Surgical results of an endoscopic endonasal approach for clival chordomas

Abstract

The endoscopic endonasal transclival approach allows an appropriate extent of resection with acceptable complication rates in comparison with other approaches. In our series, the accomplishment of gross total removal was associated with the relationship between the tumors and surrounding structures, such as the pituitary gland and the cavernous portion of the intracranial carotid artery (ICA).

Endoscopic Endonasal Transclival Approaches: Case Series and Outcomes for Different Clival Regions

“…14,15,18 There was 1 intraoperative ICA injury out of 55 procedures, which was consistent with previously reported rates of up to 2%. 10 This 43year-old woman with a history of neurofibromatosis type 1 reported a remote history of craniotomy with radiation therapy for a right-sided brain tumor. Medical records were no longer available.…”

“…Extended endoscopic endonasal approaches to the clivus have been increasingly described by several groups, particularly as an option for the surgical management of malignancies. [4][5][6][7][8][9][10][13][14][15] Our postoperative to intraoperative CSF leak rate was 6.7% for all cases and 25% among malignancies. This rate is similar to previously reported rates of up to 33% for clival chordomas.…”

“…This rate is similar to previously reported rates of up to 33% for clival chordomas. [6][7][8]10,19,20 GTR was achieved in 100% of malignant cases approached with curative intent. This included two clival chordomas.…”

“…This paradigm shift has been facilitated by advances in rigid endoscopic instrumentation, neuronavigation, and the development of a collaborative model for skull base surgery involving both otolaryngologists and neurosurgeons. Initial outcomes data from small case series for these approaches have been promising, particularly for the treatment of clival chordomas, [6][7][8][9][10][11][12] with several reports describing the feasibility and limitations of the extended endoscopic endonasal transclival approach with respect to regional anatomy. 4,9,11,[13][14][15] Because so few cases of endoscopic endonasal transclival approaches have been published, the goal of this study is to continue to investigate this surgical technique's safety and efficacy.…”

Combined Transnasal and Transcranial Removal of a Giant Clival Chordoma

“…The transnasal and transclival approach is for many chordomas a feasible and safe surgical access. [1][2][3] Larger tumors, especially those with extensive intradural retrochiasmal and/ or deep cervical expansion, are most often resected by open craniotomy. A large number of transcranial approaches have been described in the last decade.…”