gms | German Medical Science

Objective: to evaluate clinical presentation, radiological features, surgical aspects and treatment results in a consecutive series of patients harbouring a clival chordoma.

Methods: Clinical, radiological, surgical and follow-up-data in a consecutive series of 22 patients operated between January 1989 and June 2007 in two neurosurgical institutions were retrospectively reviewed.

Results: The main presenting symptom in the 12 men and 10 women (mean age 49.7 yrs) was diplopia in 9 patients (40.9%). Clinical examination revealed palsy of the sixth and caudal cranial nerves in 6 (27.3%) patients each. Preoperative magnetic resonance imaging and bone window computed tomography scanning demonstrated involvement of the upper third of the clivus in 18 (81.8%), the middle third in 15 (68.2%) and lower third in 7 (31.8%) patients. Brainstem compression was present in 13 (59.1%) cases. Tumor resection was most commonly performed via the transsphenoidal route (50%). Postoperative radiological assessment revealed complete tumor resection in 7 (31.8%) patients. Adjuvant radiotherapy was administered in 14 (63.6%) cases. One patient died after surgery. The mean Karnofsky performance score in the remaining patients improved from 78 preoperatively to 84 after surgery. After a mean follow-up period of 47 months with clinical and radiological assessment, tumor progression was observed in 9 patients and tumor follow-up is being continued in 12 patients. Four patients underwent a second surgery for tumor recurrence.

Conclusions: Clival chordomas display a heterogeneous clinical behavior irrespective of the extent of surgical resection. Adjuvant radiotherapy with heavy particles apparently prolongs the progression-free survival.