Chordomas of the skull base: surgical management and outcome

Samii, Amir; Gerganov, Venelin M.; Herold, Christian; Hayashi, Nakamasa; Naka, Takahiko; Mirzayan, M. Javad; Ostertag, Helmut; Samii, Madjid

doi:10.3171/jns-07/08/0319

Cited by 147 publications

(105 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Compared with those in previous major clinical reports (mean follow-up 52.6 months), 8,10,11,17,49,58 the follow-up in our series (average 75.98 months) was the longest after that reported by Forsyth et al (99 months). 17 At the last followup examination, 35% of our patients had died of tumor progression or complications from it.…”

Section: Status Of the Disease And Survivalcontrasting

confidence: 50%

“…patient population, tumor location, and extension In our series epidemiological data are comparable to those reported in the literature (Table 4): we found a male predilection with a male/female ratio of 2:1 8,30,38 and an onset peak age of 46.7 years. 1,8,10,11,18,19,49,53 Whether sex and age can affect prognosis is still a matter of debate. We did not find any significant correlation between patient sex and survival.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Skull base chordomas: clinical outcome in a consecutive series of 45 patients with long-term follow-up and evaluation of clinical and biological prognostic factors

Boari

Gagliardi

Cavalli

et al. 2016

JNS

View full text Add to dashboard Cite

OBJECTIVE Skull base chordomas (SBCs) are rare dysembryogenetic invasive tumors with a variable tendency for recurrence. According to previous studies, the recurrence rate seems to be affected by both clinical variables and tumor biological features. The authors present the results of treatment of SBCs in a large series of patients and investigate the role of 1p36 chromosomal region loss of heterozygosity (LOH) as a prognostic factor. METHODS Between 1990 and 2011, 45 patients were treated for SBCs. The mean follow-up was 76 months (range 1–240 months). An LOH analysis was performed in 27 cases. Survival analysis was performed to determine clinical and biological parameters correlating with clinical outcome. RESULTS The 5- and 10-year overall survival rates were 67% and 57%, respectively. Five- and 10-year progression-free survival rates were 58% and 44%, respectively. Multivariate analysis showed that extent of resection, adjuvant radiation therapy, and absence of rhinopharynx invasion were positive independent predictors of overall survival. The latter 2 variables and a younger patient age were positive independent predictors of progression-free survival. Twenty-one patients showed 1p36 LOH. All events of recurrence and death clustered in the group of patients with 1p36 LOH; however, this biological marker was not statistically significant on multivariate analysis. CONCLUSIONS Resection is the treatment of choice in primary and recurrent SBC. Patient age, rhinopharynx invasion at diagnosis, extent of tumor removal, and postoperative radiation therapy influence SBC prognosis. Genetic analysis, even while showing interesting results, did not reveal 1p36 LOH as an independent predictor of clinical outcome.

show abstract

Section: Status Of the Disease And Survivalcontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Skull base chordomas: clinical outcome in a consecutive series of 45 patients with long-term follow-up and evaluation of clinical and biological prognostic factors

Boari

Gagliardi

Cavalli

et al. 2016

JNS

View full text Add to dashboard Cite

show abstract

“…1 While radical resection should be the goal when feasible-as the extent of tumor removal has been a positive prognosticator for chordomas-aggressive resections have been associated with significant morbidity. 1,7,8,20,24,31,51,58 Radiation therapy in any form (conventional, stereotactic, Gamma Knife, or proton beam) plays an effective but adjuvant role. 31,32 Although chondrosarcomas often involve the clivus, patients with these lesions typically present with more lateral extensions, which are not ideal indications for purely midline approaches, and thus transcranial routes are often preferred.…”

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

confidence: 99%

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

Carrabba¹,

Dehdashti²,

Gentili³

2008

FOC

View full text Add to dashboard Cite

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.

show abstract

“…The current accepted treatment approach for managing chordomas involves wide local excision of the tumour followed by high dose radiotherapy. The main aim for this treatment modality is palliation with curative intent due to high recurrence rates and a poor 5-10 years survival rate [15][16][17]. However, it is not clear whether this is related to the size of the initial lesion or the difficulty in appropriate removal due to complex anatomy of the involved regions.…”

Section: Discussionmentioning

confidence: 99%

A Parapharyngeal Soft Tissue Chordoma Presenting with Synchronous Cervical Lymph Node Metastasis: An Unusual Presentation

Khurram

Biswas

Fernando

2016

Head and Neck Pathol

View full text Add to dashboard Cite

A 63 year old male presented with a three month history of dysphagia, neck swelling and an oropharyngeal swelling on examination. Initial fine needle aspiration cytology and magnetic resonance imaging (done at a peripheral hospital) suggested a salivary gland neoplasm with lymph node metastasis. An infra-temporal approach was employed to excise the tumour mass and a modified radical neck dissection undertaken to remove the cervical metastasis. Histopathological examination with immunohistochemistry confirmed this to be a soft tissue chordoma. To the best of our knowledge, this is the first documented report of an extra-axial soft tissue chordoma presenting with synchronous metastatic disease. Though rare, this adds to the list of differential diagnoses for complex parapharyngeal lesions. A multidisciplinary approach between head and neck surgery, histopathology, radiology and sarcoma teams is paramount for arriving at the correct diagnosis and to deliver optimal treatment.

show abstract

Chordomas of the skull base: surgical management and outcome

Cited by 147 publications

References 42 publications

Skull base chordomas: clinical outcome in a consecutive series of 45 patients with long-term follow-up and evaluation of clinical and biological prognostic factors

Skull base chordomas: clinical outcome in a consecutive series of 45 patients with long-term follow-up and evaluation of clinical and biological prognostic factors

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

A Parapharyngeal Soft Tissue Chordoma Presenting with Synchronous Cervical Lymph Node Metastasis: An Unusual Presentation

Contact Info

Product

Resources

About