J Neurol Surg B Skull Base 2016; 77 - FP-11-06
DOI: 10.1055/s-0036-1592494

Extracranial Surgery of the Skull Base and Craniovertebral Junction Chordomas

Alexey Shkarubo 1, Dmitriy Andreev 1, Nikolay Konovalov 2, Petr Zelenkov 2, Konstantin Koval 1, Ilia Chernov 3
  • 1Department of Neurooncology, the N.N. Burdenko Neurosurgery Institute, Moscow, Russian Federation
  • 2Department of Spinal surgery, the N.N. Burdenko Neurosurgery Institute, Moscow, Russian Federation
  • 3The I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation

Objective: Optimization of surgical treatment of skull base and craniovertebral junction chordomas.

Methods: During the 1985–2015 period, 432 patients with skull base chordomas were operated. In 1985–2006, 207 patients were operated, 126 (61%) by transcranial approaches and 81 (39%) by extracranial approaches (transnasal and transoral). During the 2007–2015 period, 225 patients with skull base chordomas were operated, 58 (25.8%) by a variety of transcranial approaches, and 167 (74.2%) by extracranial. Twenty-eight patients underwent simultaneous combined operation: occipito spondylodesis and transoral removal of the tumor.

Results: By transnasal approach (n = 186) in 30.6% (57 patients) the tumor was removed totally; in 48.4% (90)—subtotal; in 16.7% (31)—partial; in 1.6% (3)—removed less than 50% of the tumor volume; in 2.7% (5) biopsy. By transoral approach (n = 46) in 26% (12), the tumor was removed totally; in 48% (22)—subtotally; in 26% (12)—partially. By simultaneous transoral and transnasal approach in 10.5% (2) the tumor was removed totally; in 68.5% (13)—subtotally; in 21% (4)—partially. Postoperative CSF nasal leak (n = 186) in 5.4% (10). Postoperative mortality by extracranial approaches (n = 242) was 1.2% (3).

Conclusion: Using of the new technologies in the skull base and CVJ surgery of the chordomas can improve the results of surgical treatment. Implementation in practice the simultaneous OSD improves radicalism of tumor removal in patients who had previously considered in fact inoperable.