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Brown NJ, Gendreau J, Kuo CC, Nguyen O, Yang C, Catapano JS, Lawton MT. Assessing survival outcomes and complication profiles following surgical excision and radiotherapy as interventions for skull base chordoma: a systematic review of operative margins and surgical approaches. J Neurooncol 2023; 165:41-51. [PMID: 37880419 DOI: 10.1007/s11060-023-04477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Despite their precarious behavioral classification (benign and low grade on histopathology yet behaviorally malignant), great strides have been taken to improve prognostication and treatment paradigms for patients with skull base chordoma. With respect to surgical techniques, lateral transcranial (TC) approaches have traditionally been used, however endoscopic endonasal approaches (EEA) have been advocated for midline lesions. Nonetheless, due to the rarity of this pathology (0.2% of all intracranial neoplasms), investigations within the literature remain limited to small retrospective series. Furthermore, radiotherapeutic treatments investigated to date have proven largely ineffective. METHODS Accordingly, we performed a systematic review in order to profile surgical and survival outcomes for skull base chordoma. Fixed and random-effect meta-analyses were performed for categorical variables including GTR, STR, 5-year OS, 10-year OS, 5-year PFS, and 10-year PFS. Additionally, we pooled eligible studies for formal meta-analysis to compare outcomes by surgical approach (lateral versus midline). Statistical analyses were performed using R Studio 'metafor' package or Cochrane Review Manager. Furthermore, meta-analysis of pooled mortality rates and sub-analyses of operative margin and surgical complications were used to compare midline versus lateral approaches via the Mantel-Haenszel method. We considered all p-values < 0.05 to be statistically significant. RESULTS Following the systematic search and screen, 55 studies published between 1993 and 2022 reporting data for 2453 patients remained eligible for analysis. Sex distribution was comparable between males and females, with a slight predominance of male-identifying patients (0.5625 [95% CI: 0.5418; 0.3909]). Average age at diagnosis was 42.4 ± 12.5 years, while average age of treatment initiation was 43.0 ± 10.6 years. Overall, I2 value indicated notable heterogeneity across the 55 studies [I2 = 56.3% (95%CI: 44.0%; 65.9%)]. With respect to operative margins, the rate of GTR was 0.3323 [95% CI: 0.2824; 0.3909], I2 = 91.9% [95% CI: 90.2%; 93.4%], while the rate of STR was significantly higher at 0.5167 [95% CI: 0.4596; 0.5808], I2 = 93.1% [95% CI: 91.6%; 94.4%]. The most common complication was CSF leak (5.4%). In terms of survival outcomes, 5-year OS rate was 0.7113 [95% CI: 0.6685; 0.7568], I2 = 91.9% [95% CI: 90.0%; 93.5%]. 10-year OS rate was 0.4957 [95% CI: 0.4230; 0.5809], I2 = 92.3% [95% CI: 89.2%; 94.4%], which was comparable to the 5-year PFS rate of 0.5054 [95% CI: 0.4394; 0.5813], I2 = 84.2% [95% CI: 77.6%; 88.8%] and 10-yr PFS rate of 0.4949 [95% CI: 0.4075; 0.6010], I2 = 14.9% [95% CI: 0.0%; 87.0%]. There were 55 reported deaths for a perioperative mortality rate of 2.5%. The relative risk for mortality in the midline group versus the lateral approach group did not indicate any substantial difference in survival according to laterality of approach (-0.93 [95% CI: -1.03, -0.97], I2 = 95%, (p < 0.001). CONCLUSION Overall, these results indicate good 5-year survival outcomes for patients with skull base chordoma; however, 10-year prognosis for skull base chordoma remains poor due to its radiotherapeutic resistance and high recurrence rate. Furthermore, mortality rates among patients undergoing midline versus lateral skull base approaches appear to be equivocal.
