Extended endoscopic endonasal surgery for clival chordoma and chondrosarcoma: Our experience in 14 cases.

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Extended endoscopic endonasal surgery for clival chordoma and chondrosarcoma: Our experience in 14 cases.

Neurocirugia (Astur). 2018 Apr 21;:

Authors: Culebras D, Torales J, Reyes LA, Zapata L, García S, Roldán P, Langdon C, Alobid I, Enseñat J

Abstract
OBJECTIVE: To report our experience in the management of chordoma and chondrosarcoma with extended endoscopic endonasal surgery.
METHOD: We performed a retrospective analysis of a series of 14 patients with clival chordoma or chondrosarcoma who had extended endoscopic endonasal surgery from 2008 to 2016 performed by the same multidisciplinary team.
RESULTS: We had fourteen patients (male/female 2:1), with a mean age of 49years for chordoma and 32 for chondrosarcoma. The most common clinical presentation was diplopia in 78.5% of cases, followed by dysphagia in 28.6%. Histologically, 71.4% were chordomas and 28.6% were chondrosarcomas. In addition, invasion of at least two thirds or more of the clivus was found in 81% of the cases; in 57.1% there was intradural invasion, and in 35.7% invasion of the sella turcica. In 42.8% of cases, the degree of resection was total and in 21.5% subtotal. The most common complication was CSF fistula, occurring in 28.6% of the cases, with only one case requiring surgery to repair it. Adjuvant treatment with Proton Beam was performed in 35.7% of cases and with conventional radiotherapy in 21.5%. Mean follow-up was 53.5months and tumour recurrence or progression was found in 21.5% of the cases, two of which had not received adjuvant treatment. There were no deaths.
CONCLUSION: The extended endoscopic endonasal approach (EEEA) performed by an experienced team is a good alternative for the management of these lesions. Intradural invasion may be related to an increased risk of complications and worse clinical presentation, in addition to a lower rate of total resection.

PMID: 29691145 [PubMed - as supplied by publisher]

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