specialized multidisciplinary team improved the resection rate compared to a historical cohort with an excellent morbidity profile.

Long-term outcome of primary clival chordomas: a single-center retrospective study with an emphasis on the timing of recurrences based on the primary treatment

“…5,[7][8][9][10] In the current study, data from some groups were missing due to insufficient follow-up length. In our facility, the EOR got better in the later years; 22 therefore, those who underwent GTR did not receive as long a follow-up period as those who underwent STR or biopsy.…”

The impact of obesity on rates of post-operative CSF leak following endoscopic skull base surgery: results from a prospective international multi-centre cohort study

“…Tumours of the sellar region are now primarily approached via an endoscopic endonasal transsphenoidal approach (TSA), and more recently the indications for endoscopic endonasal surgery have broadened to include extrasellar lesions of the ventral skull base, which can be resected via an expanded endonasal approach (EEA) (1)(2)(3)(4). Although these less invasive approaches are demonstrably associated with improved neurological outcomes following surgery when compared to more traditional transcranial approaches, the significant shortcoming associated with their use is the occurrence of post-operative CSF leak (5)(6)(7)(8)(9).…”