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Affiliation(s)
- Nolan J Brown
- Department of Neurological Surgery, University of California-Irvine, Orange, CA, USA
| | - Julian Gendreau
- Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
| | - Cathleen C Kuo
- Department of Neurological Surgery, University of California-Irvine, Orange, CA, USA
| | - Oanh Nguyen
- Department of Neurological Surgery, University of California-Irvine, Orange, CA, USA
| | - Chenyi Yang
- Department of Neurological Surgery, University of California-Irvine, Orange, CA, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, 2910 North Third Avenue, Phoenix, AZ, 85013, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, 2910 North Third Avenue, Phoenix, AZ, 85013, USA.
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Hall J, Yanagihara TK, Wang TJC. Commentary: Fractionated Radiotherapy After Gross Total Resection of Clival Chordoma: A Systematic Review of Survival Outcomes. Neurosurgery 2023; 93:e19-e20. [PMID: 36861997 DOI: 10.1227/neu.0000000000002445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 03/03/2023] Open
Affiliation(s)
- Jacob Hall
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ted K Yanagihara
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York, USA
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Pellegrini F, Brocca D, Cuna A, Stafa A, Lee AG. Unilateral Compressive Optic Neuropathy As the Presenting Manifestation of Clival Chordoma: A Case Report. Cureus 2022; 14:e24440. [PMID: 35637819 PMCID: PMC9128761 DOI: 10.7759/cureus.24440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2022] [Indexed: 11/28/2022] Open
Abstract
The optic nerve(s) may be compressed by a number of intracranial and intraorbital masses. Compression may be isolated to the optic nerve or may involve other intracranial or intraorbital structures with variable presentation. A 26-year-old man presented with complaints of progressive painless visual loss in the right eye for eight months. Examination revealed isolated unilateral optic atrophy consistent with a diagnosis of compressive optic neuropathy. Magnetic resonance imaging of the brain showed compression of the anterior visual pathways due to a lesion radiologically compatible with clival chordoma. He underwent subtotal neurosurgical resection and pathology was consistent with chordoma. Although rare, isolated unilateral visual loss may be the only presenting manifestation of clival chordoma.
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Gomes JPP, Veloso JDRC, Altemani AMDAM, Chone CT, Altemani JMC, de Freitas CF, Lima CSP, Braz-Silva PH, Costa ALF. Three-Dimensional Volume Imaging to Increase the Accuracy of Surgical Management in a Case of Recurrent Chordoma of the Clivus. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1168-1174. [PMID: 30275439 PMCID: PMC6180943 DOI: 10.12659/ajcr.911592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Patient: Male, 53 Final Diagnosis: Clivus chordoma Symptoms: Pain the eye Medication: — Clinical Procedure: — Specialty: Radiology
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Affiliation(s)
- João Pedro Perez Gomes
- Division of General Pathology, Department of Stomatology, School of Dentistry, University of Sao Paulo (USP), São Paulo, SP, Brazil
| | - José de Ribamar Castro Veloso
- Department of Orthodontics and Radiology, School of Dentistry, University City of São Paulo (UNICID), São Paulo, SP, Brazil
| | | | - Carlos Takahiro Chone
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Claudio Fróes de Freitas
- Department of Orthodontics and Radiology, School of Dentistry, University City of São Paulo (UNICID), São Paulo, SP, Brazil
| | - Carmen Silvia Passos Lima
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Paulo Henrique Braz-Silva
- Division of General Pathology, Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Andre Luiz Ferreira Costa
- Department of Orthodontics and Radiology, School of Dentistry, University City of São Paulo (UNICID), São Paulo, SP, Brazil
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Ahmed AS, Flemmer MC. The nerve of legal entrapment. Oxf Med Case Reports 2018; 2018:omy045. [PMID: 30094043 PMCID: PMC6080053 DOI: 10.1093/omcr/omy045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/20/2018] [Indexed: 11/13/2022] Open
Abstract
Chordomas are a rare type of bone tumor that arises from the embryological remnant of the notochord. They originate at any point along the axial spine with the sacrum and the skull based region being the most commonly affected sites. Chordomas are slowly growing, indolent tumors, presenting insidiously, but also carry a high recurrence rate with a tendency to invade contiguous structure making their treatment challenging. The current standard of care for localized chordoma is aggressive cytoreductive surgery followed by high dose adjuvant radiotherapy. We present a unique case of a 72-year-old lawyer with a skull base chordoma invading into the hypoglossal canal and causing isolated hypoglossal nerve paralysis.
