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Surgical resection of skull-base chordomas: experience in case selection for surgical approach according to anatomical compartments and review of the literature

  • Clinical Article - Brain Tumors
  • Published:
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Abstract

Background

Chordoma is a rare bony malignancy known to have a high rate of local recurrence after surgery. The best treatment paradigm is still being evaluated. We report our experience and review the literature. We emphasize on the difference between endoscopic and open craniotomy in regard to the anatomical compartment harboring the tumor, the limitations of the approaches and the rate of surgical resection.

Method

We retrospectively collected all patients with skull-base chordomas operated on between 2004 and 2014. Detailed radiological description of the compartments being occupied by the tumor and the degree of surgical resection is discussed.

Results

Eighteen patients were operated on in our facility for skull-base chordoma. Seventeen endoscopic surgeries were done in 15 patients, and 7 craniotomies were done in 5 patients. The mean age was 48.9 years (±19.8 years). When reviewing the anatomical compartments, we found that the most common were the upper clivus (95.6%) and lower clivus (58.3%), left cavernous sinus (66.7%) and petrous apex (∼60%). Most of the patients had intradural tumor involvement (70.8%). In all craniotomy cases, there was residual tumor in multiple compartments. In the endoscopic cases, the most difficult compartments for total resection were the lower clivus, and lateral extensions to the petrous apex or cavernous sinus.

Conclusions

Our experience shows that the endoscopic approach is a good option for midline tumors without significant lateral extension. In cases with very lateral or lower extensions, additional approaches should be added trying to achieve complete resection.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Tel-Aviv Medical Center, 6 Weizman Street, Tel-Aviv, 6423906, Israel

    Nir Shimony, Lior Gonen, Ben Shofty & Nevo Margalit

  2. Department of Otolaryngology–Head and Neck Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel

    Avraham Abergel & Dan M. Fliss

Authors
  1. Nir Shimony
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  2. Lior Gonen
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  3. Ben Shofty
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  4. Avraham Abergel
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  6. Nevo Margalit
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Corresponding author

Correspondence to Nevo Margalit.

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Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This is a retrospective study, for which formal consent is not required.

Disclosures

There are no prior publications or submissions with any overlapping information, including studies and patients.

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Shimony, N., Gonen, L., Shofty, B. et al. Surgical resection of skull-base chordomas: experience in case selection for surgical approach according to anatomical compartments and review of the literature. Acta Neurochir 159, 1835–1845 (2017). https://doi.org/10.1007/s00701-016-3032-9

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  • DOI: https://doi.org/10.1007/s00701-016-3032-9

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