title: Endoscopic surgery of skull base chordomas.
abstract: Objective To assess our clinical experience in treating midline intracranial pathology using minimally invasive surgical techniques. Design Retrospective chart review of patients undergoing endoscopic endonasal resection of clival chordomas. Setting Two tertiary referral centers in Australia and New Zealand. Main Outcome Measures Patients were assessed by intraoperative findings (macroscopic resection rate, tumor size, and operative complications) and clinical outcomes (residual disease, postoperative complications, recurrence rate, and mortality). Results Fourteen patients underwent endoscopic resection of clival chordomas (seven primary, seven revision) with a mean follow-up of 41.45 months (3 to 104 months). Macroscopic resection rates were 71% and 29%, respectively. Mean operative time was 386 minutes. Overall cerebrospinal fluid (CSF) leak rate was 3/14 (21%) and, using the nasoseptal flap, it was 0/5 (0%). Two patients developed late recurrence; one died of disease and one was treated with intensity modulated radiation therapy. Overall mortality was 2/14 (14%). Conclusion Endoscopic resection of clival chordomas is a safe and viable alternative to the traditional open approach. The nasoseptal flap is an excellent method of obtaining a watertight skull base closure. Furthermore, this series highlighted the fact that the primary attempt at surgery offers the best chance to achieve a total resection.
authors.affiliation: Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, South Australia, Australia.
authors.forename: Neil C-W
authors.initials: NC
authors.lastname: Tan
authors.forename: Yuresh
authors.initials: Y
authors.lastname: Naidoo
authors.forename: Sakiko
authors.initials: S
authors.lastname: Oue
authors.forename: Hamish
authors.initials: H
authors.lastname: Alexander
authors.forename: Simon
authors.initials: S
authors.lastname: Robinson
authors.forename: Agadha
authors.initials: A
authors.lastname: Wickremesekera
authors.forename: Steve
authors.initials: S
authors.lastname: Floreani
authors.forename: Nick
authors.initials: N
authors.lastname: Vrodos
authors.forename: Steve
authors.initials: S
authors.lastname: Santoreneos
authors.forename: Eng
authors.initials: E
authors.lastname: Ooi
authors.forename: Matthew
authors.initials: M
authors.lastname: McDonald
authors.forename: Peter-John
authors.initials: PJ
authors.lastname: Wormald
keywords: chordoma; endonasal; endoscopic; minimally invasive; skull base; surgery