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Affiliation(s)
- Ali S Ahmed
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Mark C Flemmer
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
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Jäger D, Barth TFE, Brüderlein S, Scheuerle A, Rinner B, von Witzleben A, Lechel A, Meyer P, Mayer-Steinacker R, Baer AV, Schultheiss M, Wirtz CR, Möller P, Mellert K. HOXA7, HOXA9, and HOXA10 are differentially expressed in clival and sacral chordomas. Sci Rep 2017; 7:2032. [PMID: 28515451 PMCID: PMC5435709 DOI: 10.1038/s41598-017-02174-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/10/2017] [Indexed: 12/20/2022] Open
Abstract
Chordomas are rare tumours of the bone arising along the spine from clivus to sacrum. We compared three chordoma cell lines of the clivus region including the newly established clivus chordoma cell line, U-CH14, with nine chordoma cell lines originating from sacral primaries by morphology, on genomic and expression levels and with patient samples from our chordoma tissue bank. Clinically, chordomas of the clivus were generally smaller in size at presentation and patients with sacral chordomas had more metastases and more often recurrent disease. All chordoma cell lines had a typical physaliphorous morphology and expressed brachyury, S100-protein and cytokeratin. By expression analyses we detected differentially expressed genes in the clivus derived cell lines as compared to the sacral cell lines. Among these were HOXA7, HOXA9, and HOXA10 known to be important for the development of the anterior-posterior body axis. These results were confirmed by qPCR. Immunohistologically, clivus chordomas had no or very low levels of HOXA10 protein while sacral chordomas showed a strong nuclear positivity in all samples analysed. This differential expression of HOX genes in chordomas of the clivus and sacrum suggests an oncofetal mechanism in gene regulation linked to the anatomic site.
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Affiliation(s)
- Daniela Jäger
- Institute of Pathology, University of Ulm, Ulm, Germany
| | | | | | | | - Beate Rinner
- Division of Biomedical Research, Medical University of Graz, Graz, Austria
| | | | - André Lechel
- Department of Internal Medicine I, University of Ulm, Ulm, Germany
| | - Patrick Meyer
- Department of Dermatology, University of Ulm, Ulm, Germany
| | | | | | | | | | - Peter Möller
- Institute of Pathology, University of Ulm, Ulm, Germany.
| | - Kevin Mellert
- Institute of Pathology, University of Ulm, Ulm, Germany
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7
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Matloob SA, Nasir HA, Choi D. Proton beam therapy in the management of skull base chordomas: systematic review of indications, outcomes, and implications for neurosurgeons. Br J Neurosurg 2016; 30:382-7. [PMID: 27173123 DOI: 10.1080/02688697.2016.1181154] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Chordomas are rare tumours affecting the skull base. There is currently no clear consensus on the post-surgical radiation treatments that should be used after maximal tumour resection. However, high-dose proton beam therapy is an accepted option for post-operative radiotherapy to maximise local control, and in the UK, National Health Service approval for funding abroad is granted for specific patient criteria. OBJECTIVES To review the indications and efficacy of proton beam therapy in the management of skull base chordomas. The primary outcome measure for review was the efficacy of proton beam therapy in the prevention of local occurrence. METHODS A systematic review of English and non-English articles using MEDLINE (1946-present) and EMBASE (1974-present) databases was performed. Additional studies were reviewed when referenced in other studies and not available on these databases. Search terms included chordoma or chordomas. The PRISMA guidelines were followed for reporting our findings as a systematic review. RESULTS A total of 76 articles met the inclusion and exclusion criteria for this review. Limitations included the lack of documentation of the extent of primary surgery, tumour size, and lack of standardised outcome measures. Level IIb/III evidence suggests proton beam therapy given post operatively for skull base chordomas results in better survival with less damage to surrounding tissue. CONCLUSIONS Proton beam therapy is a grade B/C recommended treatment modality for post-operative radiation therapy to skull base chordomas. In comparison to other treatment modalities long-term local control and survival is probably improved with proton beam therapy. Further, studies are required to directly compare proton beam therapy to other treatment modalities in selected patients.
