Abstract
BackgroundCranial base chordomas are typically indolent and usually appear as encapsulated tumors. They slowly grow by infiltrating the bone, along with the lines of least resistance. Due to its relationship with important neurovascular structures, skull base chordoma surgery is challenging.ObjectiveThe usefulness of intraoperative magnetic resonance imaging (IO-MRI) in achieving the goal of surgery, is evaluated in this study.MethodsBetween March 2018 and March 2020, 42 patients were operated on for resection of skull base chordomas in our institution. All of them were operated on under IO-MRI. Patients were analyzed retrospectively for identifying common residue locations, complications and early post-operative outcomes.ResultsIn 22 patients (52,4%) gross total resection was achieved according to the final IO-MRI. In 20 patients (47,6%) complete tumor removal was not possible because of extension to the petrous bone (8 patients), pontocerebellar angle (6 patients), prepontine cistern (4 patients), temporobasal (1 patient), cervical axis (1 patient). In 13 patients, the surgery was continued after the first IO-MRI control was performed, which showed a resectable residual tumor. 7 of these patients achieved total resection according to the second IO-MRI, in the other 6 patients all efforts were made to ensure maximal resection of the tumor as much as possible without morbidity. Repeated IO-MRI helped achieve gross total resection in 7 patients (53.8%).ConclusionsOur study proves that the use of IO-MRI is a safe method that provides the opportunity to show the degree of resection in skull base chordomas and to evaluate the volume and location of the residual tumor intraoperatively. Hence IO-MRI can improve the life expectancy of patients because it provides an opportunity for both gross total resection and maximal safe resection in cases where total resection is not possible.
Highlights
Chordoma is an uncommon, locally aggressive tumor originating from remnants of the primitive notochordal tissue along the cranialspinal axis, which accounts 1% to 4% of all bone malignancies and constitutes 0.1% to 0.2% of all primary intracranial neoplasms [1,2,3,4]
We present our experience with 42 patients with skull base chordomas, which is the first case series of skull base chordomas operated with a fully endonasal endoscopic approach combined with neuronavigation system and under intraoperative magnetic resonance imaging (IO-magnetic resonance imaging (MRI)) reported in the literature
In 22 patients (52,4%) gross total resection was achieved according to the final IO-MRI
Summary
Locally aggressive tumor originating from remnants of the primitive notochordal tissue along the cranialspinal axis, which accounts 1% to 4% of all bone malignancies and constitutes 0.1% to 0.2% of all primary intracranial neoplasms [1,2,3,4]. Cranial base chordomas are often indolent lesions because of their typically slow growth pattern [1,2,3, 5]. They progress by infiltrating the low-resistance areas of the bone so cause the local destruction of the anatomic markers [1,2,3, 5]. Cranial base chordomas are typically indolent and usually appear as encapsulated tumors. They slowly grow by infiltrating the bone, along with the lines of least resistance. Due to its relationship with important neurovascular structures, skull base chordoma surgery is challenging
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