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KMID : 0942820090080020149
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Journal of Korean Brain Tumor Society
2009 Volume.8 No. 2 p.149 ~ p.154
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Comparative Analysis on the Surgical Methods for the Clival Chordoma : The Usefullness of the Endoscope Assisted Transsphenoidal Approach
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Chung Jong-Chul
Kim Seung-Min
Jung Sung-Sam
Park Ki-Seok
Park Moon-Sun
Kim Han-Kyu
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Abstract
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Objective: Chordomas, whether involving the clivus or simply situated anterior to the brainstem, present a technical challenge for adequate exposure and safe resection. Transsphenoidal approach is safer and easier than any other approaches, but it has some limitation of resectability in laterally extended tumor. The objective of this paper is to demonstrate the advantages of endoscope assisted transsphenoidal approach to remove paraclival lesion on the midline.
Methods: Nine patients with clival chordomas underwent surgery in our institution from 2002 to 2009. There were two men and seven women who ranged in age between 4 and 59 years. Four patients underwent stage operation by both transsphenoidal surgery and transpetrosal or transcavernous surgery. Three patients underwent only transsphenoidal surgery and two underwent only transpetrosal surgery. For image guidance, both endoscope and neuronavigation system were used in all surgical procedures.
Results: Gross total removal was achieved in 33.3% and subtotal removal was achieved in 55.5%. The mean follow-up period was 44.2 months. The mortality rate during the follow-up period was 11.1%.
Conclusion: For accessing clival chordoma via an anterior route, visualization of the tumor with the endoscope and navigation system is readily achievable and have the advantages of confirmation the anatomy that cannot be seen in the conventional transsphenoidal approach. This study shows transsphenoidal approach become safer and easier if the tumor is located on upper two thirds of the clivus and located on the midline.
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KEYWORD
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Chordoma, Neuroendoscope, Transsphenoidal approach
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