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Affiliation(s)
- Samir A Matloob
- a Victor Horsley Department of Neurosurgery , National Hospital for Neurology and Neurosurgery , Queen Square, London , UK
| | - Haleema A Nasir
- a Victor Horsley Department of Neurosurgery , National Hospital for Neurology and Neurosurgery , Queen Square, London , UK
| | - David Choi
- a Victor Horsley Department of Neurosurgery , National Hospital for Neurology and Neurosurgery , Queen Square, London , UK
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8
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Sartori G, Scarpazza C, Codognotto S, Pietrini P. An unusual case of acquired pedophilic behavior following compression of orbitofrontal cortex and hypothalamus by a Clivus Chordoma. J Neurol 2016; 263:1454-5. [DOI: 10.1007/s00415-016-8143-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/16/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
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Radzikowska J, Gronkiewicz Z, Kukwa A, Lisik W, Czarnecka AM, Krzeski A, Kukwa W. Nasopharyngeal chordoma in a patient with a severe form of sleep-disordered breathing: A case report. Oncol Lett 2015; 10:1805-1809. [PMID: 26622754 DOI: 10.3892/ol.2015.3393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 01/22/2015] [Indexed: 12/18/2022] Open
Abstract
Nasopharyngeal chordoma is a rare type of malignant neoplasm that originates in the remnants of the notochord, a primitive tissue of embryonic origin preserved outside the axial skeleton. Approximately one-third of chordomas are located in the base of the skull, in the midline of the body. The slow growth rate of the tumor, which gradually fills the nasopharyngeal cavity, contributes to a delayed oncological diagnosis. Among its isolated and non-specific symptoms, the obstruction of the nasopharynx is dominant, thus, sleep-disordered breathing (SDB) may occur. The current study presents the case of a 32-year-old female patient who was incidentally diagnosed with a nasopharyngeal chordoma during a diagnostic examination for SDB. The diagnostic examination was performed as a part of a research program for pathologically obese patients who qualified for bariatric surgery. Following tumor resection, a significant improvement in various polysomnographic parameters occurred, including a decrease in the apnea hypopnea index from 53.5 to 6.4 and an increase in the mean saturation rate from 92.5 to 95%, confirming that an association exists between tumor obstruction of the nasopharynx and SDB. The incidental diagnosis of this rare type of neoplasm drew attention to diagnostic and therapeutic problems associated with nasopharyngeal chordomas. Furthermore, it indicated the necessity for the accurate laryngological examination of patients with SDB.
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Affiliation(s)
- Joanna Radzikowska
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
| | - Zuzanna Gronkiewicz
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
| | - Andrzej Kukwa
- Department of Otolaryngology and Head and Neck Disease, University of Varmia and Mazuria School of Medicine, Olsztyn 10-082, Poland
| | - Wojciech Lisik
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw 02-005, Poland
| | - Anna M Czarnecka
- Department of Oncology, Military Institute of Medicine, Warsaw 04-141, Poland
| | - Antoni Krzeski
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
| | - Wojciech Kukwa
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
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10
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Skull base chondroid chordoma: atypical case manifesting as intratumoral hemorrhage and literature review. Clin Neuroradiol 2014; 24:313-20. [PMID: 25070287 DOI: 10.1007/s00062-014-0321-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 07/01/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Chondroid chordoma (CC) is a rare but commonest subtype of chordoma with little reported clinical information. The present study summarizes and updates present knowledge of CC. METHODS Literature search for demographic data and clinical appearance of cranial CCs except for those entirely confined to the sinonasal region. RESULTS A total of 48 English language papers published from 1968-2013 were retrieved describing 132 CCs as skull base tumors. The male-to-female ratio was 1:1. The mean age at diagnosis was 43 years, predisposing to the third to fifth decades of life. The clival (34%) and spheno-occipital (29%) regions were the most frequent sites of origin followed by the sellar (12%) and sphenoid (5%) regions. Intratumoral calcification and bony erosion were identified as the characteristic neuroimaging findings. Surgical resection by the transcranial, transsphenoidal, transnasal, transpharyngeal, or transpalatal route with or without adjuvant radiotherapy was the main treatment option. The initial treatment outcome was satisfactory in 82% of cases with considerably better prognosis compared with typical chordomas. CONCLUSION CC is a distinct entity to be discriminated from the typical type of chordoma. There are no distinguishing features on magnetic resonance imaging between CC and typical chordoma. Intratumoral calcification and concurrent bony erosion on neuroimaging should suggest the possibility of CC. Extensive surgical resection and adjuvant radiotherapy can achieve satisfactory outcome.
