Contemporary surgical management of skull base chordomas—Anatomical reflections on a single center experience retrospective case series

Spiessberger, Alexander; Dogra, Siddhant; Golub, Danielle; Grueter, Basil; Nasim, Mansoor; Schneider, Steven J.; Moriggl, Bernhard; Dehdashti, Amir R.; Schulder, Michael

doi:10.1002/ca.23840

Cited by 2 publications

(1 citation statement)

References 22 publications

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“…EEA is increasingly employed for CVJ chordoma resection as technique modifications have allowed for more lateral exposures. 11,37,[49][50][51][52] EEA establishes a corridor to the ventral brainstem unobstructed by cranial nerves or the vertebral arteries and minimizes brain retraction. 49 Based on their cadaveric study, Little et al demonstrated that en-doscopic endonasal clivectomy does not generate significant OC instability.…”

Section: Discussionmentioning

confidence: 99%

Anatomical determinants of occipitocervical fusion in skull base chordoma resection: a systematic review of the literature with illustrative cases

Golub,

Küffer,

Garrel

et al. 2024

Neurosurgical Focus

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OBJECTIVE Skull base chordomas are rare, locally osseo-destructive lesions that present unique surgical challenges due to their involvement of critical neurovascular and bony structures at the craniovertebral junction (CVJ). Radical cytoreductive surgery improves survival but also carries significant morbidity, including the potential for occipitocervical (OC) destabilization requiring instrumented fusion. The published experience on OC fusion after CVJ chordoma resection is limited, and the anatomical predictors of OC instability in this context remain unclear. METHODS PubMed and Embase were systematically searched according to the PRISMA guidelines for studies describing skull base chordoma resection and OC fusion. The search strategy was predefined in the authors’ PROSPERO protocol (CRD42024496158). RESULTS The systematic review identified 11 surgical case series describing 209 skull base chordoma patients and 116 (55.5%) who underwent OC instrumented fusion. Most patients underwent lateral approaches (n = 82) for chordoma resection, followed by midline (n = 48) and combined (n = 6) approaches. OC fusion was most often performed as a second-stage procedure (n = 53), followed by single-stage resection and fusion (n = 38). The degree of occipital condyle resection associated with OC fusion was described in 9 studies: total unilateral condylectomy reliably predicted OC fusion regardless of surgical approach. After lateral transcranial approaches, 4 studies cited at least 50%–70% unilateral condylectomy as necessitating OC fusion. After midline approaches—most frequently the endoscopic endonasal approach (EEA)—at least 75% unilateral condylectomy (or 50% bilateral condylectomy) led to OC fusion. Additionally, resection of the medial atlantoaxial joint elements (the C1 anterior arch and tip of the dens), usually via EEA, reliably necessitated OC fusion. Two illustrative cases are subsequently presented, further exemplifying how the extent of CVJ bony elements removed via EEA to achieve complete chordoma resection predicts the need for OC fusion. CONCLUSIONS Unilateral total condylectomy, 50% bilateral condylectomy, and resection of the medial atlantoaxial joint elements were the most frequently described independent predictors of OC fusion in skull base chordoma resection. Additionally, consistent with the occipital condyle harboring a significantly thicker joint capsule at its posterolateral aspect, an anterior midline approach seems to tolerate a greater degree of condylar resection (75%) than a lateral transcranial approach (50%–70%) prior to generating OC instability.

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Section: Discussionmentioning

confidence: 99%

Anatomical determinants of occipitocervical fusion in skull base chordoma resection: a systematic review of the literature with illustrative cases

Golub,

Küffer,

Garrel

et al. 2024

Neurosurgical Focus

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Not Every Size Fits All: Surgical Corridors for Clival and Cervical Chordomas—A Systematic Review of the Literature and Illustrative Cases

Maugeri,

Bonosi,

Brunasso

et al. 2024

JCM

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Introduction. Clival chordomas represent a rare but clinically significant subset of skull base tumors, characterized by a locally aggressive nature and a location in proximity to vital neurovascular structures. Surgical resection, often combined with adjuvant therapies, remains the cornerstone of clival chordoma treatment, and various approaches and techniques have evolved to maximize tumor removal while preserving neurological function. Recent advancements in skull base surgery, imaging, and adjuvant therapies have improved outcomes by reducing morbidity and thus enhancing long-term survival. Methods and Results. We have conducted a systematic review on PubMed/Medline following PRISMA guidelines regarding indications, the extent of resection (EOR), and complication rates. Then, we present three illustrative cases from our personal experience, which started 25 years ago with CVJ instrumentation procedures and 15 years ago with anterior decompressive transmucosal procedures performed with the aid of an operative microscope, an endoscope, and neuroradiological monitoring. Conclusions. Traditionally, the transoral approach (TOA) is the most frequently used corridor for accessing the lower clivus and the anterior craniovertebral junction (CVJ), without the need to mobilize or retract neural structures; however, it is associated with a high rate of complications. The endonasal approach (EEA) provides access to the anterior CVJ as well as to the lower, middle, and superior clivus, decreasing airway and swallowing morbidity, preserving palatal function, decreasing postoperative pain, and reducing the incidence of tracheostomy. The submandibular retropharyngeal approach (SRA) allows unique access to certain cervical chordomas, which is better suited when the lesion is located below the clivus and in the midline.

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Contemporary surgical management of skull base chordomas—Anatomical reflections on a single center experience retrospective case series

Cited by 2 publications

References 22 publications

Anatomical determinants of occipitocervical fusion in skull base chordoma resection: a systematic review of the literature with illustrative cases

Anatomical determinants of occipitocervical fusion in skull base chordoma resection: a systematic review of the literature with illustrative cases

Not Every Size Fits All: Surgical Corridors for Clival and Cervical Chordomas—A Systematic Review of the Literature and Illustrative Cases

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