gms | German Medical Science

Objective: Clivus chordomas are a rare tumor entity considered as low-grade malignancies. Treatment of choice encompasses radical surgical resection - if possible - followed by radiotherapy. Since the huge variety of tumor extension, different surgical approaches appear rational. Within the last ten years, however, coming along with the improved visual quality of the endoscopes, the transnasal endoscopic approach gained importance.

Methods: We retrospectively analyzed 69 surgical interventions in 49 patients with chordomas of the clivus between 2006-2019. We assessed tumor extension, the surgical approach, grade of surgical resection, neurological deficits prior and after surgery, and progression-free-survival in the primary and recurrent state.

Results: In 33 cases, we performed the primary surgery, in 36 cases, patients had already previous treatment. In primary cases, the most frequently used surgical approach was the navigation-guided transnasal endoscopic one (58%); in recurrences, however, the retrosigmoidal and the pterional approach dominated. Comparing the observation time between 2006-2012 versus 2012-2019, the endoscopic approach developed being the most dominant approach. In the group of primary surgery, we had no major complication; in recurrences, however, two patients had a post-operative hemorrhage and one was suffering from stroke. CSF leakage, as a minor complication, was seen in 11% of the entire cohort. In summary, we achieve progression-free survival over 5 years within 46%.

Conclusion: In surgical resection of clivus chordomas, the transnasal endoscopic approach has developed to the most preferred one, especially in primary surgery, however, considering the huge variety of tumor extension, alternative approaches are also necessary, especially in the recurrent state.