Expanded Endoscopic Endonasal Approach (EEEA) for Clival Chordomas

Waleed Abbass,Amr Mohsen

doi:10.4236/ojmn.2020.103036

Abstract

Objective: To evaluate the role of expanded endoscopic endonasal approach in removal of clival chordomas. Patients & Methods: Nine patients with clival chordomas were operated upon in Cairo University hospital from September 2015 to September 2018 using the EEEA a recurrent case and seven new cases were involved in these study and ten operations were done. All patients had preoperative neurological and radiological examination. The study was focusing on the approach, efficacy of tumor removal, reconstruction of the base and complications related to this approach. Results: Nine patients were operated in this study in which ten operations were done. It included six males (66.6%) and three females (33.3%) with age ranging from 4 years to 63 years with average age 40.7 years. Headache and diplopia were the most common symptoms found in six patients (66.6%). Brainstem affection was found in two patients (22.2%). Lower cranial nerves affection was found in two patients (22.2%). One case developed CSF leakage postoperatively (11.1%). Two patients underwent tracheostomy. We achieve total removal in four patients (44.4%), near total removal in one patient (11.1%) and subtotal tumor resection in four patients (44.4%). Conclusion: EEEA for clival chordomas is safe and effective approach regarding the results of the incidence of complications, and the percentage of tumor resection.

Highlights

Skull base chordomas are locally destructive slowly growing expanding tumors that arise from the remnants of the notochord
EEEA for clival chordomas is safe and effective approach regarding the results of the incidence of complications, and the percentage of tumor resection
Special instruments are needed in extended endonasal approach as the Mayfield head clamp to fix the head which is important during dissection of the tumor from the brainstem and neurovascular structures

Summary

Introduction

Skull base chordomas are locally destructive slowly growing expanding tumors that arise from the remnants of the notochord. They may extend superiorly to the level of cribriform plate of the ethmoids and inferiorly to the craniovertebral. Arch of C1 and to level of 2nd cervical vertebrae. It may extend laterally beyond the level of the cavernous sinus and the internal carotid artery and may reach the infra-temporal fossa [1] [2]. Several different approaches have been used as transnasal, transoral, orbitozygomatic subtemporal infratemporal, far-lateral transcondylar and transpetrosal, which have been used for removal of these tumors. Morbidities and mortality may be related to the open approach [3]

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Discussion

Conclusion