Endoscopic endonasal approach in the management of skull base chordomas—clinical experience on a large series, technique, outcome, and pitfalls View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2013-11-19

AUTHORS

Salvatore Chibbaro, Jan Frederick Cornelius, Sebastien Froelich, Leonardo Tigan, Pierre Kehrli, Christian Debry, Antonio Romano, Philippe Herman, Bernard George, Damien Bresson

ABSTRACT

Skull base chordomas represent very interesting neoplasms, due to their rarity, biological behavior, and resistance to treatment. Their management is very challenging. Recently, the use of a natural corridor, through the nose and the sphenoid sinus, improved morbidity and mortality allowing also for excellent removal rates. Prospective analysis of 54 patients harboring a skull base chordoma that were managed by extended endonasal endoscopic approach (EEA). Among the 54 patients treated (during a 72 months period), 21 were women and 33 men, undergoing 58 procedures. Twenty-two cases (40 %) were recurrent and 32 (60 %) newly diagnosed chordomas. Among the 32 newly diagnosed chordomas, a gross total resection was achieved in 28 cases (88 %), a near total (>95 % of tumor) in 2 cases (6 %), a partial (>50 % of tumor) in 2 cases (6 %). Among the 22 recurrent chordomas, resection was complete in 7 cases (30 %), near total in 7 (30 %), and partial in 8 (40 %). The global gross total resection rate was 65 % (35/54 cases). Four patients (11 %) recurred and 4 (11 %) progressed within a mean follow-up of 34 months (range 12–84 months). Four patients (11 %) were re-operated; one patient (1.8 %) died due to disease progression, one patient (1.8 %) died 2 weeks after surgery due to a massive bleeding from an ICA pseudo aneurysm. CSF leakage occurred in four patients (8 %), and meningitis in eight cases (14 %). No new permanent neurological deficit occurred. The EEA management of skull base chordomas requires a long and gradual learning curve that once acquired offers the possibility of either similar or better resection rates as compared to traditional approaches while morbidity is improved. More... »

PAGES

217-225

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10143-013-0503-9

DOI

http://dx.doi.org/10.1007/s10143-013-0503-9

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1048792295

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24249430


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75 nose
76 outcomes
77 patients
78 permanent neurological deficits
79 pitfalls
80 possibility
81 procedure
82 progression
83 prospective analysis
84 pseudo aneurysm
85 rarity
86 rate
87 recurrent chordoma
88 removal rate
89 resection
90 resection rate
91 resistance
92 series
93 sinus
94 skull base chordomas
95 sphenoid sinus
96 surgery
97 technique
98 total
99 total resection
100 total resection rate
101 traditional approaches
102 treatment
103 use
104 weeks
105 women
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