A Comparative Study Between Traditional Microscopic Surgeries and Endoscopic Endonasal Surgery for Skull Base Chordomas

Oishi Yumiko Oishi, Ryota Tamura, Satoshi Takahashi, Yukina Morimoto, Mizuto Sato, Tomo Horikoshi, Shady Hassaan, Kazunari Yoshida, Masahiro Toda

Research output: Contribution to journalArticle

Abstract

Background: Skull base chordomas (SBCs) are rare clinically aggressive neoplasms, developing local recurrences after surgical resection. Although SBCs have traditionally been resected by craniotomy or microscopic transsphenoidal surgery (TSS), the recent development of the endoscopic endonasal approach (EEA) has revolutionized treatment strategies through minimally invasive techniques. This study aimed to evaluate clinical outcomes after traditional microsurgeries or EEAs for SBCs. Methods: The present retrospective study investigated 66 patients with primary SBCs who underwent surgery between 1977 and 2019. Resection was performed via EEA in 17 cases, craniotomy in 23, transoral approach in 8, TSS in 12, staged surgery in 4, and others in 2. The median follow-up period for progression-free survival (PFS) was 19.5 months. Results: There were no significant differences in preoperative tumor volume or resection rate among these approaches. The incidence of postoperative cranial nerve palsy was significantly lower in EEA than that in craniotomy (P < 0.05). Although total resection was observed in 4 cases of EEA expanding into the superior and inferior part of the clivus, no cases of transoral approach or TSS achieved total resection for both parts. No significant difference in PFS was found among these approaches. Multivariate analysis showed that being female and the absence of radiotherapy were significantly associated with shorter PFS (P < 0.05 and P < 0.001, respectively). The resection rate was not associated with PFS. Conclusions: EEA is a less invasive surgical approach for SBCs. The development of surgical instruments and postoperative radiotherapy will further improve patients' outcomes.

Original languageEnglish
JournalWorld neurosurgery
DOIs
Publication statusAccepted/In press - 2019 Jan 1

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Chordoma
Skull Base
Disease-Free Survival
Craniotomy
Local Neoplasm Recurrences
Radiotherapy
Posterior Cranial Fossa
Cranial Nerve Diseases
Microsurgery
Tumor Burden
Surgical Instruments
Multivariate Analysis
Retrospective Studies
Incidence

Keywords

  • Chordoma
  • Clivus
  • Endoscopic endonasal approach
  • Skull base

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

A Comparative Study Between Traditional Microscopic Surgeries and Endoscopic Endonasal Surgery for Skull Base Chordomas. / Yumiko Oishi, Oishi; Tamura, Ryota; Takahashi, Satoshi; Morimoto, Yukina; Sato, Mizuto; Horikoshi, Tomo; Hassaan, Shady; Yoshida, Kazunari; Toda, Masahiro.

In: World neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

Yumiko Oishi, Oishi ; Tamura, Ryota ; Takahashi, Satoshi ; Morimoto, Yukina ; Sato, Mizuto ; Horikoshi, Tomo ; Hassaan, Shady ; Yoshida, Kazunari ; Toda, Masahiro. / A Comparative Study Between Traditional Microscopic Surgeries and Endoscopic Endonasal Surgery for Skull Base Chordomas. In: World neurosurgery. 2019.
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AU - Yumiko Oishi, Oishi

AU - Tamura, Ryota

AU - Takahashi, Satoshi

AU - Morimoto, Yukina

AU - Sato, Mizuto

AU - Horikoshi, Tomo

AU - Hassaan, Shady

AU - Yoshida, Kazunari

AU - Toda, Masahiro

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N2 - Background: Skull base chordomas (SBCs) are rare clinically aggressive neoplasms, developing local recurrences after surgical resection. Although SBCs have traditionally been resected by craniotomy or microscopic transsphenoidal surgery (TSS), the recent development of the endoscopic endonasal approach (EEA) has revolutionized treatment strategies through minimally invasive techniques. This study aimed to evaluate clinical outcomes after traditional microsurgeries or EEAs for SBCs. Methods: The present retrospective study investigated 66 patients with primary SBCs who underwent surgery between 1977 and 2019. Resection was performed via EEA in 17 cases, craniotomy in 23, transoral approach in 8, TSS in 12, staged surgery in 4, and others in 2. The median follow-up period for progression-free survival (PFS) was 19.5 months. Results: There were no significant differences in preoperative tumor volume or resection rate among these approaches. The incidence of postoperative cranial nerve palsy was significantly lower in EEA than that in craniotomy (P < 0.05). Although total resection was observed in 4 cases of EEA expanding into the superior and inferior part of the clivus, no cases of transoral approach or TSS achieved total resection for both parts. No significant difference in PFS was found among these approaches. Multivariate analysis showed that being female and the absence of radiotherapy were significantly associated with shorter PFS (P < 0.05 and P < 0.001, respectively). The resection rate was not associated with PFS. Conclusions: EEA is a less invasive surgical approach for SBCs. The development of surgical instruments and postoperative radiotherapy will further improve patients' outcomes.

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