Humans ; Chordoma/surgery* ; Femur ; Biomarkers, Tumor

Adult ; Altitude ; Chordoma ; surgery ; Endoscopy ; Female ; Humans ; Nasal Cavity ; surgery ; Paranasal Sinuses ; surgery ; Skull Base ; surgery ; Video-Assisted Surgery

Aged ; Chordoma ; pathology ; surgery ; Humans ; Immunohistochemistry ; Male ; Nose Neoplasms ; pathology ; surgery

This paper reported one patient who was treated through transphenoidal-upslope approach by lateral rhinotomy and the tumor was successfully removed. The patient was male of 38 years old. He suffered intermittent headache with blurred vision and left eye outreach disorder for more than a year. The visual inspection showed there was dark area of the left eye lateral. CT showed slopes density placeholder and bone window showed the slope of bone quality had been severely damaged. MRI showed T1 image slopes parts and other low signal placeholder forward to invade the sphenoid sinus. In addition, there was undermine the slope bone and brain stem boundaries clearly and T2 images showed high-signal, inhomogeneous enhancement. We found during the operation that the slope was partially destroyed and part of the tumor was prominent to the pharynx tumor. The pathologic examination confirmed that it is chordoma.
Adult ; Chordoma ; surgery ; Cranial Fossa, Posterior ; surgery ; Humans ; Male ; Microsurgery ; methods ; Skull Base Neoplasms ; surgery ; Sphenoid Bone ; surgery

Clival chordoma is a rare malignant tumor which arises from the remnants of notochord. Although it is a slow-growing tumor that rarely metastasize to other organs, it is regarded as clinically malignant because of local invasiveness and high recurrence rate. Furthermore, because its location is critical and surgical resection is difficult, it has poor prognosis. Neurosurgeons have traditionally taken the lead in managing tumor, however, with the development of endoscopic techniques and wide spread of usage in skull base surgery, the role of ENT surgeon has become bigger recently. We report a recent case of recurrent clival chordoma successfully removed by endoscopic extended transclival approach.
Chordoma* ; Cranial Fossa, Posterior ; Natural Orifice Endoscopic Surgery ; Notochord ; Prognosis ; Recurrence ; Skull Base

Aged ; Brain Neoplasms ; diagnosis ; surgery ; Chordoma ; diagnosis ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed

OBJECTIVE: To investigate whether 3D-printed artificial vertebral body can reduce prosthesis subsidence rate for patients with cervical chordomas, through comparing the rates of prosthesis subsidence between 3D printing artificial vertebral body and titanium mesh for anterior spinal reconstruction after total spondylectomy. METHODS: This was a retrospective analysis of patients who underwent surgical treatment for cervical chordoma at our hospital from March 2005 to September 2019. There were nine patients in the group of 3D artificial vertebral body (3D group), and 15 patients in the group of titanium mesh cage (Mesh group). The patients' characteristics and treatment data were extracted from the medical records, including age, gender, CT hounsfield unit of cervical vertebra and surgical information, such as the surgical segments, time and blood loss of surgery, frequency and degree of prosthesis subsidence after surgery. Radiographic observations of prosthesis subsidence during the follow-up, including X-rays, CT, and magnetic resonance imaging were also collected. SPSS 22.0 was used to analysis the data. RESULTS: There was no significant difference between the two groups in gender, age, CT hounsfield unit, surgical segments, time of surgery, blood loss of posterior surgery and total blood loss. Blood loss of anterior surgery was 700 (300, 825) mL in 3D group and 1 500 (750, 2 800) mL in Mesh group (P < 0.05). The prosthesis subsidence during the follow-up, 3 months after surgery, there was significant difference between the two groups in mild prosthesis subsidence (P < 0.05). The vertebral height of the 3D group decreased less than 1 mm in eight cases (no prosthesis subsidence) and more than 1 mm in one case (mild prosthesis subsidence). The vertebral height of the Mesh group decreased less than 1 mm in five cases (no prosthesis subsidence), and more than 1 mm in eight cases (mild prosthesis subsidence). Two patients did not have X-rays in 3 months after surgery. There was a statistically significant difference between the two groups in the prosthesis subsidence rate at the end of 12 months (P < 0.01). The vertebral height of eight cases in the 3D group decreased less than 1 mm (no prosthesis subsidence) and one case more than 3 mm (severe prosthesis subsidence). Four of the 15 cases in the Mesh group decreased less than 1 mm (no prosthesis subsidence), two cases more than 1 mm (mild prosthesis subsidence), and nine cases more than 3 mm (severe prosthesis subsidence). There was a statistically significant difference between the two groups in the prosthesis subsidence rate at the end of 24 months (P < 0.01). The vertebral height of seven cases in the 3D group decreased less than 1 mm (no prosthesis subsidence), one case more than 3 mm (severe prosthesis subsidence), and one case died with tumor. One case in the Mesh group decreased less than 1 mm (no prosthesis subsidence), one case more than 1 mm (mild prosthesis subsidence), 11 case more than 3 mm (severe prosthesis subsidence), one case died with tumor and one lost the follow-up. Moreover, at the end of 12 months and 24 months, there was significant difference between the two groups in severe prosthesis subsidence rate (P < 0.01). CONCLUSION 3D-printed artificial vertebral body for anterior spinal reconstruction after total spondylectomy for patients with cervical chordoma can provide reliable spinal stability, and reduce the incidence of prosthesis subsidence after 2-year follow-up.
Humans ; Chordoma/surgery* ; Retrospective Studies ; Vertebral Body ; Titanium ; Cervical Vertebrae/surgery* ; Printing, Three-Dimensional ; Spinal Fusion/methods* ; Treatment Outcome

