Transoral vs. endoscopic endonasal approach for clival/upper cervical chordoma

Satoka Shidoh, Masahiro Toda, Takeshi Kawase, Hideo Nakajima, Toshiki Tomita, Kaoru Ogawa, Kazunari Yoshida

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

The surgical results of 18 cases of clival/upper cervical chordoma treated in the last decade via the endoscopic endonasal approach (EEA, 9 cases) and the transoral-transpalatal approach (TO-TPA, 9 cases) were compared. Each group showed the same incidence of subdural invasion, with 5 cases each. The superior (frontal base) and lateral surgical fields were wider by EEA, but the inferior view lower than the cranio-vertebral junction (CVJ) was wider by TO-TPA. Gross total removal was achieved in 3 cases in the EEA group, but in only 1 case in the TO-TPA group. Differences in radicality might be due to the extent of the lateral and subdural overview. However for large tumors extending below the CVJ, TO-TPA was the only viable approach for surgical removal. Surgical complications were higher in the EEA (4 cases) than the TO-TPA group (1 case), and were mainly caused by aggressive management of subdural invasion in the EEA group. Post-operative oral intake was earlier and the operative time was shorter in the EEA group. The surgical results were more radical and less invasive in the EEA group than the TO-TPA group. However in tumors extending below the CVJ, the surgical field in EEA was limited, indicating the need to use the transoral route or a combination of routes. A higher complication rate following subdural management was a negative factor that requires improvement in the EEA group and two-staged EEA followed by a transcranial approach may be considered for the cases with subdural invasion.

Original languageEnglish
Pages (from-to)991-998
Number of pages8
JournalNeurologia Medico-Chirurgica
Volume54
Issue number12
DOIs
Publication statusPublished - 2014 Dec 15

Fingerprint

Chordoma
Operative Time
Neoplasms
Incidence

Keywords

  • Cranio-vertebral junction
  • Endoscopic endonasal approach
  • Transoral approach
  • Transpalatal approach

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Transoral vs. endoscopic endonasal approach for clival/upper cervical chordoma. / Shidoh, Satoka; Toda, Masahiro; Kawase, Takeshi; Nakajima, Hideo; Tomita, Toshiki; Ogawa, Kaoru; Yoshida, Kazunari.

In: Neurologia Medico-Chirurgica, Vol. 54, No. 12, 15.12.2014, p. 991-998.

Research output: Contribution to journalArticle

Shidoh, Satoka ; Toda, Masahiro ; Kawase, Takeshi ; Nakajima, Hideo ; Tomita, Toshiki ; Ogawa, Kaoru ; Yoshida, Kazunari. / Transoral vs. endoscopic endonasal approach for clival/upper cervical chordoma. In: Neurologia Medico-Chirurgica. 2014 ; Vol. 54, No. 12. pp. 991-998.
@article{8403cfec23d4427986096ccf55c82b0b,
title = "Transoral vs. endoscopic endonasal approach for clival/upper cervical chordoma",
abstract = "The surgical results of 18 cases of clival/upper cervical chordoma treated in the last decade via the endoscopic endonasal approach (EEA, 9 cases) and the transoral-transpalatal approach (TO-TPA, 9 cases) were compared. Each group showed the same incidence of subdural invasion, with 5 cases each. The superior (frontal base) and lateral surgical fields were wider by EEA, but the inferior view lower than the cranio-vertebral junction (CVJ) was wider by TO-TPA. Gross total removal was achieved in 3 cases in the EEA group, but in only 1 case in the TO-TPA group. Differences in radicality might be due to the extent of the lateral and subdural overview. However for large tumors extending below the CVJ, TO-TPA was the only viable approach for surgical removal. Surgical complications were higher in the EEA (4 cases) than the TO-TPA group (1 case), and were mainly caused by aggressive management of subdural invasion in the EEA group. Post-operative oral intake was earlier and the operative time was shorter in the EEA group. The surgical results were more radical and less invasive in the EEA group than the TO-TPA group. However in tumors extending below the CVJ, the surgical field in EEA was limited, indicating the need to use the transoral route or a combination of routes. A higher complication rate following subdural management was a negative factor that requires improvement in the EEA group and two-staged EEA followed by a transcranial approach may be considered for the cases with subdural invasion.",
keywords = "Cranio-vertebral junction, Endoscopic endonasal approach, Transoral approach, Transpalatal approach",
author = "Satoka Shidoh and Masahiro Toda and Takeshi Kawase and Hideo Nakajima and Toshiki Tomita and Kaoru Ogawa and Kazunari Yoshida",
year = "2014",
month = "12",
day = "15",
doi = "10.2176/nmc.st.2014-0135",
language = "English",
volume = "54",
pages = "991--998",
journal = "Neurologia Medico-Chirurgica",
issn = "0470-8105",
publisher = "Japan Neurosurgical Society",
number = "12",

