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

Culebras, Diego; Torales, Jorge; Reyes, Luís; Zapata, Luis; García, Sergio; Roldán, Pedro; Langdon, Cristóbal; Alobid, Issam; Enseñat, Joaquim

doi:10.1016/j.neucie.2018.03.001

Cited by 5 publications

(6 citation statements)

References 22 publications

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“…After these articles were excluded, 24 articles remained and were included in our analysis; seventeen articles were specific to endoscopic surgery, 8 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 five articles were specific to open surgery, 31 32 33 34 35 and two articles provided unbiased results for both endoscopic and open surgery. 36 37 Combined this provided details of 672 patients who underwent endoscopic surgery and 195 patients who underwent open surgery ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…6 7 This has been traditionally achieved by an open-surgical approach; however, recently, there is an increasing role for endoscopic approaches which some studies report may be more advantageous to the patient. 8 9…”

Section: Introductionmentioning

confidence: 99%

“…6,7 This has been traditionally achieved by an open-surgical approach; however, recently, there is an increasing role for endoscopic approaches which some studies report may be more advantageous to the patient. 8,9 Chordomas are particularly radioresistant and this places the emphasis on aggressive surgical cytoreduction with follow-up adjuvant radiotherapy. 10 Additionally, chemotherapy has not been shown to be particularly effective in chordomas, with its use being limited to palliative treatment.…”

Section: Introductionmentioning

confidence: 99%

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Systematic Review Comparing Open versus Endoscopic Surgery in Clival Chordomas and a 10-Year Single-Center Experience

Mirza

Visagan

Okasha

et al. 2021

J Neurol Surg B Skull Base

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Objectives Chordomas are rare, slow-growing, and osteo-destructive tumors of the primitive notochord. There is still contention in the literature as to the optimal management of chordoma. We conducted a systematic review of the surgical management of chordoma along with our 10-year institutional experience. Design A systematic search of the literature was performed in October 2020 by using MEDLINE and EMBASE for articles relating to the surgical management of clival chordomas. We also searched for all adult patients surgically treated for primary clival chordomas at our institute between 2009 and 2019. Participants Only articles describing chordomas arising from the clivus were included in the analysis. For our institution experience, only adult primary clival chordoma cases were included. Main Outcome Measures Patients were divided into endoscopic or open surgery. Rate of gross total resection (GTR), recurrence, and complications were measured. Results Our literature search yielded 24 articles to include in the study. Mean GTR rate among endoscopic cases was 51.9% versus 41.7% for open surgery. Among the eight cases in our institutional experience, we found similar GTR rates between endoscopic and open surgery. Conclusion Although there is clear evidence in the literature that endoscopic approaches provide better rates of GTR with fewer overall complications compared to open surgery. However, there are still situations where endoscopy is not viable, and thus, open surgery should still be considered if required.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Systematic Review Comparing Open versus Endoscopic Surgery in Clival Chordomas and a 10-Year Single-Center Experience

Mirza

Visagan

Okasha

et al. 2021

J Neurol Surg B Skull Base

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“…Common indications for the transclival approach include clival chordomas, 105,106 petroclival meningiomas, 107 and chondrosarcomas. 108 This approach can also be used for odontoidectomy. 109,110 Given the lateral exposure of this approach is limited by the eustachian tubes and parapharyngeal carotid arteries, this approach is best suited for midline infra- and retro-sellar, clival, and prepontine lesions.…”

Section: Endoscopic Endonasal Approachmentioning

confidence: 99%

Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

et al. 2021

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The sellar, suprasellar, and parasellar space contain a vast array of pathologies, including neoplastic, congenital, vascular, inflammatory, and infectious etiologies. Symptoms, if present, include a combination of headache, eye pain, ophthalmoplegia, visual field deficits, cranial neuropathy, and endocrine manifestations. A special focus is paid to key features on CT and MRI that can help in differentiating different pathologies. While most lesions ultimately require histopathologic evaluation, expert knowledge of skull base anatomy in combination with awareness of key imaging features can be useful in limiting the differential diagnosis and guiding management. Surgical techniques, including endoscopic endonasal and transcranial neurosurgical approaches are described in detail.

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“…1 Management commonly includes surgical resection via an endoscopic endonasal approach (EEA) with consideration for adjuvant proton beam radiotherapy. 2,3 After resection of clival chordoma, vascularized coverage of the ventral skull base is paramount to avoid complications such as cerebrospinal fluid (CSF) leak and meningitis, and this is typically achieved using a nasoseptal flap (NSF) at the time of initial surgery. 4 While the NSF is a popular initial reconstructive option, failure rates increase in the setting of skull base radiation; a study by Thorp and colleagues found that in 37 patients with anterior skull base defects reconstructed with NSF who underwent radiation, 10.8% developed osteoradionecrosis (ORN), 8.1% developed a CSF leak, 8.1% developed pneumocephalus, and 2.7% developed meninigitis.…”

Section: Introductionmentioning

confidence: 99%

Bilateral Inferior Turbinate Flaps for Salvage Reconstruction after Proton Beam Radiotherapy for Clival Chordoma

Crawford,

Saripella,

DeConde

et al. 2023

J Neurol Surg Rep

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Clival chordoma is a rare, aggressive, notochord-derived tumor primarily managed with surgery via an endoscopic endonasal approach (EEA) and adjuvant proton beam radiotherapy. Reconstruction is commonly performed with a nasoseptal flap (NSF) at the time of initial surgery. While failures of the NSF are rare, they can occur following the initial surgery or in the setting of osteoradionecrosis. Salvage repair typically requires transfer of alternative vascularized tissues outside of the previously radiated field including regional scalp flaps such as pericranial or temporoparietal fascial flaps, or free vascularized tissue transfer. Here we describe the case of a 29-year-old woman with a history of clival chordoma with widespread skull base osteomyelitis secondary to NSF necrosis after proton beam radiotherapy. We describe successful skull base reconstruction with intranasal bilateral inferior turbinate flaps based on the sphenopalatine artery with lateral nasal wall extension, despite prior proton beam therapy and a failed prior vascularized intranasal reconstruction.

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

Cited by 5 publications

References 22 publications

Systematic Review Comparing Open versus Endoscopic Surgery in Clival Chordomas and a 10-Year Single-Center Experience

Systematic Review Comparing Open versus Endoscopic Surgery in Clival Chordomas and a 10-Year Single-Center Experience

Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

Bilateral Inferior Turbinate Flaps for Salvage Reconstruction after Proton Beam Radiotherapy for Clival Chordoma

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