OBJECTIVENasal endoscope has been used increasingly during skull base surgery. However, most of endoscopic surgery limited to the repair of cerebrospinal rhinorrhea, decompression of traumatic optic nerve, hypophysectomy, etc. This study was undertaken to determine whether endoscopic endonasal approach was safe and effective for the resection of tumors located in petroclival region and infratemporal fossa.

METHODSSeventeen patients with tumors of petroclival region and infratemporal fossa treated by endoscopic endonasal surgery between January 2002 and February 2005 were studied prospectively. The operative technique was described in detail. There were 5 chordoma, 1 esthesioneuroblastoma, 1 chondrosarcoma, 1 lymphoma, 1 craniopharyngioma, 1 hemangioblastoma, 4 meningioma, 1 schwannoma, and 2 metastatic carcinoma. 3 patients were selected for neuronavigation-aided endoscopic endonasal surgery.

RESULTSTotal tumor removal was obtained in 15 cases, subtotal removal in 2 case. With follow-up of 5 to 43 months, 1 case with chordoma was recurrent 5 months later postoperatively and underwent reoperation subsequently. The other cases with benign tumors were no recurrence. All of 5 cases with malignant tumors followed up for longer than 2 years were no recurrence and death. The complications included subarachnoid hemorrhage in 1 patient, transient cerebrospinal leakage in 2 cases.

CONCLUSIONSThe endoscopic endonasal surgery provides satisfied treatment for selected tumors of petroclival region and infratemporal fossa. This approach promises a simple and rapid access to petroclival region and infratemporal fossa. It is a safe, minimally invasive and efficient procedure. Using neuronavigation system, it is helpful to determining anatomical landmark and removing the tumor completely and securely.

Adult ; Aged ; Chordoma ; surgery ; Endoscopy ; methods ; Female ; Humans ; Male ; Meningioma ; surgery ; Middle Aged ; Nose ; surgery ; Petrous Bone ; surgery ; Skull Base Neoplasms ; surgery

OBJECTIVETo study the clinical value of the whole-course endoscopic extended transsphenoidal approach assisted by neuronavigation in surgical resection of complex sphenoclival lesions.

METHODSImage reconstruction and registration were performed for 15 patients with complex sphenoclival lesions using the neuronavigation system, and the bilateral nasal extended transsphenoidal approach was adopted to remove the lesions with a whole-course endoscopic procedure.

RESULTSPostoperative pathological examination reported pituitary adenomas in 7 cases, chordomas in 5 cases, and cavernous angiomas in 3 cases. Total removal of the lesions was achieved in 10 cases, subtotal removal in 4 cases, and partial removal in 1 case. Transient polyuria occurred in 3 cases and 2 patients experienced temporary cerebrospinal rhinorrhea. No death occurred in these cases after the operation. During the follow-up ranging from 3 to 26 months, only 2 patients with partial lesion removal showed recurrence and received subsequent radiotherapy.

CONCLUSIONThe combination of whole-course endoscopic technique and neuronavigation can help improve the surgical outcomes and reduce complications of complex sphenoclival lesion removal via the extended transsphenoidal approach.

Adult ; Aged ; Chordoma ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neuroendoscopy ; Neuronavigation ; Pituitary Neoplasms ; surgery ; Skull Base Neoplasms ; surgery ; Sphenoid Bone ; pathology ; surgery

OBJECTIVE: To explore the application of endoscopic endonasal approach in surgery for skull base tumor. METHOD: From August 2000 to February 2009, retrospective analyses were performed on clinical data of 21 patients with skull base lesions treated by endoscopic endonasal surgery. There were 3 chordoma, 6 olfactory neuroblastoma, 4 squamous cancer, 5 malignant melanoma, 1 mucoepidermoid carcinoma, 2 sphenoidal malignant adenoma. RESULT: Total tumor removal was obtained in 21 cases,subtotal removal in 2 cases. With follow up of 24 to 108 months, 4 cases were recurred, 5 cases were dead. The complications included cerebrospinal fluid (CSF) leak in 2 patients, intracranial infection after the endoscopic surgery in 1 patient. In the two patients with CSF leak, one case cured by internal medicine and another cured by endoscopic surgery. CONCLUSION The endoscopic endonasal surgery could provide sufficient treatment for skull base tumor, and is a safe, minimally invasive and efficient procedure, but indication should be exactitude selected.
Adult ; Aged ; Chordoma ; surgery ; Endoscopy ; Esthesioneuroblastoma, Olfactory ; surgery ; Female ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Retrospective Studies ; Skull Base Neoplasms ; surgery