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Predicting the Need for Occipitocervical Fusion for Patients with Lower Clival Chordoma: A Single-Center Retrospective Study.

Authors :
Hong S
Shinya Y
Lakomkin N
Mahajan A
Laack NN
O'Brien E
Stokken JK
Janus JR
Pinheiro Neto C
Choby GW
Peris Celda M
Link MJ
Elder BD
Van Gompel JJ
Source :
World neurosurgery [World Neurosurg] 2024 Jul; Vol. 187, pp. e321-e330. Date of Electronic Publication: 2024 Apr 20.
Publication Year :
2024

Abstract

Objective: To assess the impact of tumor extension into the occipital condyle (OC) in lower clival chordoma management and the need for occipito-cervical fusion (OCF).<br />Methods: A retrospective analysis was conducted on 35 patients with lower clival chordoma. The preoperative area of the intact OCs, Hounsfield units, and the integrity of the apical ligament and the tectorial membrane were assessed using preoperative imaging.<br />Results: Seven (20%) patients were in the OCF group. The OCF group exhibited a higher prevalence of preoperative pain in the neck or head (P = 0.006), ligament absence (P = 0.022), and increased propensity for postoperative wound issues (P = 0.022) than the non-OCF group. The OCF group had less intact OCs (P < 0.001) and higher spinal instability neoplastic score (P = 0.002) than the non-OCF group. All patients with intact OCs < 60% underwent OCF, and those with OCs ≥ 70% were treated without OCF. Those with OCs between 60% and 69% underwent OCF if the ligaments were eroded, and did not undergo OCF if the ligaments were intact. Treatment strategies varied, with endoscopic endonasal approach alone being common. Radiation therapy was administered to 89% of patients. All 3 patients treated with OCF after tumor resection had wound issues; none treated with OCF before resection had wound issues. None developed atlanto-occipital instability. Survival rates did not significantly differ between groups.<br />Conclusions: In the absence of mobility-related neck pain, patients with lower clival chordoma and intact OC ≥ 60%, intact apical ligament, and intact tectorial membrane, may not require OCF.<br /> (Copyright © 2024 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1878-8769
Volume :
187
Database :
MEDLINE
Journal :
World neurosurgery
Publication Type :
Academic Journal
Accession number :
38649026
Full Text :
https://doi.org/10.1016/j.wneu.2024.04.081