The endoscope-assisted ventral approach compared with open microscope-assisted surgery for clival chordomas

Ricardo J. Komotar, Robert M. Starke, Daniel M.S. Raper, Vijay K. Anand, Theodore H. Schwartz

Research output: Contribution to journalReview article

71 Scopus citations

Abstract

BACKGROUND: The current management paradigm for clival chordomas includes cytoreductive surgery with adjuvant radiotherapy. Surgical approaches have traditionally utilized the microscope to remove these lesions through approaches that require extensive bone drilling, brain retraction, and mobilization of normal anatomy to create a suitably large corridor. The endoscopic ventral approaches provide a direct route to the tumor using natural orifices. Little data exist comparing these 2 surgical strategies. We conducted a systematic review of case series and case reports in hope of furthering our understanding of the role of endoscopy in the management of these difficult cranial base lesions. METHODS: We performed a MEDLINE (1950 to 2010) search to identify relevant studies. Statistical analyses of categorical variables such as extent of resection, morbidity, and visual outcome were carried out using chi-square and Fisher exact tests. RESULTS: Thirty-seven studies, involving 766 patients, were included. Compared with the open surgery cohort, the endoscopic cohort had a significantly higher percentage of gross total resection (61.0% vs. 48.1%; P = 0.010), fewer cranial nerve deficits (1.3% vs. 24.2%, P < 0.001), fewer incidences of meningitis (0.9% vs. 5.9%, P = 0.029), less mortality (4.7% vs. 21.6%, P < 0.001), and fewer local recurrences (16.9% vs. 40.0%, P = 0.0001). There was no significant difference in the incidence of postoperative cerebrospinal fluid leak (P = 0.084). Follow-up was longer in the open compared with the endoscopic cohort (59.7 vs. 18.5 months, P < 0.001). CONCLUSIONS: Our systematic analysis supports the endoscopic ventral approaches as a safe and effective alternative for the treatment of certain clival chordomas. Although the overall literature supports this technique in carefully selected patients, longer follow-up is needed to more definitively address therapeutic efficacy. Careful patient selection and meticulous multilayer closure are critical to obtaining maximal resection and acceptably low cerebrospinal fluid leak rates.

Original languageEnglish (US)
Pages (from-to)318-327
Number of pages10
JournalWorld neurosurgery
Volume76
Issue number3-4
DOIs
StatePublished - Jan 1 2011
Externally publishedYes

Keywords

  • Chordoma
  • Clival
  • Endoscopic
  • Open
  • Outcomes
  • Surgery
  • Systematic analysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Fingerprint Dive into the research topics of 'The endoscope-assisted ventral approach compared with open microscope-assisted surgery for clival chordomas'. Together they form a unique fingerprint.

  • Cite this