Endoscope-assisted far-lateral transcondylar approach for craniocervical junction chordomas: a retrospective case series and cadaveric dissection

Abstract

OBJECTIVE Craniocervical junction (CCJ) chordomas are a neurosurgical challenge because of their deep localization, lateral extension, bone destruction, and tight relationship with the vertebral artery and lower cranial nerves. In this study, the authors present their surgical experience with the endoscope-assisted far-lateral transcondylar approach (EA-FLTA) for the treatment of CCJ chordomas, highlighting the advantages of this corridor and the integration of the endoscope to reach the anterior aspect and contralateral side of the CCJ and the possibility of performing occipitocervical fusion (OCF) during the same stage of surgery. METHODS Nine consecutive cases of CCJ chordomas treated with the EA-FLTA between 2013 and 2020 were retrospectively reviewed. Preoperative characteristics, surgical technique, postoperative results, and clinical outcome were analyzed. A cadaveric dissection was also performed to clarify the anatomical landmarks. RESULTS The male/female ratio was 1.25, and the median age was 36 years (range 14–53 years). In 6 patients (66.7%), the lesion showed a bilateral extension, and 7 patients (77.8%) had an intradural extension. The vertebral artery was encased in 5 patients. Gross-total resection was achieved in 5 patients (55.6%), near-total resection in 3 (33.3%), and subtotal resection 1 (11.1%). In 5 cases, the OCF was performed in the same stage after tumor removal. Neither approach-related complications nor complications related to tumor resection occurred. During follow-up (median 18 months, range 5–48 months), 1 patient, who had already undergone treatment and radiotherapy at another institution and had an aggressive tumor (Ki-67 index of 20%), showed tumor recurrence at 12 months. CONCLUSIONS The EA-FLTA provides a safe and effective corridor to resect extensive and complex CCJ chordomas, allowing the surgeon to reach the anterior, lateral, and posterior portions of the tumor, and to treat CCJ instability in a single stage.

Fractionated Radiotherapy After Gross Total Resection of Clival Chordoma: A Systematic Review of Survival Outcomes

“…Review of references resulted in 2 additional studies included, thus totaling 22 studies included for final quantitative analysis, with data available for 108 patients in total (Figure 1). 17-38…”

“…23,25,26,28-30,36 An additional 18 studies lost points for inadequate selection within their nonexposed cohort (patients not undergoing RT). 17-21,23,25-29,31-35,37,38…”

“…A total of 7 studies lost 1 point for inadequate followup time. 23,25,26,[28][29][30]36 An additional 18 studies lost points for inadequate selection within their nonexposed cohort (patients not undergoing RT). [17][18][19][20][21]23,[25][26][27][28][29][31][32][33][34][35]37,38…”

The Impact of Expanded Endoscopic Approaches on Long Term Outcomes for Clival Malignancies - A Case Series

“…Given the suboptimal outcomes seen with purely open approaches (ventral or lateral), pure EEA, and hybrid open-EEA approaches, work is needed to advance outcomes with low clival lesions. More recently reported, the endoscope-assisted far lateral transcondylar approach is a promising technique that could potentially improve outcomes [39].…”

Extreme Far-Lateral Approach for Recurrent Chordoma: 3-Dimensional Operative Video

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Craniocervical junction chordomas (CCJC) are rare malignant tumors that invade the skull base and lead to bone destruction and instability. [1][2][3] En bloc removal with wide margins is the treatment of choice. 4 The extreme far-lateral approach provides control of the CCJ neurovascular structures and the tumor-brainstem interface.

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