J Neurol Surg B Skull Base 2012; 73 - A173
DOI: 10.1055/s-0032-1314091

Endoscopic Endonasal Surgery for Skull Base Chordomas

M. Koutourousiou 1(presenter), M. J. Tormenti 1, A. Paluzzi 1, S. L. Henry 1, C. D. Pinheiro-Neto 1, E. W. Wang 1, J. C. Fernandez-Miranda 1, C. H. Snyderman 1, P. A. Gardner 1
  • 1Pittsburgh, Pennsylvania, USA

Objective: Gross total resection (GTR) 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 with notable outcomes.

Design: We present the results of EES and analyze the factors that influence the outcome of this technique.

Methods: From April 2003 to March 2011, 60 patients underwent EES for primary (n = 35) or previously treated (n = 25) skull base chordomas. We retrospectively reviewed their medical files and imaging studies and evaluated the degree of GTR and complications.

Results: The overall rate of GTR of skull base chordomas was 66.7% (82.9% in primary and 44% in previously treated cases). The most important limitations for GTR were tumor volume >20 cm (P = 0.042), tumor location in the lower clivus with lateral extension (P = 0.022), and previously treated disease (P = 0.002). The learning curve had a significant impact on GTR, increasing the rate to 88.9% (92.6% in primary cases, 63.6% in previously treated) during recent years (P < 0.0001). The most frequent complication was cerebrospinal fluid leak in 12 cases (20%) resulting in meningitis in 2 (3.3%). Carotid injuries occurred in two cases (3.3%) without any resulting deficit. Neurological complications included new cranial neuropathies in four patients (6.7%). There was no operative mortality in our series.

Conclusions: For the treatment of skull base chordomas, EES represents a competitive alternative to transcranial approaches with minimal morbidity and high rates of GTR when performed by experienced skull base surgeons.