title: The influence of skull base chordoma on lower urinary tract symptoms.
abstract: OBJECTIVE
  To provide the first insights into the potential role of skull base chordoma, which causes brainstem compression in and around Barrington's nucleus and its effect on the micturition center. Chordoma is a rare malignant bone tumor that originates from the remnants of the embryonic notochord, which normally forms and dissolves during early fetal development. Although it is a slowly growing tumor, it displays local invasive growth.
  
  
  METHODS
  Urodynamic testing of 22 symptomatic patients was performed. All women and men with skull base chordoma treated in 2 hospitals in Germany between 1986 and 2007 were studied. Follow-up periods ranged from 6 months to 10 years. Lower urinary tract symptoms were documented in patients with acute brainstem compression because of local chordoma growth.
  
  
  RESULTS
  Of 74 patients treated, 22 (7 women, 15 men) with a median age of 37 years were evaluated with voiding diaries and computer urodynamic investigation. Urodynamic testing of 22 symptomatic patients revealed detrusor overactivity in 55%, low compliance bladder in 14%, detrusor-sphincter dyssynergia in 45%, and uninhibited sphincter relaxation in 27%. Despite the description of incomplete emptying and urgency, 4 patients had normal urodynamic findings (18%). Brain magnetic resonance images of the lesions of the symptomatic patients were obtained to determine the side of lesions.
  
  
  CONCLUSIONS
  The dorsolateral pons, including pontine reticular nucleus and the reticular formation and the locus coeruleus, seems to be mainly responsible for lower urinary tract symptoms in our patients with skull base chordoma and brainstem compression.
authors.affiliation: Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University Göttingen, Germany. Electronic address: rasigari@yahoo.de.
authors.forename: R
authors.initials: R
authors.lastname: Akhavan-Sigari
authors.affiliation: Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Abili
authors.affiliation: Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University Göttingen, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Rohde
authors.affiliation: Department of Urology, Hannover Medical School, Hannover, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Tezval
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000150:complications / Q000503:physiopathology*; D001933:Brain Stem / Q000473:pathology; D002817:Chordoma / Q000150:complications / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000150:complications*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D053158:Nocturia / Q000150:complications; D009672:Notochord / Q000473:pathology; D011149:Pons / Q000473:pathology; D019291:Skull Base / Q000473:pathology*; D011795:Surveys and Questionnaires; D001743:Urinary Bladder / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000150:complications; D014549:Urinary Incontinence / Q000150:complications; D016055:Urinary Retention / Q000150:complications; D014554:Urination; D014555:Urination Disorders / Q000150:complications; D014563:Urodynamics; D055815:Young Adult