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Predicting the Need for Occipitocervical Fusion for Patients with Lower Clival Chordoma: A Single-Center Retrospective Study.
- Source :
-
World neurosurgery [World Neurosurg] 2024 Jul; Vol. 187, pp. e321-e330. Date of Electronic Publication: 2024 Apr 20. - Publication Year :
- 2024
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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.)
- Subjects :
- Humans
Female
Male
Retrospective Studies
Middle Aged
Adult
Aged
Cranial Fossa, Posterior surgery
Cranial Fossa, Posterior diagnostic imaging
Treatment Outcome
Young Adult
Chordoma surgery
Chordoma diagnostic imaging
Spinal Fusion methods
Skull Base Neoplasms surgery
Skull Base Neoplasms diagnostic imaging
Occipital Bone surgery
Occipital Bone diagnostic imaging
Cervical Vertebrae surgery
Subjects
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