}

TY - JOUR

T1 - Transoral vs. endoscopic endonasal approach for clival/upper cervical chordoma

AU - Shidoh, Satoka

AU - Toda, Masahiro

AU - Kawase, Takeshi

AU - Nakajima, Hideo

AU - Tomita, Toshiki

AU - Ogawa, Kaoru

AU - Yoshida, Kazunari

PY - 2014/12/15

Y1 - 2014/12/15

N2 - The surgical results of 18 cases of clival/upper cervical chordoma treated in the last decade via the endoscopic endonasal approach (EEA, 9 cases) and the transoral-transpalatal approach (TO-TPA, 9 cases) were compared. Each group showed the same incidence of subdural invasion, with 5 cases each. The superior (frontal base) and lateral surgical fields were wider by EEA, but the inferior view lower than the cranio-vertebral junction (CVJ) was wider by TO-TPA. Gross total removal was achieved in 3 cases in the EEA group, but in only 1 case in the TO-TPA group. Differences in radicality might be due to the extent of the lateral and subdural overview. However for large tumors extending below the CVJ, TO-TPA was the only viable approach for surgical removal. Surgical complications were higher in the EEA (4 cases) than the TO-TPA group (1 case), and were mainly caused by aggressive management of subdural invasion in the EEA group. Post-operative oral intake was earlier and the operative time was shorter in the EEA group. The surgical results were more radical and less invasive in the EEA group than the TO-TPA group. However in tumors extending below the CVJ, the surgical field in EEA was limited, indicating the need to use the transoral route or a combination of routes. A higher complication rate following subdural management was a negative factor that requires improvement in the EEA group and two-staged EEA followed by a transcranial approach may be considered for the cases with subdural invasion.

AB - The surgical results of 18 cases of clival/upper cervical chordoma treated in the last decade via the endoscopic endonasal approach (EEA, 9 cases) and the transoral-transpalatal approach (TO-TPA, 9 cases) were compared. Each group showed the same incidence of subdural invasion, with 5 cases each. The superior (frontal base) and lateral surgical fields were wider by EEA, but the inferior view lower than the cranio-vertebral junction (CVJ) was wider by TO-TPA. Gross total removal was achieved in 3 cases in the EEA group, but in only 1 case in the TO-TPA group. Differences in radicality might be due to the extent of the lateral and subdural overview. However for large tumors extending below the CVJ, TO-TPA was the only viable approach for surgical removal. Surgical complications were higher in the EEA (4 cases) than the TO-TPA group (1 case), and were mainly caused by aggressive management of subdural invasion in the EEA group. Post-operative oral intake was earlier and the operative time was shorter in the EEA group. The surgical results were more radical and less invasive in the EEA group than the TO-TPA group. However in tumors extending below the CVJ, the surgical field in EEA was limited, indicating the need to use the transoral route or a combination of routes. A higher complication rate following subdural management was a negative factor that requires improvement in the EEA group and two-staged EEA followed by a transcranial approach may be considered for the cases with subdural invasion.

KW - Cranio-vertebral junction

KW - Endoscopic endonasal approach

KW - Transoral approach

KW - Transpalatal approach

UR - http://www.scopus.com/inward/record.url?scp=84918535924&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84918535924&partnerID=8YFLogxK

U2 - 10.2176/nmc.st.2014-0135

DO - 10.2176/nmc.st.2014-0135

M3 - Article

C2 - 25446380

AN - SCOPUS:84918535924

VL - 54

SP - 991

EP - 998

JO - Neurologia Medico-Chirurgica

JF - Neurologia Medico-Chirurgica

SN - 0470-8105

IS - 12

ER -