Clivus Chordoma: Case Report and Current Considerations on Endoscopic Endonasal Trans-Sphenoid Surgery with Neurosurgeon-Otolaryngologist Collaboration
DOI:
https://doi.org/10.19166/med.v14i1.9245Keywords:
Chordoma, Clivus, Endoscopic endonasal, CollaborationAbstract
Chordomas, infrequent malignancies primarily located along the craniospinal axis, showcase gradual growth and localized bone destruction, with the clival region involved in approximately 25-35% of cases. Headaches accompanied by neurological deficits are the typical clinical presentations. Complete surgical resection is the mainstay, with recent collaborative efforts between otorhinolaryngologists and neurosurgeons leading to a positive shift from traditional craniotomic procedures to endoscopic endonasal approaches, fostering minimally invasive techniques and utilizing endoscopy for primary visualization across the neuraxis. Furthermore, the concept of team surgery has been introduced, involving simultaneous contributions from ENT surgeons and Neurosurgeons at all stages of the procedure, including the approach, resection, and reconstruction phases. This report presents a series of two successful cases of clival chordomas managed using the endoscopic endonasal approach at Siloam Hospital Lippo Village This indicates its potential as a viable surgical choice, particularly within medical centers that possess the necessary specialties. Successful implementation is notably enhanced through collaborative efforts between otolaryngologists and neurosurgeons, underscoring the significance of interdisciplinary teamwork.
References
1. Anagiotos A, Preuss SF, Drebber U, Jumah MD. Multiple craniocervical chordomas presenting as a parapharyngeal mass. Head Neck. 2013 Nov;35(11):E325-E327. https://doi.org/10.1002/hed.23185
2. Dehdashti AR, Karabatsou K, Ganna A, Witterick I, Gentili F. Expanded endoscopic endonasal approach for treatment of clival chordomas: early results in 12 patients. Neurosurgery. 2008;63(2):299-309. https://doi.org/10.1227/01.neu.0000316414.20247.32
3. Khawaja AM, Venkatraman A, Mirza M. Clival chordoma: case report and review of recent developments in surgical and adjuvant treatments. Pol J Radiol. 2017;82:670-675. https://doi.org/10.12659/pjr.902008
4. Fontes R, O'Toole JE. Chordoma of the thoracic spine in an 89-year-old. Eur Spine J. 2012;21(Suppl 4):S428-S432. https://doi.org/10.1007/s00586-011-1980-6
5. Menezes AH. Craniovertebral junction neoplasms in the pediatric population. Childs Nerv Syst. 2008;10:1173-1186. https://doi.org/10.1007/s00381-008-0598-4
6. Sun X, Hornicek F, Schwab JH. Chordoma: an update on the pathophysiology and molecular mechanisms. Curr Rev Musculoskelet Med. 2015;8(4):344-352. https://doi.org/10.1007/s12178-015-9311-x
7. Walcott BPNB, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol. 2012;13(2):69-76. https://doi.org/10.1016/s1470-2045(11)70337-0
8. Lobo BC, Baumanis MM, Nelson RF. Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: a systematic review. Laryngoscope Investig Otolaryngol. 2017;2(5):215-224. https://doi.org/10.1002/lio2.75
9. Vellutini EA, Balsalobre L, Hermann DR, Stamm AC. The endoscopic endonasal approach for extradural and intradural clivus lesions. World Neurosurg. 2014;82(6 Suppl):S106-S115. https://doi.org/10.1016/j.wneu.2014.07.031
10. Safarian M, Sadeghi M, Saedi B. Endoscopic sphenoid sinus anatomic considerations: A study on 60 cadavers. Iran J Otorhinolaryngol. 2021 Jul;33(117):237-242. https://doi.org/10.22038/ijorl.2021.47273.2554
11. Prevedello DM, Doglietto F, Jane JA Jr, Jagannathan J, Han J, Laws ER Jr. History of endoscopic skull base surgery: its evolution and current reality. J Neurosurg. 2007 Jul;107(1):206-213. https://doi.org/10.3171/jns-07/07/0206
12. Ismail M, Abdelaziz AA, Darwish M. A comparison between collaborative and single surgeon approach in endoscopic endonasal surgery to sphenoid sinus. Eur Arch Otorhinolaryngol. 2019;276:1095-1100. https://doi.org/10.1007/s00405-019-05305-y
13. Jarmula J, de Andrade EJ, Kshettry VR, Recinos PF. The current state of visualization techniques in endoscopic skull base surgery. Brain Sci. 2022 Oct 3;12(10):1337. https://doi.org/10.3390/brainsci12101337
14. Matoušek P, Lipina R, Palecek T, Hrbac T, Komínek P. Transnasal endoscopic surgery of the pituitary gland - the benefit of collaboration between otorhinolaryngologist and neurosurgeon. Ceska Slov Neurol N. 2010;73:542-545.
