Endoscopic resection of chordomas in different clival regions.
CONCLUSIONS
The endoscopic approaches developed for the treatment of the chordomas according to the different clival location provide the possibility for more complete tumor resection with maximal preservation of anatomic structures and reduction of the overall incidence of complications.


OBJECTIVE
The endoscope has recently been applied in patients with chordomas, but rare studies report the various endoscopic approaches in the treatment of chordomas in the different regions of clivus. In this study, the authors present their experience with these techniques in patients with chordomas.


METHODS
Four chordomas in the upper-middle clivus underwent an endoscopic transseptal transsphenoidal (ETT) approach. Five macro-chordomas involving whole clivus underwent an extended ETT approach. Three chordomas in the lower clivus underwent an endoscopic transoropharyngeal (ETOP) approach. The surgical access points were designed for each patient. After safe planes were identified along the surgical access points, the tumor was fractionally removed.


RESULTS
Seven gross total, four subtotal, and one partial resection were achieved after surgery. At 6 months to 3 years follow-up, eight patients were recurrence-free and two patients had unchanged residual tumor. One patient with recurrent chordoma underwent second surgery and subsequent intensity modulated radiation therapy (IMRT). The other patient with a recurrent chordoma died 1 year postoperation.
Hong Jiang
Wei
W
Department of Otolaryngology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China. jiangwh68@126.com
Ping Zhao
Su
S
Hai Xie
Zhi
Z
Zhang
Hua
H
Zhang
Junyi
J
Yun Xiao
Jian
J
D000293:Adolescent; D000328:Adult; D002817:Chordoma / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications / Q000175:diagnosis; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed