Is Tumor Seeding a Risk Factor for Endoscopic Endonasal Resection of Clival Chordomas?

Introduction: Clival chordomas are slowly growing, aggressive tumors that originate from the extra-axial remnants of the notochord. Current management of these tumors involves surgical resection combined with radiation therapy. Given the location and invasive nature of these tumors, complete resection can prove difficult. A variety of both open and endoscopic therapeutic approaches have evolved, and, combined with the improvements in proton therapy, long-term control of these tumors appears to be improving. However, in recent literature the relatively rare complication of surgical seeding or surgical pathway recurrence has been reported. We report a case of surgical seeding following primary resection and review the world literature regarding surgical pathway recurrence.

Methods: We report a case of a patient with a large chordoma that required treatment with a combined endoscopic endonasal and external transcervical approach. The patient subsequently developed recurrent disease along the cervical skin incision secondary to surgical seeding with no signs of sinonasal seeding. Literature review and case reports were identified by a comprehensive search of MEDLINE for the years 1950-2012.

Conclusion: Tumor seeding can occur anywhere along the operative route and this may require additional surgery and/or an increased field of radiation therapy. Awareness of this rare occurrence is important for prevention and surveillance purposes. No reports of sinonasal seeding of malignancy have been seen in the literature. The use of novel techniques to minimize exposure to tumor seeding, including primary endoscopic resection and “clean” oncologic technique, help limit tumor seeding.