15. Lindert EJ, Ingels K, Mylanus E, Grotenhuis JA. Variations of endonasal anatomy: relevance for the endoscopic endonasal transsphenoidal approach. Acta Neurochir. 2010;152(6):1015-1020. https://doi.org/10.1007/s00701-010-0629-2
16. Samara L, Alobid I, Enseñat J, De Notaris M, Bernal-Sprekelsen M. Neurosurgeon-otolaryngologist collaboration in endonasal approaches to the clivus and suprasellar region. B-ENT. 2011;7 Suppl 17:33-9. PMID: 22338373. https://pubmed.ncbi.nlm.nih.gov/22338373/
17. Yousaf J, Afshari FT, Ahmed SK, Chavda SV, Sanghera P, Paluzzi A. Endoscopic endonasal surgery for clival chordomas — a single institution experience and short term outcomes. Br J Neurosurg. 2019; 33(4):388-393. https://doi.org/10.1080/02688697.2019.1567683
18. Sahyouni R, Goshtasbi K, Mahmoodi A, Chen JW. A historical recount of chordoma. J Neurosurg Spine. 2018;28(4):422–428. https://doi.org/10.3171/2017.7.SPINE17668
19. Campbell RG, Prevedello DM, Ditzel Filho L, Otto BA, Carrau RL. Contemporary management of clival chordomas. Curr Opin Otolaryngol Head Neck Surg. 2015;23(2):153–161. https://doi.org/10.1097/moo.0000000000000140
20. Alshammari J, Monnier P, Daniel RT, Sandu K. Clival chordoma with an atypical presentation: a case report. J Med Case Rep. 2012;6(1):410. DOI:10.1186/1752-1947-6-410. https://doi.org/10.1186/1752-1947-6-410
21. Jho HD. The expanding role of endoscopy in skull-base surgery. Indic Instrum Clin Neurosurg. 2001;48:287–305. PMID: 11692647
22. Rai R, Iwanaga J, Shokouhi G, Loukas M, Mortazavi M, Oskouian R, et al. A comprehensive review of the clivus: anatomy, embryology, variants, pathology, and surgical approaches. Child’s Nervous Syst. 2018;34(8):1451–1458. https://doi.org/10.1007/s00381-018-3875-x
23. Garzaro M, Zenga F, Raimondo L, Pacca P, Pennacchietti V, Riva G, et al. Three-dimensional endoscopy in transnasal transsphenoidal approach to clival chordomas. Head Neck. 2016;38(Suppl 1):E1814–E1819. https://doi.org/10.1002/hed.24324
24. Wang S-S, Li J-F, Zhang S-M, Jing J-J, Xue L. A virtual reality model of the clivus and surgical simulation via transoral or transnasal route. Int J Clin Exp Med. 2014;7(10):3270–3279. https://pmc.ncbi.nlm.nih.gov/articles/PMC4238541/
25. Paluzzi A, Gardner P, Fernandez-Miranda JC, Snyderman C. The expanding role of endoscopic skull base surgery. Br J Neurosurg. 2012;26(5):649–661. https://doi.org/10.3171/CASE21366
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