Introduction The endoscopic endonasal route has demonstrated to be the approach of choice for a large majority of clival chordomas (CCs). However, its results in elderly patients are under-evaluated in the literature. The aim of this study is to assess the surgical outcome for these patients, determining the factors associated with a larger tumor resection in this population. Materials and Methods Our institutional database of CC has been retrospectively reviewed, to identify all cases over 65 years old, operated through an endoscopic endonasal approach (EEA). Preoperative clinical and radiological features were considered, as well as surgical results, morbidity, and patients' outcome at follow-up. Results Out of our series of 143 endoscopic surgical procedures for CC, 34 (23.8%) were in patients older than 65 and 10 in older than 75 (7.0%). Gross tumor removal was achieved in 22 cases (64.7%). Complications consisted of 2 (5.9%) postoperative cerebrospinal leaks, 1 (2.9%) meningitis, 1 (2.9%) permanent cranial nerve VI palsy, 1 (2.9%) pneumonia, and 2 (5.9%) urinary infections. In 39.1% of cases, the preoperative ophthalmoplegia improved or resolved. Twenty-seven patients (79.4%) underwent radiation therapy. At follow-up (37.7 ± 44.9 months), 13 patients (38.2%) showed a recurrence/progression and 13 (38.3%) deceased. Conclusion EEA can be a useful approach in elderlies, balancing the large tumor removal with an acceptable morbidity rate, even if higher than that for general CC population. However, patient selection remains crucial. A multidisciplinary evaluation is important to assess not only their medical conditions, but also their social and familiar conditions.

中文翻译：

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内镜经鼻入路治疗老年患者斜坡脊索瘤：临床特征、患者结果和复发率

简介 内镜鼻内途径已被证明是大多数斜坡脊索瘤 (CC) 的首选方法。然而，文献中对其在老年患者中的结果评价不足。本研究的目的是评估这些患者的手术结果，确定与该人群中较大肿瘤切除术相关的因素。材料和方法 我们对 CC 机构数据库进行了回顾性审查，以确定所有 65 岁以上、通过内镜鼻内入路 (EEA) 手术的病例。考虑了术前的临床和放射学特征，以及手术结果、发病率和患者随访结果。结果 在我们的 143 例 CC 内窥镜手术中，34 例 (23.8%) 患者年龄超过 65 岁，10 例患者年龄超过 75 岁 (7.0%)。22例（64.7%）实现肉眼肿瘤切除。并发症包括 2 例（5.9%）术后脑脊漏、1 例（2.9%）脑膜炎、1 例（2.9%）永久性颅神经 VI 麻痹、1 例（2.9%）肺炎和 2 例（5.9%）尿路感染。39.1%的病例术前眼肌麻痹得到改善或缓解。27 名患者（79.4%）接受了放射治疗。随访（37.7±44.9个月）时，13名患者（38.2%）出现复发/进展，13名患者（38.3%）死亡。结论 EEA 对于老年人来说是一种有用的方法，可以在大肿瘤切除与可接受的发病率之间取得平衡，即使发病率高于一般 CC 人群。然而，患者的选择仍然至关重要。多学科评估不仅可以评估他们的医疗状况，还可以评估他们的社会和熟悉状况。