1
|
Li L, Wei KL, Liu MS, Wang QL, Zeng TF, Chen RZ, Xia XW, Zhang HT. Hematoporphyrin derivative-mediated photodynamic techniques for the diagnosis and treatment of chordoma. Photodiagnosis Photodyn Ther 2024; 48:104231. [PMID: 38821238 DOI: 10.1016/j.pdpdt.2024.104231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/10/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Chordoma is a rare congenital low-grade malignant tumor characterized by infiltrative growth. It often tends to compress important intracranial nerves and blood vessels, making its surgical treatment extremely difficult. Besides, the efficacy of radiotherapy and chemotherapy is limited. The photosensitizer hematoporphyrin derivative (HPD) can emit red fluorescence under 405 nm excitation and produce reactive oxygen species for tumor therapy under 630 nm excitation. Herein, we investigated the effects of the photosensitizer hematoporphyrin derivative (HPD) on different cell lines of chordoma and xenograft tumors under 405 nm and 630 nm excitation. METHODS The photosensitizer hematoporphyrin derivative (HPD) and Two different chordoma cell lines (U-CH1, JHC7) were used for the test. The in vitro experiments were as follows: (1) the fluorescence intensity emitted by chordoma cells excited by different 405 nm light intensities was observed under a confocal microscope; (2) the Cell Counting Kit-8 (CCK-8) assay was performed to detect the effects of different photosensitizer concentrations and 630 nm light energy densities on the activity of chordoma cells. In the in vivo experiments, (3) Fluorescence visualization of chordoma xenograft tumors injected with photosensitizer via tail vein under 405 nm excitation; (4) Impact of 630 nm excitation of photosensitizer on the growth of chordoma xenograft tumors. RESULTS (1) The photosensitizers in chordoma cells and chordoma xenografts of nude mice were excited by 405 nm to emit red fluorescence; (2) 630 nm excitation photosensitizer reduces chordoma cell activity and inhibits chordoma xenograft tumor growth in chordoma nude mice. CONCLUSION Photodynamic techniques mediated by the photosensitizer hematoporphyrin derivatives can be used for the diagnosis and treatment of chordoma.
Collapse
Affiliation(s)
- Lei Li
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, 541001 Guilin, China
| | - Kai-Lun Wei
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, 541001 Guilin, China
| | - Ming-Song Liu
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, 541001 Guilin, China
| | - Qi-Lin Wang
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, 541001 Guilin, China
| | - Tong-Fei Zeng
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, 541001 Guilin, China
| | - Rui-Zhe Chen
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, 541001 Guilin, China
| | - Xue-Wei Xia
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, 541001 Guilin, China
| | - Hong-Tian Zhang
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, 541001 Guilin, China.
| |
Collapse
|
2
|
Tanaka Y, Abe D, Inaji M, Hara S, Sakai R, Maehara T. Intraoperative Telestration System in Endoscopic Transsphenoidal Surgery Contributes to Improved Surgical Safety and Efficient Surgical Education. World Neurosurg 2024:S1878-8750(24)01273-7. [PMID: 39067687 DOI: 10.1016/j.wneu.2024.07.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of a "telestration" system in which the mentor annotates the view of the surgical field, for endoscopic transsphenoidal surgery (ETS). METHODS The use of telestration was evaluated for sellar floor-opening during ETS and for a task performed using ETS simulation training. During ETS, the mentor outlined the opening area of the sella turcica on the monitor and then the trainee surgeon opened the sella, either with the telestration displayed (telestration (+) group, n = 8) or without (telestration (-) group, n = 7). In the task using an ETS training model, 18 subjects were asked to touch the indicated targets with the forceps, once with the instructions given via telestration and once with verbal instructions only. RESULTS During ETS, the telestration (+) group had a significantly higher concordance rate between the planned bone window and actual bone window than the telestration (-) group (92.97 ± 4.16% vs. 77.57 ± 10.51%, P = 0.014). In the ETS model, the time required to finish the task was significantly less with telestration than with verbal instructions alone (P = 0.002). None of the subjects had errors when telestration was used, while subjects made an average of 0.33 ± 0.59 errors and had to re-listen to the instructions 0.27 ± 0.46 times when only verbal instructions were given. CONCLUSIONS The use of the telestration system during ETS facilitated the communication of the mentor's intentions to the trainee surgeon and contributed to safer, more accurate surgery. The system was also thought to be useful in reducing operative time.
Collapse
Affiliation(s)
- Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Daisu Abe
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryosuke Sakai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
3
|
Campisi BM, Costanzo R, Gulino V, Avallone C, Noto M, Bonosi L, Brunasso L, Scalia G, Iacopino DG, Maugeri R. The Role of Augmented Reality Neuronavigation in Transsphenoidal Surgery: A Systematic Review. Brain Sci 2023; 13:1695. [PMID: 38137143 PMCID: PMC10741598 DOI: 10.3390/brainsci13121695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
In the field of minimally invasive neurosurgery, microscopic transsphenoidal surgery (MTS) and endoscopic transsphenoidal surgery (ETS) have been widely accepted as a safe approach for pituitary lesions and, more recently, their indications have been extended to lesions at various skull base regions. It is mandatory during transsphenoidal surgery (TS) to identify key anatomical landmarks in the sphenoid sinus and distinguish them from the lesion. Over the years, many intraoperative tools have been introduced to improve the neuronavigation systems aiming to achieve safer and more accurate neurosurgical interventions. However, traditional neuronavigation systems may lose the accuracy of real-time location due to the discrepancy between the actual surgical field and the preoperative 2D images. To deal with this, augmented reality (AR)-a new sophisticated 3D technology that superimposes computer-generated virtual objects onto the user's view of the real world-has been considered a promising tool. Particularly, in the field of TS, AR can minimize the anatomic challenges of traditional endoscopic or microscopic surgery, aiding in surgical training, preoperative planning and intra-operative orientation. The aim of this systematic review is to analyze the potential future role of augmented reality, both in endoscopic and microscopic transsphenoidal surgeries.
Collapse
Affiliation(s)
- Benedetta Maria Campisi
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Roberta Costanzo
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Vincenzo Gulino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Chiara Avallone
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Manfredi Noto
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Lapo Bonosi
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital, 95122 Catania, Italy;
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (B.M.C.); (V.G.); (C.A.); (M.N.); (L.B.); (L.B.); (D.G.I.); (R.M.)
| |
Collapse
|
4
|
Dannhoff G, Gallinaro P, Todeschi J, Ganau M, Spatola G, Ollivier I, Cebula H, Mallereau CH, Baloglu S, Pop R, Proust F, Chibbaro S. Approaching Intradural Lesions of the Anterior Foramen Magnum and Craniocervical Junction: Anatomical Comparison of the Open Posterolateral and Anterior Extended Endonasal Endoscopic Approaches. World Neurosurg 2023; 178:e410-e420. [PMID: 37482086 DOI: 10.1016/j.wneu.2023.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Lesions of the foramen magnum (FM) and craniocervical junction area are traditionally managed surgically through anterior, anterolateral, and posterolateral skull-base approaches. This anatomical study aimed to compare the usefulness of a modified extended endoscopic approach, the so-called far-medial endonasal approach (FMEA), versus the traditional posterolateral far-lateral approach (FLA). METHODS Ten fixed silicon-injected heads specimens were used in the Skull Base ENT-Neurosurgery Laboratory of the University Hospital of Strasbourg, France. A total of 20 FLAs and 10 FMEAs were realized. A high-resolution computed tomography scan was performed for quantitative analysis of the different approaches. The analysis aimed to estimate the extent of surgical exposure and freedom of movement (maneuverability) through the operating channel using a polygonal surface model to obtain a morphometric estimation of the area of interest (surface and volume) on postdissection computed tomography scans using Slicer 3D software. RESULTS FMEA allows for a more direct route to the anterior FM, with wider brainstem exposure compared with the FLA and an excellent visualization of all anterior midline structures. The limitations of the FMEA include the deep and narrow surgical corridor and difficulty in reaching lesions located laterally over the jugular foramen and hypoglossal canal. CONCLUSIONS The FMEA and FLA are both effective surgical routes to reach FM and craniocervical junction lesions. Modern skull base surgeons should have a good command of both because they appear complementary. This anatomical study provides the tools for comprehensive preoperative evaluations and selection of the most appropriate surgical approach.
Collapse
Affiliation(s)
- Guillaume Dannhoff
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France; Neuroradiology Unit, Strasbourg University Hospital, Strasbourg, France; Skull Base ENT-Neurosurgery Laboratory, University Hospital of Strasbourg, Strasbourg, France.