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11
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Koechlin NO, Simmen D, Briner HR, Reisch R. Combined transnasal and transcranial removal of a giant clival chordoma. J Neurol Surg Rep 2014; 75:e98-e102. [PMID: 25083400 PMCID: PMC4110148 DOI: 10.1055/s-0034-1373668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/31/2014] [Indexed: 10/25/2022] Open
Abstract
Clival chordomas confront the surgeon with the task of resecting an aggressively invasive and destructive tumor in a critical surrounding. For many, mainly smaller, chordomas, the transnasal transclival approach is a feasible and safe surgical access. Larger tumors and especially those with extensive intradural, retrochiasmal, and/or deep cervical expansion are mostly approached by open craniotomy. Staged procedures are also commonly used in the case of expansive tumor growth. We present the first case of a single-session combined transnasal and transcranial approach to radically resect a large clival chordoma.
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Affiliation(s)
- Nicolas O Koechlin
- Centre for Endoscopic and Minimally Invasive Neurosurgery, Klinik Hirslanden, Zurich, Switzerland
| | - Daniel Simmen
- ORL-Zentrum, Center for Otology, Skull Base Surgery, Rhinology and Facial Plastic Surgery, Klinik Hirslanden, Zurich, Switzerland
| | - Hans Rudolf Briner
- ORL-Zentrum, Center for Otology, Skull Base Surgery, Rhinology and Facial Plastic Surgery, Klinik Hirslanden, Zurich, Switzerland
| | - Robert Reisch
- Centre for Endoscopic and Minimally Invasive Neurosurgery, Klinik Hirslanden, Zurich, Switzerland
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Mason E, Van Rompaey J, Carrau R, Panizza B, Solares CA. Anatomical and computed tomographic analysis of the transcochlear and endoscopic transclival approaches to the petroclival region. Laryngoscope 2013; 124:628-36. [PMID: 24105807 DOI: 10.1002/lary.24378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/31/2013] [Accepted: 07/31/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Advances in the field of skull base surgery aim to maximize anatomical exposure while minimizing patient morbidity. The petroclival region of the skull base presents numerous challenges for surgical access due to the complex anatomy. The transcochlear approach to the region provides adequate access; however, the resection involved sacrifices hearing and results in at least a grade 3 facial palsy. An endoscopic endonasal approach could potentially avoid negative patient outcomes while providing a desirable surgical window in a select patient population. STUDY DESIGN Cadaveric study. METHODS Endoscopic access to the petroclival region was achieved through an endonasal approach. For comparison, a transcochlear approach to the clivus was performed. Different facets of the dissections, such as bone removal volume and exposed surface area, were computed using computed tomography analysis. RESULTS The endoscopic endonasal approach provided a sufficient corridor to the petroclival region with significantly less bone removal and nearly equivalent exposure of the surgical target, thus facilitating the identification of the relevant anatomy. The lateral approach allowed for better exposure from a posterolateral direction until the inferior petrosal sinus; however, the endonasal approach avoided labyrinthine/cochlear destruction and facial nerve manipulation while providing an anteromedial viewpoint. The endonasal approach also avoided external incisions and cosmetic deficits. The endonasal approach required significant sinonasal resection. CONCLUSIONS Endoscopic access to the petroclival region is a feasible approach. It potentially avoids hearing loss, facial nerve manipulation, and cosmetic damage.
