title: Repeat operations in the management of clival chordomas: palliative surgery.
abstract: Some chordomas have a very poor prognosis because of their aggressive growth nature, but the efficacy of repeat operations for these cases has not been well documented. This report concerns 3 patients with aggressive chordoma of the clivus, who underwent operations 6 to 12 times over a period of 8 to 17 years because of symptomatic regrowth. Overall mean interval between repeat operations was 18 months with a range from 5 to 57 months and survival times were 9 to19 years after the first surgery. Main symptoms before each operation were diplopia and visual disturbance. Repeat palliative operations by intentional extradural debulking of the tumour to decompress offending neural structures, as well as maximal removal of the tumour, using appropriate skull base approaches, can mitigate progressive symptoms, and may result in better quality and some prolongation of life, although our patients gradually deteriorated neurologically throughout the clinical course.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan. kakyosh@hsp.md.shinshu-u.ac.jp
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kyoshima
authors.forename: Susumu
authors.initials: S
authors.lastname: Oikawa
authors.forename: Miki
authors.initials: M
authors.lastname: Kanaji
authors.forename: Hideo
authors.initials: H
authors.lastname: Zenisaka
authors.forename: Takeomi
authors.initials: T
authors.lastname: Takizawa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Goto
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Takasawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tokushige
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sakai
mesh_terms: D002817:Chordoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D003388:Cranial Fossa, Posterior / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D010166:Palliative Care / Q000379:methods*; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data*; D019292:Skull Base Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery