Surgical approaches and strategies for skull base chordomas

Tamaki, Norihiko; Nagashima, Tatsuya; Ehara, Kazumasa; Motooka, Yasuhiko; Barua, Kanak Kanti

doi:10.3171/foc.2001.10.3.10

Cited by 41 publications

(21 citation statements)

References 42 publications

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“…None of these approaches will be described as they have already been the subject of numerous other publications. 2,3,11,18,27,30,34,35,41,49,[53][54][55][56][57]61,63 Among these 43 patients, 19 (44%) were female, and the median age of the entire group was 43.7 years. The median duration of symptoms was 6.8 months.…”

Section: Patients and Surgical Approachesmentioning

confidence: 99%

“…1,61 The choice of surgical route depends on a number of factors including the location and main extension of the tumor as well as the experience and comfort level of the surgeon. Because clival tumors are generally midline tumors that displace the neuraxis dorsally or dorsolaterally, anterior midline approaches, such as the transbasal extended frontal, 55 transsphenoidal, 9,40,41 transmaxillary, 34 midfacial degloving, 49 and transoral, 11 are generally preferred.…”

Section: Current State Of the Art In Surgical Approaches For Clival Lmentioning

confidence: 99%

“…However, lateral extension of clival lesions to the parasellar region, petrous bone, and occipital condyle requires a lateral approach to the clivus that can be combined with an anterior approach. 3,44,[55][56][57]61 Chordomas are by far the most common tumors arising from the clivus. 38,43 Emanating from remnants of the notochord, chordomas exhibit slow expansile growth with infiltration and destruction of bone as well as compression of adjacent neurovascular structures.…”

Section: Current State Of the Art In Surgical Approaches For Clival Lmentioning

confidence: 99%

“…6,60 The lateral approaches comprise the pterional, frontoorbitozygomatic, 61 infratemporal, 54,57 transpetrosal, 3,30,44,53 combined suprainfratentorial retrosigmoid, 25,63 and far lateral suboccipital. 2,56 For larger tumors, combined and staged procedures have also been proposed.…”

mentioning

confidence: 99%

“…2,56 For larger tumors, combined and staged procedures have also been proposed. 61 The increasing use of the endoscope in transsphenoidal surgery 4,14,15,37 and its application to other lesions of the skull base have opened another chapter in skull base surgery. The versatility of this minimally invasive technique has widened the boundaries of the pituitary fossa to include regions far beyond the sellar floor.…”

mentioning

confidence: 99%

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Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach

Carrabba¹,

Dehdashti²,

Gentili³

2008

FOC

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Object Clival lesions pose significant challenges with regard to their surgical management. The expanded endoscopic endonasal (EEE) approach is a promising minimally invasive technique for lesions of the central skull base. The authors' aim in the current paper was to discuss the surgical treatment of clival lesions and to present the technical details, indications, and limitations of the EEE approach. Data from a recent endoscopically treated group will be compared with findings in a previous cohort of patients treated via classic open anterior and lateral approaches. Methods Since June 2005, 17 patients with clival lesions underwent surgery via the EEE approach. Suitable candidates were chosen according to lesion characteristics, clinical parameters, and surgical goals. Neurological outcomes, Karnofsky Performance Scale scores, the extent of lesion resection, and complications were evaluated among these patients. Eighteen percent of the patients in the endoscopic group presented with recurrent disease. Another series of 43 patients, who had undergone resection of clival lesions via an anterior (rhinotomy, maxillectomy, microscopic transsphenoidal surgery, or transoral surgery) or lateral (pterional, frontoorbitozygomatic, or combined suprainfratentorial retrosigmoid) approach, was similarly reviewed. Twenty-three of these patients (53%) presented with recurrent disease and thus had undergone prior surgery. Results Following the EEE approach, 11 (79%) of 14 patients who had presented with neurological symptoms experienced improvement, and gross-total resection was achieved in 59% of the patients and subtotal removal in 41%. Complications included CSF leakage (24%), tension pneumocephalus (6%), and intracranial hematoma (6%). The patient with the latter complication was the only one who experienced permanent neurological worsening. In the open resection group, neurological worsening occurred in 33% of the patients (14 of 43). Total and grosstotal removals were achieved in 84% of patients and subtotal removal in 14%. Conclusions The EEE approach has been shown to be a safe and effective technique for the resection of clival lesions with limited lateral extension. The choice of surgical approach must be tailored according to both patient and tumor characteristics. Although the 2 patient series featured in this paper are not comparable—because of a selection bias—higher rates of neurological morbidity and total and gross-total resections were observed in the open resection group. Given the long survival of some patients, the EEE approach should be favored whenever reasonable.