| | - Paolo Gallinaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Julien Todeschi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Mario Ganau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Giorgio Spatola
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Irène Ollivier
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Hélène Cebula
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | | | - Seyyid Baloglu
- Neuroradiology Unit, Strasbourg University Hospital, Strasbourg, France
| | - Raoul Pop
- Neuroradiology Unit, Strasbourg University Hospital, Strasbourg, France
| | - Francois Proust
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Salvatore Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France; Neuroradiology Unit, Strasbourg University Hospital, Strasbourg, France; Skull Base ENT-Neurosurgery Laboratory, University Hospital of Strasbourg, Strasbourg, France
| |
Collapse
|
5
|
Goto Y, Kawaguchi A, Inoue Y, Nakamura Y, Oyama Y, Tomioka A, Higuchi F, Uno T, Shojima M, Kin T, Shin M. Efficacy of a Novel Augmented Reality Navigation System Using 3D Computer Graphic Modeling in Endoscopic Transsphenoidal Surgery for Sellar and Parasellar Tumors. Cancers (Basel) 2023; 15:cancers15072148. [PMID: 37046809 PMCID: PMC10093001 DOI: 10.3390/cancers15072148] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
In endoscopic transsphenoidal skull base surgery, knowledge of tumor location on imaging and the anatomic structures is required simultaneously. However, it is often difficult to accurately reconstruct the endoscopic vision of the surgical field from the pre-surgical radiographic images because the lesion remarkably displaces the geography of normal anatomic structures. We created a precise three-dimensional computer graphic model from preoperative radiographic data that was then superimposed on a visual image of the actual surgical field and displayed on a video monitor during endoscopic transsphenoidal surgery. We evaluated the efficacy of this augmented reality (AR) navigation system in 15 consecutive patients with sellar and parasellar tumors. The average score overall was 4.7 [95% confidence interval: 4.58-4.82], which indicates that the AR navigation system was as useful as or more useful than conventional navigation in certain patients. In two patients, AR navigation was assessed as less useful than conventional navigation because perception of the depth of the lesion was more difficult. The developed system was more useful than conventional navigation for facilitating an immediate three-dimensional understanding of the lesion and surrounding structures.
Collapse
Affiliation(s)
- Yoshiaki Goto
- Department of Neurosurgery, University of Teikyo Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 179-8606, Japan
| | - Ai Kawaguchi
- Department of Neurosurgery, University of Teikyo Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 179-8606, Japan
| | - Yuki Inoue
- Department of Neurosurgery, University of Teikyo Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 179-8606, Japan
| | - Yuki Nakamura
- Department of Neurosurgery, University of Teikyo Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 179-8606, Japan
| | - Yuta Oyama
- Department of Neurosurgery, University of Teikyo Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 179-8606, Japan
| | - Arisa Tomioka
- Department of Neurosurgery, University of Teikyo Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 179-8606, Japan
| | - Fumi Higuchi
- Department of Neurosurgery, University of Teikyo Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 179-8606, Japan
| | - Takeshi Uno
- Department of Neurosurgery, University of Teikyo Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 179-8606, Japan
| | - Masaaki Shojima
- Department of Neurosurgery, University of Teikyo Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 179-8606, Japan
| | - Taichi Kin
- Department of Neurosurgery, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 133-8655, Japan
| | - Masahiro Shin
- Department of Neurosurgery, University of Teikyo Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 179-8606, Japan
| |
Collapse
|
6
|
Gendreau J, Jimenez A, Lozinsky S, Zenonos G, Gardner P, Raza S, Dea N, Gokaslan Z, Choby G, Van Gompel J, Redmond K, Gallia G, Bettegowda C, Rowan N, Kuo CC, Mukherjee D. Radiotherapy After Gross Total Resection of Skull Base Chordoma: A Surveillance, Epidemiology, and End Results Database Analysis of Survival Outcomes. World Neurosurg 2023; 172:e68-e76. [PMID: 36509323 DOI: 10.1016/j.wneu.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Skull base chordoma is a rare and locally destructive malignancy which presents unique therapeutic challenges. While achieving gross total resection (GTR) confers the greatest survival advantage, the role of adjuvant radiotherapy (RT) for patients who receive GTR remains unclear in the absence of prospective trials. Here, we aim to assess the effect of RT on survival outcomes in skull base chordoma patients who receive GTR by utilizing the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Patients with diagnostic, primary site, and resection codes specific for chordoma, skull base, and GTR, respectively, were queried in the SEER database (2000-2018). Kaplan-Meier curves (log-rank test) were constructed and Cox proportional hazards models were used to assess survival outcomes. RESULTS A total of 115 skull base chordomas undergoing GTR were identified, of which 37 (32%) received no RT and 78 (68%) received RT. Median follow-up was 55.00 months (range: 0.00-227.00). Overall survival (OS) of patients with GTR was 85% and 70% at 5 and 10 years, respectively. Multivariate Cox proportional hazard analysis among chordoma patients undergoing GTR found age ≥65 (P < 0.01) was associated with poorer OS outcomes. RT appeared to trend toward offering benefit in terms of OS in patients after GTR, however this did not achieve statistical significance in the adjusted model (HR = 0.51, CI = 0.23-1.16, P = 0.09). When comparing, disease-specific survival was also not improved in patients undergoing RT (HR = 0.58, CI = 0.23-1.46, P = 0.25). CONCLUSIONS It remains unclear whether RT after GTR of chordoma improved survival outcomes among SEER database patients.
