title: Endoscopic endonasal approach for clival chordomas.
abstract: OBJECTIVE
  Cranial base chordomas are difficult lesions to treat. The endoscopic endonasal approach (EEA) takes advantage of the natural sinus corridor and may provide a less invasive approach for these midline tumors.
  
  
  METHODS
  Patients undergoing EEA for chordomas were selected from a database of more than 800 consecutive patients undergoing EEA at the University of Pittsburgh Medical Center and were retrospectively evaluated. Additionally, a systematic review of the literature of endoscopic endonasally resected chordomas was performed and compared with our personal experience.
  
  
  RESULTS
  Twenty patients (8 females and 12 males) underwent 26 endoscopic EEAs for cranial base chordomas. Eight chordomas (40%) were recurrent. Treatment of the 12 newly diagnosed chordomas included 8 total resections (66.7%), 2 near total resections (16.7%), and 2 subtotal resections (16.7%). Treatment of the 8 recurrent chordomas included 1 gross total resection (12.5%), 2 near total resections (25.0%), and 5 subtotal resections (62.5%). Two patients (10%) had recurrences, and 5 patients (25%) progressed during the mean follow-up period of 13 months (range, 1-45 months). Five patients (25%) underwent re-resection, 1 patient was lost to follow-up, and 1 patient died secondary to progression of disease. There was 1 intraoperative vascular complication with no sequelae. The cerebrospinal fluid leak rate was 25%, and there were no cases of bacterial meningitis. The incidence of a new permanent neurological complication was 5%. A systematic review of the literature yielded a total of 26 cases of chordomas resected via a completely endoscopic endonasal technique.
  
  
  CONCLUSIONS
  Endoscopic endonasal resection of cranial base chordomas is safe once adequate experience is gained with the technique. This approach provides the potential for, at the least, similar resections compared with traditional cranial base approaches while potentially limiting morbidity.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Martina
authors.initials: M
authors.lastname: Stippler
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gardner
authors.forename: Carl H
authors.initials: CH
authors.lastname: Snyderman
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Carrau
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Prevedello
authors.forename: Amin B
authors.initials: AB
authors.lastname: Kassam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002817:Chordoma / Q000401:mortality* / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D004724:Endoscopy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D010414:Pennsylvania / Q000453:epidemiology; D012888:Skull Neoplasms / Q000401:mortality* / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult