Endoscopic resection of skull base chordoma via the combined oral and nasal approach

Objective To summarize the efficacy and safety of endoscopic resection of skull base chordoma via the combined oral and nasal approach. Methods The clinical data and follow⁃up data of 192 patients with skull base chordoma admitted to the Department of Otorhinolaryngology, Head and Neck Surgery, Xuanwu Hospital, Capital Medical University from December 2008 to December 2022 were retrospectively analyzed. The surgical efficacy was evaluated according to the degree of tumor resection, the emission of clinical symptoms, the incidence of postoperative complications, and the prognosis. Kaplan ⁃ Meier was used for survival analysis. Results All patients underwent endoscopic resection of skull base chordoma via the combined oral and nasal approach. Among the 192 patients, 80.21% (154/192) achieved imaging total resection (gross total resection group) and 19.79% (38/192) with residual imaging (residual group). Two patients died during perioperative period. Postoperative complications included cerebrospinal fluid leakage [6.77% (13/192)], new nerves dysfunction [6.25% (12/192)], subarachnoid hemorrhage [2.08% (4/192)] and intracranial infection [1.56% (3/192)]. Follow up of 81 (52, 120) months resulted in 57 deaths. The median survival time in the gross total resection group was 7.41 years, while in the residual group it was 4.33 years. The difference in survival time between the 2 groups was statistically significant (χ2 = 23.018, P = 0.002). Conclusions Endoscopic combined oral and nasal approach can effectively remove skull base chordoma, prolong survival time, and have a good prognosis. Surgical gross total resection of tumors is an important indicator for predicting prognosis.