A watch, wait, and rescan approach for incidental benign-appearing notochordal lesions of the skull base

IF 3 2区医学 Q2 CLINICAL NEUROLOGY Neurosurgical focus Pub Date : 2024-05-01 DOI:10.3171/2024.2.focus23912

Inga E. Usher, Evangelos Drosos, Abdalla Morsy, Andrea Wadeson, Roger Laitt, Sarah Abdulla, Aparna Madhavan, Jane Halliday, Scott Rutherford, Andrew T. King, Omar N. Pathmanaban

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Abstract

OBJECTIVE

The aim of this study was to describe the natural history of incidental benign-appearing notochordal lesions of the skull base with specific attention to features that can make differentiation from low-grade chordoma more difficult, namely contrast uptake and bone erosion.

METHODS

In this retrospective case series, the authors describe the clinical outcomes of 58 patients with incidental benign-appearing notochordal lesions of the clivus, including those with minor radiological features of bone erosion or contrast uptake.

RESULTS

All lesions remained stable during a median follow-up of almost 3 years. Thirty-seven (64%) patients underwent contrast-enhanced MRI; lesions in 14 (38%) of these patients exhibited minimal contrast enhancement. Twenty-seven (47%) patients underwent CT; lesions in 6 (22%) of these patients exhibited minimal bone erosion.

CONCLUSIONS

These data make the case for monitoring selected cases of benign-appearing notochordal lesions of the clivus in the first instance even when there is minor contrast uptake or minimal bone erosion.

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对颅底偶然出现的良性脊索瘤病变采取观察、等待和重新扫描的方法

目的：本研究旨在描述颅底偶发良性脊索瘤病变的自然病史，特别关注那些可能导致与低级别脊索瘤更难鉴别的特征，即对比剂摄取和骨侵蚀。方法在这一回顾性病例系列中，作者描述了 58 例颅底偶然出现的良性脊索瘤病变患者的临床结果，包括那些具有骨侵蚀或造影剂摄取等轻微放射学特征的患者。结果在近 3 年的中位随访期间，所有病变均保持稳定。37例（64%）患者接受了造影剂增强磁共振成像检查；其中14例（38%）患者的病变显示出最小的造影剂增强。结论：这些数据表明，即使造影剂摄取较少或骨侵蚀程度较轻，也应首先对某些看似良性的梭形细胞病变病例进行监测。

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