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Affiliation(s)
- Eric Mason
- Department of Otolaryngology, Center for Cranial Base Surgery, Georgia Regents University, Augusta, Georgia, U.S.A
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13
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Stamm AC, Balsalobre L, Hermann D, Chisholm E. Endonasal endoscopic approach to clival and posterior fossa chordomas. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.otot.2011.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
We investigated the outcomes of chordomas of the craniocervical junction after surgery including complication rates, survival, associated adverse factors, and quality of life. We present our results and lessons learned from surgeries performed between 1982 and 2007 in the National Hospital for Neurology and Neurosurgery, London. Patients undergoing transfacial, transoral, and transmandibular surgeries for chordomas of the craniocervical junction were enrolled in this study. Chi-square, Fisher exact tests, and log-rank survival analysis were used to determine significant adverse factors (p < 0.05). In our series, 80 operations were performed in 66 patients; 37 patients were male, 29 female. Age at presentation was commonly 40 to 60 years. After surgery, pain was the same or better in 98.1% of patients; 18.6% of patients presented with myelopathy, of whom 27.8% improved, 44.4% remained unchanged, 27.8% deteriorated. Complication rates were as follows: velopharyngeal incompetence 2%, dysphagia 3%, failure of fixation 2%, sepsis 5%, meningitis 5%, wound infection 3%, chest infection 6%, cerebrospinal fluid leakage 5%. Five- and 10-year overall survivals were 62% and 39%, respectively. Complication rates for these major operations can be minimized in specialist centers, with careful patient selection and counseling. Quality of life and survival are significantly improved after surgery.
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Affiliation(s)
- David Choi
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Jian BJ, Bloch OG, Yang I, Han SJ, Aranda D, Parsa AT. A comprehensive analysis of intracranial chordoma and survival: a systematic review. Br J Neurosurg 2011; 25:446-53. [PMID: 21749184 DOI: 10.3109/02688697.2010.546896] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Despite the published information on cranial chordoma, most of the data regarding survival in these patients has come from a single institution. Here, we perform a systematic review of the literature to evaluate across multiple institutions the overall survival after treatment for intracranial chordoma. MATERIALS AND METHODS We systematically analysed every study published in English and found a total of over 2000 patients being treated for intracranial chordoma. The overall 5-year and 10-year survivals in these patients were stratified according to the age (<5 years vs. >5 years and <40 years vs. >40 years), treatment (surgery and radiation vs. surgery alone) and histological findings (chondroid vs. typical). Data were analysed via Pearson chi-square test and student t-test when appropriate. RESULTS A total of 560 non-duplicated patients treated for cranial chordoma met inclusion criteria for this systematic analysis. The survival rate among these patients was 63% (299 patients) and 16% (176 patients) for 5-year and 10-year survivals, respectively. There was no difference in overall survival between the two groups when a cut-off age of 40 years was used (<40 years = 50% vs. >40 years = 51% at 5-year survival; p = 0.1), but when 5 years was used as the cut-off age, then survival was better for patients in the group older than 5 years of age (<5 years = 14% vs. >5 years = 66%; p = 0.001). There was no difference between 5-year survival in patients with chordoma with histological chondroid features and those with chordoma possessing typical histology (45% vs. 67%; p = 0.06). When patients who only received surgery were compared to those patients who were treated with surgical intervention in combination with adjuvant radiation treatment, no difference in survival rate was found (54% vs. 56% at 5 years; p = 0.8). CONCLUSION The results of our systematic study provide data to predict the survival of intracranial chordoma patients across multiple institutions. Our data suggest that patients younger than 5 years of age may be associated with a worse prognosis, and adjuvant radiation therapy and histological type were not associated with the improvement of survival rates.
