Chordomas and Chondrosarcomas of the Clivus

Abstract

Objective: To report chordomas and chondrosarcoma cases treated with endoscopic assisted transnasal transclival approach.

Method: Retrospective case series of 26 patients with clivus chordomas and 2 patient with chondrosarcoma, treated between 1996 and 2011 at a tertiary referral center using the endoscopic assisted transnasal-transclival approach. The extension of the surgical procedure was classified in gross-total, subtotal and partial resection. Eighteen were primary cases and 10 had previous operation. The most common symptoms was diplopia (VI nerve palsy: 61%), all regions involved by the tumor were reported. Patients were submitted to endoscopic assisted transnasal-transclival (TN-TC) approach with or without transpterygoidal (TP) approach. Four patients were also submitted to petrous approach.

Results: In patients who presented chordomas/chondrosarcomas (28 cases), range of surgical resection was: in 14 patients (50%) gross total resection, in 7 (25%) subtotal removal, and in 7 (25%) partial removal. In 10 cases there was tumor extension to posterior fossa, and 6 cases achieved gross total resection. Postoperative complications were: CSF leak (6 cases), 5 of them before using the nasal septal flap. Meningitis (3 cases). Pneumoencephalus (2) and 3 deaths.

Conclusion: Endoscopic assisted transnasal surgery is an alternative way to treat these cases and in expert hands this technique can obtain good results. The extent of resection was better in cases without previous surgery than in reoperation cases. Posterior fossa invasion was not a restriction factor to gain a gross total resection, using this technique. Complication as CSF leak dropped dramatically after skull base reconstruction using the triple “F”(fat, fascia and nasal septal flap).