title: OUTCOME OF CLIVAL CHORDOMAS AFTER SKULL BASE SURGERIES WITH MEAN FOLLOW-UP OF 10 YEARS.
abstract: OBJECTIVE
  Skull base chordomas are clinically malignant because of the difficulty of total removal, high recurrence rate, and occasional drop metastasis. Although aggressive surgical resection and postoperative radiation have been recommended, the long-term outcome remains unsatisfactory.
  
  
  METHODS
  From 1992 to 2011, we treated 24 patients with skull base chordoma using aggressive surgical removal as a principal strategy. Skull base approaches were selected according to tumor extension to remove the tumor and surrounding bone as completely as possible. After surgery, all patients were closely observed with MRI to find small and localized recurrent tumors, which were treated with gamma-knife radiosurgery or surgical resection. The mean postoperative follow-up duration was 10.2 years (range, 1-17.2 years).
  
  
  RESULTS
  The 5-, 10-, and 15-year overall survival rates were 86%, 72%, and 72%, respectively. The 5- and 10-year progression-free survival rates were 47% and 35%, respectively. Tumor extension to the brainstem and partial tumor removal were the factors related to poor survival.
  
  
  CONCLUSIONS
  Our results suggest that aggressive surgical removal improves the long-term outcome of patients with skull base chordoma. We would like to emphasize that skull base chordomas should be aggressively removed using various skull base approaches.
authors.affiliation: Department of Neurosurgery, Fukushima Medical University.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Tamura
authors.forename: Taku
authors.initials: T
authors.lastname: Sato
authors.forename: Yugo
authors.initials: Y
authors.lastname: Kishida
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ichikawa
authors.forename: Keiko
authors.initials: K
authors.lastname: Oda
authors.forename: Eiji
authors.initials: E
authors.lastname: Ito
authors.forename: Tadashi
authors.initials: T
authors.lastname: Watanabe
authors.forename: Jun
authors.initials: J
authors.lastname: Sakuma
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Saito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002817:Chordoma / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D019292:Skull Base Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult