Endoscopic endonasal approach for skull base chordoma

Ahmed Youssef, Haitham Morsi, Remon Bazak, Ahmed Aly Ibrahim, Ahmed Farhoud, Mohamed M. Agamy
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Abstract

Chordoma is a rare slow-growing malignant bone tumor that arises from embryonic notochordal remnants in the axial skeleton. Clival chordomas have a high propensity for extension through the skull base and a high proclivity for recurrence. Recently, resection of skull base chordomas through the endoscopic transnasal approach has become the standard way of managing these lesions with the new advancements in neuronavigation and reconstructive techniques in skull base surgery. It is a retrospective study of all patients with clival chordoma that were operated upon using endoscopic endonasal resection at the Main Alexandria University Hospital during the period from March 2008 to April 2013. The extent of surgical resection was assessed intraoperatively and confirmed by the postoperative MRI study performed 8–12 weeks, 6 months, and yearly after the surgery. Twelve patients with clival chordoma were managed by endoscopic transnasal resection. Gross total resection confirmed by postoperative MRI was achieved in four cases, subtotal resection in six cases, and partial resection in two cases of clival chordoma. In cases where gross total resection was not achieved, residual tumors were adherent to vital neurovascular structures as confirmed with the utilization of an intraoperative imaging navigation device. A study of postoperative complications and possible recurrence was done for all cases. The findings of this study highlight the significance of gross total resection as a major determinant for preventing the recurrence of chordoma. Our findings also support the validity of the endoscopic approach for the management of clival chordoma especially when the approach is tailored based on the site and extent of the tumor.
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颅底脊索瘤的内窥镜鼻内入路治疗
脊索瘤是一种罕见的生长缓慢的恶性骨肿瘤,起源于轴状骨骼中的胚胎脊索残基。簇状脊索瘤极易向颅底扩展,复发率高。最近,随着颅底外科神经导航和重建技术的新进展,通过内窥镜经鼻入路切除颅底脊索瘤已成为处理这些病变的标准方法。这是一项回顾性研究,研究对象是2008年3月至2013年4月期间在亚历山大大学主医院使用内窥镜经鼻切除术治疗的所有蝶骨脊索瘤患者。手术切除的范围在术中进行评估,并通过术后 8-12 周、6 个月和一年的核磁共振成像检查进行确认。12名患有簇状脊索瘤的患者接受了内窥镜经鼻切除术。经术后磁共振成像确认,4 例实现了全切,6 例实现了次全切,2 例实现了部分切除。在未实现全切除的病例中,术中使用成像导航设备证实残留肿瘤与重要的神经血管结构粘连。对所有病例的术后并发症和可能的复发进行了研究。这项研究的结果强调了全切的重要性,这是防止脊索瘤复发的主要决定因素。我们的研究结果还证明了内窥镜方法在治疗簇状脊索瘤方面的有效性,尤其是根据肿瘤的部位和范围量身定制的方法。
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