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Long-term follow-up after endoscopic trans-sphenoidal surgery or initial observation in clivus chordomas
- Source :
- Acta Neurochirurgica. 159:1849-1855
- Publication Year :
- 2017
- Publisher :
- Springer Science and Business Media LLC, 2017.
-
Abstract
- Resection of clivus chordomas through extensive skull base approaches is associated with high mortality and morbidity even in experienced hands. We report our experience with endoscopic trans-sphenoidal surgery, or a “wait-and-scan” strategy in selected patients. Ten patients were diagnosed with clivus chordomas during an 8-year period. Six patients underwent primary treatment with endoscopic trans-sphenoidal surgery, followed by adjuvant proton-beam therapy in three of these patients. Four patients with minor symptoms were followed-up untreated. Mean follow-up was 91 months. Of the six patients operated on, total or gross total resection was achieved in four, partial resection in one and biopsy was taken in one. Preoperative cranial neuropathies resolved in three out of five patients, and no new cranial nerve palsies were encountered. Postoperative cerebrospinal fluid leak occurred in one patient. Four patients were initially followed-up without any treatment, and three of these have remained stable without tumour progression for a mean of 94 months. Due to a slow, though progressive growth of tumour, one patient was operated on after 80 months of initial observation. The natural course of clivus chordomas has yet to be defined. The endoscopic trans-sphenoidal approach is a valid, minimally invasive alternative for the treatment of clival chordomas, and in selected patients a “wait and scan” strategy can be considered. Our long-term results show low mortality and good functional outcome. An endonasal endoscopic trans-sphenoidal approach should be a principal part of the armamentarium of surgeons treating clivus chordomas.
- Subjects :
- Adult
Male
medicine.medical_specialty
Adolescent
Nose
Skull Base Neoplasms
Neurosurgical Procedures
03 medical and health sciences
0302 clinical medicine
Clivus
Chordoma
medicine
Humans
Aged
Neuroradiology
medicine.diagnostic_test
business.industry
Endoscopy
Interventional radiology
Middle Aged
medicine.disease
Surgery
Treatment Outcome
medicine.anatomical_structure
Cranial Fossa, Posterior
030220 oncology & carcinogenesis
Disease Progression
Female
Neurology (clinical)
Neurosurgery
Clivus Chordoma
business
030217 neurology & neurosurgery
Follow-Up Studies
Subjects
Details
- ISSN :
- 09420940 and 00016268
- Volume :
- 159
- Database :
- OpenAIRE
- Journal :
- Acta Neurochirurgica
- Accession number :
- edsair.doi.dedup.....73cf92c4a8de47241496e30d19e6acd9