Collapse
Affiliation(s)
- Julian Gendreau
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Adrian Jimenez
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Georgios Zenonos
- Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Paul Gardner
- Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaan Raza
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicolas Dea
- Department of Neurosurgery, University of British Columbia, Vancouver, Canada
| | - Ziya Gokaslan
- Department of Neurosurgery, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Garret Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie Van Gompel
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristin Redmond
- Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Gary Gallia
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Rowan
- Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cathleen C Kuo
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| |
Collapse
|
7
|
A Rare Case of a Primary Leiomyoma of the Clivus in an Immunocompetent Patient and a Review of the Literature Regarding Clival Lesions. Diagnostics (Basel) 2022; 13:diagnostics13010009. [PMID: 36611301 PMCID: PMC9818954 DOI: 10.3390/diagnostics13010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Leiomyomas are common lesions that are usually located in the genitourinary and gastrointestinal tracts. Primary leiomyomas at the skull base are uncommon. They are composed of well-differentiated smooth muscle cells without cellular atypia. The diagnosis of a leiomyoma has to be confirmed by immunohistochemistry. The tumor tissue is immunoreactive for SMA, S100 and cytokeratin. Leiomyomas mainly occur in immunocompromised patients. Most tumor tissues are positive for EBV. The presented case is that of a 56-year-old immunocompetent woman with a tumor on the clivus. The radiological images suggested chordoma or fibrous dysplasia. Transnasal transsphenoidal surgery was performed. The tumor tissue consisted of well-differentiated smooth muscle cells with elongated nuclei. Immunohistochemistry revealed a positive reaction for desmin, SMA and h-Caldesmon and a negative reaction for S100, beta-catenin, PGR and Ki67. The leiomyoma diagnosis was subsequently established. To the best of our knowledge, the case of a primary leiomyoma on the clivus of an immunocompetent patient is the first to be described. We also extensively reviewed the literature on the immunohistopathological and radiological differential diagnosis of clival lesions.
Collapse
|
8
|
Gupta KK, Balai E, Darr A, Jolly K. Reconstruction and Cerebrospinal Fluid Leaks in Endoscopic Endonasal Approach for the Management of Clival Chordomas-A Systematic Review. Indian J Otolaryngol Head Neck Surg 2022; 74:4807-4815. [PMID: 36742692 PMCID: PMC9895481 DOI: 10.1007/s12070-022-03114-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
The success of the endoscopic endonasal approach (EEA) to surgically manage clival chordomas (CC) relies on robust repair methods to reduce complications, such as cerebrospinal fluid (CSF) leaks. Our study aims to evaluate the existing literature to assess reconstructive techniques utilised and post-operative CSF leak rates in this cohort. A systematic review and analysis was performed of all published data related to CC patients managed with an EEA. A total of 24 articles were included, representing 363 patients and 396 procedures. A variety of reconstruction methods were used with 95.9% of studies using an intracranial repair graft, 70.8% using a nasoseptal flap (NSF), 62.5% using glue/haemostat, 58.3% using nasal packs and 75.0% employing multi-layered reconstruction. Post-operative CSF leak rate was 10.1%. The leak rate was less in subgroups where a NSF was used (9.4%) although this was not statistically significant (p = 0.273). There were no differences in leak rates when glue/haemostat (p = 0.139) or nasal packs (p = 0.550) were used. Our review is the most up-to-date synthesis of the existing literature surrounding the EEA to CCs assessing reconstruction and post-operative CSF leaks. It demonstrates most authors employ a multi-layered reconstruction method. The lack of statistical significance observed for CSF leaks in subgroups is likely due to a variety of cofounding surgeon and patient factors. Higher quality prospective randomised multi-centric studies, with reporting of specific repair techniques will enable future systematic reviews to provide a more accurate consensus regarding optimal methods of reconstruction in this field.
Collapse
Affiliation(s)
- Keshav Kumar Gupta
- Department of Surgery, Sandwell General Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Hallam Street, West Bromwich, B71 4HJ UK
| | - Edward Balai
- Department of Surgery, Sandwell General Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Hallam Street, West Bromwich, B71 4HJ UK
| | - Adnan Darr
- Department of Otorhinolaryngology, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP UK
| | - Karan Jolly
- Department of Otorhinolaryngology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, B15 2TH UK
| |
Collapse
|
9
|
Bin-Alamer O, Mallela AN, Palmisciano P, Gersey ZC, Elarjani T, Labib MA, Zenonos GA, Dehdashti AR, Sheehan JP, Couldwell WT, Lunsford LD, Abou-Al-Shaar H. Adjuvant stereotactic radiosurgery with or without postoperative fractionated radiation therapy in adults with skull base chordomas: a systematic review. Neurosurg Focus 2022; 53:E5. [DOI: 10.3171/2022.8.focus22239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE
The objective of this retrospective study was to compare the survival of patients with biopsy-proven skull base chordoma who had undergone stereotactic radiosurgery (SRS) with versus without prior fractionated radiation therapy (RT).
METHODS
Relevant articles from database inception to September 2021 were retrieved from the PubMed, Scopus, Web of Science, and Cochrane databases for a systematic review of treatment protocols. Studies were included if they 1) involved adult patients (age ≥ 18 years) with histologically and radiologically confirmed chordomas located within the clival skull base region and treated with SRS; 2) reported data on clinical features, SRS protocols, and outcomes; and 3) were written in the English language. Studies were excluded if they 1) were literature reviews, case reports, technical notes, abstracts, or autopsy reports; 2) did not clearly differentiate the data of patients with chordomas from the data of patients with different tumors or the data of patients with chordomas in locations other than the skull base; or 3) lacked histological confirmation or treatment and outcome data. Extracted data included the following: study author and publication year, patient age and sex, symptoms, cranial nerve involvement, invaded structures, lesion size, treatment modality, surgical details, histopathological type, RT modality, SRS parameters, complications, postradiosurgery outcomes, complications, and survival outcomes.
RESULTS
After the selection process, 15 articles describing 130 patients met the study eligibility criteria, including 94 patients who had undergone postresection SRS (NoRT group) and 36 who had undergone postresection fractionated RT and subsequent SRS (RT group). The NoRT and RT groups were comparable in age (51.3 vs 47.4 years, respectively), sex (57.1% vs 58.3% male), tumor volume (9.5 vs 11.2 cm3), SRS treatment parameters (maximum dose: 35.4 vs 42.2 Gy, marginal dose: 19.6 vs 20.6 Gy, treatment isodose line: 60.2% vs 65.2%), and SRS adverse effects (10.9% vs 17.6%). For the entire cohort, the 3-, 5-, and 10-year progression-free survival (PFS) rates were 23%, 9%, and 3%, respectively, and the overall survival (OS) rates were 94%, 82%, and 76%, respectively. In the NoRT group, SRS was adjuvant treatment after resection in 38 patients (40.4%), salvage treatment for recurrent tumor treated with resection alone in 10 (10.6%), and not specified in 46 (48.9%). In the RT group, SRS was boost treatment in 9 patients (25.0%), salvage treatment after recurrence in 22 (61.1%), and not specified in 5 (13.9%). There was no difference between the two groups in terms of median PFS (24.0 months [Q1 34.0, Q3 15.0] vs 23.8 months [34.0, 18.0], respectively; p = 0.8) or median OS (293.0 months [not reached, 137.4] vs not reached [not reached, 48.0], respectively; p = 0.36). The adverse radiation effect rates were comparable between the groups (10.9% vs 17.6%, respectively; p = 0.4).
CONCLUSIONS
The role of SRS in the management of skull base chordomas is still evolving. This systematic literature review of biopsy-proven chordoma revealed that tumor control and survival rates for SRS alone after chordoma surgery were not inferior to those encountered after SRS plus fractionated RT.
Collapse
Affiliation(s)
- Othman Bin-Alamer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arka N. Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Zachary C. Gersey
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Turki Elarjani
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Mohamed A. Labib
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Georgios A. Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amir R. Dehdashti
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Jason P. Sheehan
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - William T. Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - L. Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
10
|
Mayo Clinic Clival Chordoma Case Series: Impact of Endoscopic Training on Clinical Care. Cancers (Basel) 2022; 14:cancers14205104. [PMID: 36291887 PMCID: PMC9600266 DOI: 10.3390/cancers14205104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/20/2022] Open
Abstract
The management of clival chordoma in our group shifted around 2013 to mostly endoscopic, and proton beam was introduced for our multidisciplinary team. Consecutive patients who had surgical resection from 1987 to 2021 were reviewed. A total of 58 patients (39 patients after 2013) were analyzed. The mean tumor size was 3.7 cm, and the most common location was the upper clivus (43%). Compared to before 2013, after 2013, the endoscopic endonasal approach was more common (90%, p < 0.001), and more gross or near total resections (64%, p = 0.002) were attained. Ten cases (17%) were revision surgeries referred from elsewhere, and three cases (5%) underwent additional surgery elsewhere before adjuvant radiation. The postoperative cerebrospinal fluid leak occurred in 7%. Post-operative new cranial nerve deficits occurred in 32% before 2013, compared to 2.6% after 2013 (p = 0.004). For cases before 2013, 10 patients (53%) recurred during the median follow-up of 144 months (mean, 142 months), whereas for cases after 2013, seven patients (18%) recurred with a median follow-up of 35 months (mean, 42 months). 5-year progression-free survival was 58%, and 5-year overall survival was 87%. A specialized multidisciplinary team improved the resection rate compared to a historical cohort with an excellent morbidity profile.
Collapse
|
11
|
Wang Y, Peng Z, Wang Y, Fan R, Zhang H, Jiang W. The prognostic significance of different degrees of resection of skull base chordoma. CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2022; 24:2441-2452. [PMID: 35953670 DOI: 10.1007/s12094-022-02915-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Complete resection combined with postoperative radiotherapy is ideal for skull base chordomas. The recent literature suggests that the degree of surgical resection is the most important prognostic factor. METHODS We retrospectively analyzed the clinical data of 16 patients with initial chordoma treated at our center between August 2015 and December 2021 and conducted a retrospective study on the prognosis of surgical treatment of skull base chordoma between 2013 and 2022. RESULTS According to the Kaplan-Meier method, there was a significant difference in PFS between patients aged > 50 years and < 50 years, and no significant difference was observed in PFS for tumor involvement of the internal carotid artery, dura, or superior or inferior clivus. However, there was still a correlation with prognosis. As observed in the included literature, the 5-year overall survival rate was significantly higher in patients undergoing total skull base chordoma resection than in those undergoing subtotal resection (STR), which in turn was significantly higher than in those undergoing partial resection (PR). Patients undergoing subtotal resection had significantly better 5-year PFS rates than those undergoing PR. CONCLUSION Our study shows that gross total resection and STR have better survival in patients with skull base chordomas compared to PR.
Collapse
Affiliation(s)
- Yaxuan Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Zhouying Peng
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yumin Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Ruohao Fan
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Hua Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Weihong Jiang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. .,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. .,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| |
Collapse
|
12
|
Teramoto S, Tahara S, Murai Y, Sato S, Hattori Y, Kondo A, Morita A. Injury to the Extrasellar Portion of the Internal Carotid Artery during Endoscopic Transsphenoidal Surgery: A Case Report. Front Surg 2022; 9:895233. [PMID: 35620195 PMCID: PMC9127310 DOI: 10.3389/fsurg.2022.895233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Injury to the internal carotid artery (ICA) during endoscopic transsphenoidal surgery (ETSS) is a serious complication with a risk of mortality. ICA injury during ETSS usually occurs during intrasellar manipulations and rarely occurs in the extrasellar portion. Several hemostatic procedures have been proposed for ICA injury in the intrasellar portion, whereas hemostatic methods for ICA injury in the extrasellar portion, where the ICA is surrounded by bone structures, are less well known. Case Presentation A 65-year-old man with an incidental pituitary tumor underwent ETSS. The petrous portion of the left ICA was injured during resection of the sphenoid septum connected with left carotid prominence using a cutting forceps. Bleeding was too heavy for simple hemostatic techniques. Hemostasis using a crushed muscle patch was tried unsuccessfully during controlling of the bleeding. Eventually, the injured site of the ICA was covered with cotton patties followed by closing with a vascularized pedicled nasoseptal flap. Cerebral angiography immediately after surgery showed no extravasation from the injured site of the left ICA petrous portion. However, a carotid-cavernous sinus fistula originating from the injured ICA site was detected 7 days after surgery, so the vascular reconstructive surgery combined with left ICA occlusion was performed. The overall postoperative course was uneventful. Conclusion We believe that emergency application of the cottonoids may be effective for hemostasis against ICA injury in the extrasellar portion during ETSS, but further vascular reconstruction combined with ICA occlusion on the injured side and removal of the cottonoids would be required.
Collapse
Affiliation(s)
- Shinichiro Teramoto
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
- Correspondence: Shinichiro Teramoto
| | - Shigeyuki Tahara
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Shun Sato
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Yujiro Hattori
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
13
|
Wang B, Li Q, Sun Y, Tong X. Surgical Strategy for Skull Base Chordomas : Transnasal Midline Approach or Transcranial Lateral Approach. J Korean Neurosurg Soc 2022; 65:457-468. [PMID: 35286801 PMCID: PMC9082126 DOI: 10.3340/jkns.2021.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The clinical management paradigm of skull base chordomas is still challenging. Surgical resection plays an important role of affecting the prognosis. Endonasal endoscopic approach (EEA) has gradually become the preferred surgical approach in most cases, but traditional transcranial surgery cannot be completely replaced. This study presents a comparison of the results of the two surgical strategies and a summary of the treatment algorithms for skull base chordomas. METHODS We retrospectively analyzed the surgical outcomes and follow-up data of 48 patients with skull base chordomas diagnosed pathologically who received transnasal midline approaches (TMA) and transcranial lateral approaches (TLA) from 2010 to 2020. RESULTS Among the 48 patients, 36 cases were adopted TMA and 12 cases were performed with TLA. In terms of gross total resection (GTR) rate, 27.8% in TMA and 16.7% in TLA and with EEA alone it was increased to 38.9%, while 29.7% in primary surgery. In TMA, the cerebrospinal fluid (CSF) leak remains the most common complication (13 cases, 36.1%), other main complications included death, cranial nerve palsy, hypopituitarism, all the comparisons were no statistical significance. The Karnofsky Performance Scale scores in TMA were all better than those in TLA at different time, and the overall survival (OS) and recurrence free survival/progression free survival was just the reverse. CONCLUSION The EEA for skull base chordomas resection has improved the GTR rate, but transcranial approach is still an alternative approach. It is necessary to select an appropriate surgical approach based on the location and the pattern of tumor growth in order to obtain the best surgical outcomes.
