Endoscopic Endonasal Resection of Skull Base Chordoma I: Case Series and Review of Literature

Objective: Skull base chordoma is a rare tumor with slow and progressive growth. This is the reason for various proposed techniques for resection of the tumor. Endoscopic endonasal technique is a minimally invasive approach that gives surgeons opportunity of total resection of tumor and low morbidity. Total resection of the tumor is the main determining factor of prognosis. Study Design: In this article we retrospectively studied 24 patients with pathological diagnosis of skull base chordoma treated in our hospitals between 2005 and 2013. Material and Methods: All patients underwent endoscopic endonasal surgery. Overall 19 patients were primary cases but 3 and 2 cases were referred, respectively, after radiation failure and recurrence after craniotomy. Mean follow-up time was 23 months. Difficulty in swallowing and speech, diplopia, and nasal obstruction was common presenting symptoms. Result: Gross tumor resection was feasible in 18 cases. Subtotal resection was done in six cases. During follow-up, one case died from disease and tumor recurred in other eight cases; 16 patients are disease free. Eight recurrences and a single mortality occurred in cases that underwent subtotal resection or referred to us after radiation failure. The major operative complication was a case of pneumocephalus and meningitis. Conclusion: Endoscopic endonasal resection of skull base chordoma is a low morbidity approach, advisable in most cases. We think that total resection is the best surgical strategy.