Outcome of Clival Chordomas After Skull Base Surgeries With Mean Follow-Up of 10 Years

Abstract

: Background and Objective : Skull base chordomas are clinically malignant because of the difficulty of total removal, high recurrence rate, and occasional drop metastasis. Although aggressive surgical resection and postoperative radiation have been recommended, the long -term outcome remains unsatisfactory. Methods : From 1992 to 2011, we treated 24 patients with skull base chordoma using aggressive surgical removal as a principal strategy. Skull base approaches were selected according to tumor extension to remove the tumor and surrounding bone as completely as possible. After surgery, all patients were closely observed with MRI to find small and localized recurrent tumors, which were treated with gamma -knife radiosurgery or surgical resection. The mean postoperative follow -up duration was 10.2 years (range, 1 -17.2 years). Results : The 5 -, 10 -, and 15 -year overall survival rates were 86%, 72%, and 72%, respectively. The 5 -and 10 -year progression -free survival rates were 47% and 35%, respectively. Tumor extension to the brainstem and partial tumor removal were the factors related to poor survival. Conclusions : Our results suggest that aggressive surgical removal improves the long -term outcome of patients with skull base chordoma. We would like to emphasize that skull base chordomas should be aggressively removed using various skull base approaches.

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

“…Chordomas respond poorly to conventional radiotherapy [ 36 , 62 ], and therefore linear accelerator (LINAC)-based fractionated stereotactic radiotherapy (FSRT) [ 10 ] intensity-modulated radiation therapy (IMRT) [ 45 ] and proton-beam radiotherapy [ 2 – 4 , 20 , 21 , 37 , 39 , 40 ] have been used. Gamma Knife radiosurgery (GKRS) has a potential to control tumours with poor radiation sensitivity and has, accordingly, also been reported to offer an effect on chordomas [ 19 , 22 , 26 , 27 , 33 , 38 , 53 ].…”

“…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 ].…”

Endoscopic endonasal transclival removal of tumors of the clivus and anterior region of the posterior cranial fossa (results of surgical treatment of 140 patients)

“…With the development of modern endoscopic techniques, more and more studies have started to emerge in the world literature regarding the experience of surgical removal of centrally located tumors of the base of the skull using the endoscopic transclival approach [10][11][12][13][14][15][16][17][18][19][20]. According to Sanmillan et al [15], the results of using the endoscopic transclival approach for the removal of central tumors of the skull base are comparable to the results of using various transcranial approaches, and in a number of cases, they are clearly superior.…”

“…using the endoscopic transclival approach, totals 140 patients. According to the leading experts in the field, the number of such surgeries to date is as follows: Aldo Stamm [10], 23 surgeries; Vellutini Ede et al [12], 38 surgeries; Tamura et al [13], 24 surgeries; Al-Mefty et al [14], 43 surgeries; Koutourousiou et al [11], 60 surgeries; and Sen et al [21], 71 surgeries.…”

Extended endoscopic endonasal posterior (transclival) approach to tumors of the clival region and ventral posterior cranial fossa. Part 3. Analysis of surgical treatment outcomes in 127 patients

“…С развитием современной эндоскопической техники в мировой литературе появились сведения из ведущих мировых клиник об опыте хирургического удаления срединно расположенных опухолей основания черепа с использованием эндоскопического транскливального доступа (табл. 1) [11][12][13][14][15]. По мнению J. Sanmillan и соавт.…”