Collapse
Affiliation(s)
- Benlin Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Qi Li
- School of Medicine, Nankai University, Tianjin, China
| | - Yang Sun
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Xiaoguang Tong
- School of Medicine, Nankai University, Tianjin, China
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| |
Collapse
|
14
|
Baussart B, Racy E, Gaillard S. Double pedicled nasoseptal flap for skull base repair after endoscopic expanded endonasal approach. Acta Neurochir (Wien) 2022; 164:1111-1114. [PMID: 35094146 DOI: 10.1007/s00701-021-05094-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Expanded endonasal approach offers a spectacular corridor for skull base tumour resection but requires reliable multilayer reconstruction techniques with a vascularized nasoseptal flap. METHOD On the basis on our substantial experience of 136 patients operated on between January 2008 and January 2020, the double pedicled nasoseptal flap technique was developed for skull base repair. The technique is finely detailed. The nasal floor mucosa was preserved. CSF leakage occurred in 4% of patients. CONCLUSION Double pedicled nasoseptal flap is a reproducible and efficient technique for skull base reconstruction after expanded endonasal approach and is associated with limited rhinological complications.
Collapse
|
15
|
Sun Y, Wang L, Shi X, Liu F. Maximal Resection of Tumors Encasing the Internal Carotid Artery and Hindering Internal Carotid Artery Expansion Followed by Revascularization Surgery: A Series of Nine Cases at a Single Tertiary Center. Front Surg 2022; 9:808446. [PMID: 35252331 PMCID: PMC8893348 DOI: 10.3389/fsurg.2022.808446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeCerebral reconstruction appears to play a diminished role in managing complex skull base tumors involving vital neurovascular structures.Materials and MethodsPatients with recurrent or progressive middle cranial fossa tumors treated by radical resection followed by extracranial-to-intracranial (EC-IC) bypass from 2014 to 2019 were included. Balloon test occlusion (BTO) was performed preoperatively.ResultsOverall, 9 patients (5 males, 4 females; mean age, 29.9 years) were enrolled. The lesions arose from the parasellar region (3), cavernous sinus (3), petroclival region (2), or orbital apex (1), and all encased the cavernous/petrous portion of the internal carotid artery. Before tumor resection, internal maxillary artery (IMA) bypass was performed for 7 patients, cervical EC-IC bypass was performed for 1 patient, and interposed superficial temporal artery (STA) bypass was performed for 1 patient. BTO failed in 8 patients and was tolerated by one patient. Intraoperative blood flow of the interposed graft was 79.7 ± 37.86 ml/min after IMA bypass, 190.6 ml/min following cervical EC-IC bypass and 75 ml/min after interposed STA bypass. All bypasses were patent on intraoperative indocyanine green angiography. Radical tumor resection was achieved in 5 patients (55.6%), and patency was confirmed postoperatively in 88.8% (8/9) of bypasses. Six patients showed favorable outcomes at discharge. At the 2-year follow-up, 7 patients (77.8%) had favorable outcomes (Karnofsky Performance Scale score>80). At the 1.5-year follow-up, one patient had died due to infarction; at the 3-year follow-up, another patient had developed tumor recurrence despite being asymptomatic.ConclusionCerebral bypass remains a vital tool for managing select middle cranial fossa tumors that invade or erode the surrounding neurovasculature or hinder carotid artery expansion and are difficult to resect.
Collapse
Affiliation(s)
- Yuming Sun
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Long Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiangen Shi
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xiangen Shi
| | - Fangjun Liu
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
16
|
Karampouga M, Tsetsos F, Sakellariou P, Baltas I. Outcomes and issues of 12 chordomas treated in a single center. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chordomas stem from notochordal vestiges and rank as low-grade bone malignancies although fraught with high risk of recurrence. This study assesses the clinical outcomes of twelve chordoma cases treated in our clinic, in an effort to shed light on the often under-represented pool of results deriving from non-referral centers.
Methods
We reviewed the clinicopathological traits of all chordoma patients registered in our center since 1991. Major endpoints were overall survival (OS) and progression-free survival (PFS) estimated using the Kaplan–Meier and Nelson–Aalen methods.
