Introduction: The treatment of skull base chordomas represents a surgical challenge because of the location, invasiveness and tumor extension. In the last decade, endoscopic endonasal surgery (EES) has been employed in our Department with notable outcomes.
Methods: From April 2003 to March 2013, 90 patients underwent EES for skull base chordomas at the University of Pittsburgh Medical Center. We evaluated the degree of resection, complications and recurrence rates following EES.
Results: Ninety patients (61% male) with a mean age of 45 years (range 4-88) underwent EES for primary (n=62) or recurrent (n=28) skull base chordomas. The overall rate of gross total resection (GTR) was 69% (81% in primary and 43% in recurrent cases). Near total resection (>95% of tumor) was achieved in 15%, subtotal (>85%) in 7% and partial in 9% of the patients. The most frequent complication was cerebrospinal fluid leak in 18 cases (20%) resulting in meningitis in 3.3%. Neurological complications included new cranial neuropathies in 4 cases (4.4%) and pontine hemorrhage in one patient. Carotid injuries occurred in 3 cases without any resulting deficit. There was no operative mortality in our series. Following EES, 48 patients (53%) received radiation therapy (proton beam in 39 cases). During a mean follow-up of 25 months (range 1-91), the tumor recurrence rate was 34% (26% after GTR and 54% after non-GTR) and most of these cases (74%) underwent repeat EES. The recurrence free period varied from 1 to 57 months (mean 15 months). In the most recent follow-up, 54 patients (60%) remain free of tumor and 11 (12%) have died due to disease progression.
Conclusions: EES represents a competitive alternative to craniotomies for the treatment of skull base chordomas with minimal morbidity and high rates of GTR when performed by an experienced skull base surgical team.
Patient Care: Provide surgical outcomes in 10-year experience of a relatively new technique for the treatment of skull base chordomas. Prove the efficacy of endoscopic endonasal surgery in the treatment of these tumors. Popularize a surgical approach that shows very high tumor resection rates with minimal complications so that more neurosurgeons start providing this treatment option to their patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of EES in the treatment of clival chordomas. 2) Discuss the advent of endoscopic technologies and techniques that facilitates maximum tumor resection with minimal complications compared to open approaches. 3) Identify an effective treatment in the management of skull base chordomas.