gms | German Medical Science

Objective: Clival chordoma surgical treatment is very challenging. Endoscopic endonasal resection is nowadays considered the best approach for clival chordoma surgical removal. In a surgical setting surrounded by optic chiasm, cavernous sinus, basilar arteries and eloquent cerebral areas, the depth perception offered by new 3D endoscopes is helpful to better understand anatomical landmarks.

However it is still under debate if 3D endoscopy can open new perspective in the surgical management of clival chordomas compared to 2D endoscopy. To shed some more light on this hot topic we report our preliminary experience in endoscopic transnasal resection of clival chordomas with the 3D endoscope.

Method: 10 patients affected by clival chordomas underwent 11 endoscopic endonasal resections of the tumor with 3D endoscope between January 2012 and June 2014 at Neurosurgery division of Molinette hospital, Torino.

Presentation symptoms, tumor extension, degree of resection, intraoperative complication, post operative new onset neurological deficits, CSF leak rate, duration of surgery and length of hospital stay were evaluated.

Besides ENT surgeons and Neurosurgeons were asked to perform a qualitative and comparative evaluation of the 3D vision system vs. the conventional 2D one.

Results: Gross total resection was achieved in 5/11 interventions, NTR in 3/11, STR in 0/11 and PR in 3/11.

We had no major vascular complication nor a new permanent neurological complication. Cerebrospinal fluid leak (CSF) rate was 18.2% (2/11).

Perioperative mortaliy rate was 0%. One patient complained mild hypoosmia after surgery that solved within 3 months. One patient developed post operative panhypopituitarism. The qualitative assessment of 3D technology, performed at the end of each surgical procedure, showed an improvement of depth and size perception, of anatomical structures identification and of hand-eye coordination.

Conclusions: In our experience the use of 3D technology intraoperatively was helpful in recognizing anatomical landmark, allowed easy bleeding control and improved hand-eye coordination. Beside the sharp dissection usually performed with the microscope is easily accomplished with the depth perception.

However our consideration are based on a small number of patients therefore further studies are needed to demonstrate if the 3D intra-operative view can open new perspective in endoscopic removal of clival chordoma. Moreover several issues are still open in terms of quality of 3D images.