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Affiliation(s)
- Brian J Jian
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, USA
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16
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Choi D, Melcher R, Harms J, Crockard A. Outcome of 132 operations in 97 patients with chordomas of the craniocervical junction and upper cervical spine. Neurosurgery 2010; 66:59-65; discussion 65. [PMID: 20023538 DOI: 10.1227/01.neu.0000362000.35742.3d] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To study the outcomes of surgery for chordomas of the craniocervical junction and upper cervical spine as well as complication rates, survival, and associated adverse factors. METHODS Retrospective review of patients (1982-2007) at 2 European centers who underwent transoral, transfacial, transmandibular, and anterior cervical approaches for excision of chordomas of the craniocervical junction and cervical spine. The chi test and Fisher exact test were used to determine significant adverse factors (P < .05), and log-rank survival analysis was used to compare outcome in different groups. RESULTS One hundred thirty-two operations were performed in 97 patients. The most common operations were transoral surgeries and maxillotomies. After surgery, neck pain was the same or better in 98.1% of patients. Of the 18.6% of patients who presented with myelopathy, 27.8% improved, 44.4% remained unchanged, and 27.8% deteriorated. Major complication rates were velopharyngeal incompetence, 3.1%; vertebral artery stroke, 1%; wound infection, 3.1%; dysphagia, 3.1%; failure of fixation, 2.1%; sepsis, 3.1%; meningitis, 3.1%; and cerebrospinal fluid leakage, 6.2%. Five- and 10-year overall survivals were 55% and 36%, respectively. Patients who presented to our units for revision surgery, after prior attempts at resection elsewhere, were associated with a worse survival than patients who underwent de novo surgery. CONCLUSION We present, to our knowledge, the largest published series of chordomas at the craniocervical junction. Complication rates for these major operations can be minimized at specialist centers, with careful patient selection and counseling. As complete or as radical an operation as possible should be performed at first presentation; the best chance for the patient is the first chance.
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Affiliation(s)
- David Choi
- Department of Neurosurgery, Box 3, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, United Kingdom.
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Adjuvant radiation therapy and chondroid chordoma subtype are associated with a lower tumor recurrence rate of cranial chordoma. J Neurooncol 2009; 98:101-8. [PMID: 19953297 DOI: 10.1007/s11060-009-0068-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 11/08/2009] [Indexed: 10/20/2022]
Abstract
Cranial chordomas are rare tumors that have been difficult to study given their low prevalence. Individual case series with decades of data collection provide some insight into the pathobiology of this tumor and its responses to treatment. This meta-analysis is an attempt to aggregate the sum experiences and present a comprehensive review of their findings. We performed a comprehensive review of studies published in English language literature and found a total of over 2,000 patients treated for cranial chordoma. Patient information was then extracted from each paper and aggregated into a comprehensive database. The tumor recurrences in these patients were then stratified according to age (<21 vs. >21 years), histological findings (chondroid vs. typical) and treatment (surgery and radiation vs. surgery only). Data was analyzed via Pearson chi-square and t-test. A total of 464 non-duplicated patients from 121 articles treated for cranial chordoma met the inclusion criteria. The recurrence rate among all patients was 68% (314 patients) with an average disease-free interval of 45 months (median, 23 months). The mean follow-up time was 39 months (median, 27 months). The patients in younger group, patients with chordoma with chondroid histologic type, and patients who received surgery and adjuvant radiotherapy had significantly lower recurrence rate than their respective counterparts. The results of our systematic analysis provide useful data for practitioners in objectively summarizing the tumor recurrence in patients with cranial chordomas. Our data suggests that younger patients with chondroid type cranial chordoma treated with both surgery and radiation may have improved rates of tumor recurrence in the treatment of these tumors.
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Abstract
This paper describes the pathobiology of some of the more common skull base tumors. In addition to clinicopathologic features, emphasis is placed upon methods of diagnosis utilizing immunoperoxidase stains and molecular markers that may or may not impact upon prognosis.
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Affiliation(s)
- L Barnes
- Department of Pathology, Presbyterian University Hospital, Pittsburgh, PA
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