Surgical Management of Petroclival Chordomas: Report of Eight Cases

ABSTRACT

In the management of skull base chordomas, surgical treatment is essential to achieve long-term control. A petroclival chordoma growing laterally in the skull base is one of the most challenging tumors for neurosurgeons. We have treated petroclival chordomas based on the principle of maximal surgical resection of the tumor with minimal morbidity. Lateral skull base approaches were used to approach petroclival chordomas in eight patients. The surgical procedure involved removal of soft tumor tissue and extensive drilling of adjacent bony structures. Gross total resection of the tumor was achieved in six patients. Subtotal resection in the remaining two patients was associated with acceptable morbidity. In cases of petroclival chordomas, lateral skull base approaches can be used as a primary procedure, although those approaches may be associated with high rates of morbidity and mortality.

KEYWORDS

Chordoma - petrous bone - skull base - transpetrosal approach

REFERENCES

• 1 Gay E, Sekhar L N, Rubinstein E et al.. Chordomas and chondrosarcomas of the cranial base: results and follow-up of 60 patients.  Neurosurgery. 1995;  36 887-897
• 2 Al-Mefty O, Borba L A. Skull base chordomas: a management challenge.  J Neurosurg. 1997;  86 182-189
• 3 Muthukumar N, Kondziolka D, Lunsford L D, Flickinger J C. Stereotactic radiosurgery for chordoma and chondrosarcoma: further experiences.  Int J Radiat Oncol Biol Phys. 1998;  41 387-392
• 4 Colli B, Al-Mefty O. Chordomas of the craniocervical junction: follow-up review and prognostic factors.  J Neurosurg. 2001;  95 933-943
• 5 Crockard H A, Steel T, Plowman N et al.. A multidisciplinary team approach to skull base chordomas.  J Neurosurg. 2001;  95 175-183
• 6 Catalano P J, Biller H F. Extended osteoplastic maxillotomy. A versatile new procedure for wide access to the central skull base and infratemporal fossa.  Arch Otolaryngol Head Neck Surg. 1993;  119 394-400
• 7 Maniglia A J. Indications and techniques of midfacial degloving. A 15-year experience.  Arch Otolaryngol Head Neck Surg. 1986;  112 750-752
• 8 Hakuba A, Nishimura S, Jang B J. A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas.  Surg Neurol. 1988;  30 108-116
• 9 Forsyth P A, Cascino T L, Shaw E G et al.. Intracranial chordomas: a clinicopathological and prognostic study of 51 cases.  J Neurosurg. 1993;  78 741-747
• 10 Menezes A H, Gantz B J, Traynelis V C, McCulloch T M. Cranial base chordomas.  Clin Neurosurg. 1997;  44 491-509
• 11 Maira G, Pallini R, Anile C et al.. Surgical treatment of clival chordomas: the transsphenoidal approach revisited.  J Neurosurg. 1996;  85 784-792
• 12 Hitselberger W E, House W F. A combined approach to the cerebellopontine angle. A suboccipital-petrosal approach.  Arch Otolaryngol. 1966;  84 267-285
• 13 House W F, Hitselberger W E. The transcochlear approach to the skull base.  Arch Otolaryngol. 1976;  102 334-342
• 14 Morrison A W, King T T. Experiences with a translabyrinthine-transtentorial approach to the cerebellopontine angle. Technical note.  J Neurosurg. 1973;  38 382-390
• 15 Fisch U, Pillsbury H C. Infratemporal fossa approach to lesions in the temporal bone and base of the skull.  Arch Otolaryngol. 1979;  105 99-107
• 16 Malis L I. The petrosal approach.  Clin Neurosurg. 1991;  37 528-540
• 17 Sekhar L N, Estonillo R. Transtemporal approach to the skull base: an anatomical study.  Neurosurgery. 1986;  19 799-808
• 18 Al-Mefty O, Fox J L, Smith R R. Petrosal approach for petroclival meningiomas.  Neurosurgery. 1988;  22 510-517
• 19 Shiobara R, Ohira T, Kanzaki J, Toya S. A modified extended middle cranial fossa approach for acoustic nerve tumors. Results of 125 operations.  J Neurosurg. 1988;  68 358-365
• 20 Samii M, Ammirati M. The combined supra-infratentorial pre-sigmoid sinus avenue to the petro-clival region. Surgical technique and clinical applications.  Acta Neurochir (Wien). 1988;  95 6-12
• 21 Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients.  Neurosurgery. 1991;  28 869-876
• 22 Ohata K, Baba M. Otico-condylar approach. In: Hakuba A Surgical Anatomy of the Skull Base. Tokyo, Japan; Miwa-shoten 1996: 37-66
• 23 Ohata K, Hakuba A. Extended middle fossa approach with oticocondylar osteotomy.  Operative Techniques in Neurosurgery. 1999;  2 28-38
• 24 Goel A. Extended middle fossa approach for petroclival lesions.  Acta Neurochir (Wien). 1995;  135 78-83
• 25 Spetzler R F, Daspit C P, Pappas C T. The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases.  J Neurosurg. 1992;  76 588-599