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J Neurol Surg B Skull Base
DOI: 10.1055/a-2198-9169
Original Article

Outcomes of the Endoscopic Endonasal Approach for the Treatment of Clival Chordomas: A Single-Center Experience

Ahmed Alsayed 
1   Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Abdulaziz S. Alrasheed
1   Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Saif Aljabab
2   Radiation Oncology Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Mohammad Alshareef
3   Department of Otolaryngology-Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushait, Saudi Arabia
,
Buthaina Jaber Yahya
4   Department of Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
,
Abdulmajeed Alharbi
1   Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Ahmad Alroqi
1   Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Hussain Albaharna 
5   Department of Otolaryngology-Head and Neck Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
,
Saud Alromaih
1   Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Yasir Alayed
2   Radiation Oncology Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Ashwag Alqurashi
6   Department of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Saad Alsaleh
1   Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Abdulrazag Ajlan
6   Department of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract

Objective Chordoma is a low-grade malignant tumor that originates from the remnant tissue of the embryonic notochord. Postoperative or definitive radiotherapy (RT) has been used to enhance local control. This study aims to assess the outcomes of the expanded endoscopic endonasal approach (EEA) for maximal removal of clival chordomas followed by RT for visualized residual or tumor recurrence.

Materials and Methods A retrospective review was performed on consecutive patients with clival chordoma who underwent endoscopic endonasal resection in the otorhinolaryngology and neurosurgery departments, between 2016 and 2021. We included all patients with pathologically confirmed clival chordoma who were treated using the EEA. Patients who underwent combined external and endoscopic approaches or transcranial surgery were excluded.

Results Seventeen patients were included in this study. Most of them had tumors located in the middle clivus. Regarding RT, the majority of patients underwent postoperative RT. Almost half of them underwent CyberKnife (CK) RT. None of them had severe toxicities (grade 3 or higher). Three patients died, resulting in a mortality rate of 17.6% none of them related to radiation side effect. The 2-year overall survival was 82.4% (mean standard error [SE] = 1.765, 95% confidence interval [CI] = 1.505–2.024), and the progression-free survival (PFS) was 76.5% (mean SE = 3.403, 95% CI = 2.791–4.016). No distal metastasis was reported in our series.

Conclusion This series demonstrates that expanded endoscopic endonasal approach (EEA) for the resection of skull base chordomas, followed by CyberKnife radiosurgery, presents a viable alternative to proton beam therapy; however, further research is necessary to directly compare these modalities.

Keywords

chordoma - endoscopic endonasal approach - clivus - skull base - radiotherapy


Publication History

Received: 19 July 2023

Accepted: 18 October 2023

Accepted Manuscript online:
26 October 2023

Article published online:
04 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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