Results
Twelve patients, aged on average 47.9 years, were treated for primary or recurrent disease. Seven had chordomas originating in the cranium, 5 in the spine, including a bifocal tumor, and the mean time lapse between the beginning of symptoms and diagnosis was 15.4 months, marked by dull ache. Subtotal resection was achieved in 5 cases, incomplete in 5, while in 2, only biopsy was accomplished. Conformal radiotherapy was administered to 5 and stereotactic radiosurgery to 2 in the setting of recurrence. Protons were used once and targeted agents induced no clinical response in 3 patients. Median OS and PFS were 36 and 12 months, respectively, with the best outlook linked to maximal resection, spinal location, and good preoperative functional status. In all, 6 patients died of chordoma, 4 are alive, and 1 was lost. Relapse was the rule for most cases, except 2, and pulmonary metastases were ascertained in 1.
Conclusions
Our cases were typical of chordomas, implying that inadequate surgical margins and successive recurrence are negative determinants of prognosis and that interinstitutional cooperation counterbalances shortages in non-referral institutes.
Collapse
|
17
|
Napieralska A, Blamek S. Intracranial chordoma: radiosurgery, hypofractionated stereotactic radiotherapy and treatment outcomes. Rep Pract Oncol Radiother 2021; 26:764-772. [PMID: 34760311 DOI: 10.5603/rpor.a2021.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background The aim of the study was to assess the results of stereotactic radiosurgery and hypofractionated stereotactic radiotherapy (SRS/SRT) for skull base chordomas. Materials and methods Twenty-three patients aged 12-75 were treated with SRS/SRT due to skull base chordoma. In 19 patients SRS/SRT was a part of the primary therapy, while in 4, a part of the treatment of recurrence. In 4 patients SRS/SRT was used as a boost after conventional radiotherapy and in 19 cases it was the only irradiation method applied. Patients were irradiated to total dose of 6-35 Gy and median total equivalent dose of 52 Gy. Results During median follow-up of 39 months, 4 patients died. One-, two- and five-year OS was 95%, 89% and 69%, respectively. In nine patients, progression of the disease was diagnosed during study period. One-, two- and five-year progression free survival (PFS) from the end of radiotherapy was 81%, 59% and 43%, respectively. Radiotherapy was well tolerated and only two patients in our group experienced moderate treatment-related toxicity. Conclusion SRS/SRT alone or in combination with surgery is a safe and effective method of irradiation of patients with skull base chordomas. High EQD2 is necessary to achieve satisfactory treatment results.
Collapse
Affiliation(s)
- Aleksandra Napieralska
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Sławomir Blamek
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| |
Collapse
|
18
|
Fava A, Russo PD, Tardivo V, Passeri T, Câmara B, Penet N, Abbritti R, Giammattei L, Mammar H, Bernat AL, Mandonnet E, Froelich S. Endoscope-assisted far-lateral transcondylar approach for craniocervical junction chordomas: a retrospective case series and cadaveric dissection. J Neurosurg 2021; 135:1335-1346. [PMID: 33799304 DOI: 10.3171/2020.9.jns202611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Craniocervical junction (CCJ) chordomas are a neurosurgical challenge because of their deep localization, lateral extension, bone destruction, and tight relationship with the vertebral artery and lower cranial nerves. In this study, the authors present their surgical experience with the endoscope-assisted far-lateral transcondylar approach (EA-FLTA) for the treatment of CCJ chordomas, highlighting the advantages of this corridor and the integration of the endoscope to reach the anterior aspect and contralateral side of the CCJ and the possibility of performing occipitocervical fusion (OCF) during the same stage of surgery. METHODS Nine consecutive cases of CCJ chordomas treated with the EA-FLTA between 2013 and 2020 were retrospectively reviewed. Preoperative characteristics, surgical technique, postoperative results, and clinical outcome were analyzed. A cadaveric dissection was also performed to clarify the anatomical landmarks. RESULTS The male/female ratio was 1.25, and the median age was 36 years (range 14-53 years). In 6 patients (66.7%), the lesion showed a bilateral extension, and 7 patients (77.8%) had an intradural extension. The vertebral artery was encased in 5 patients. Gross-total resection was achieved in 5 patients (55.6%), near-total resection in 3 (33.3%), and subtotal resection 1 (11.1%). In 5 cases, the OCF was performed in the same stage after tumor removal. Neither approach-related complications nor complications related to tumor resection occurred. During follow-up (median 18 months, range 5-48 months), 1 patient, who had already undergone treatment and radiotherapy at another institution and had an aggressive tumor (Ki-67 index of 20%), showed tumor recurrence at 12 months. CONCLUSIONS The EA-FLTA provides a safe and effective corridor to resect extensive and complex CCJ chordomas, allowing the surgeon to reach the anterior, lateral, and posterior portions of the tumor, and to treat CCJ instability in a single stage.
Collapse
Affiliation(s)
- Arianna Fava
- 1Department of Neurosurgery, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
- 2Laboratory of Experimental and Skull Base Neurosurgery, Department of Neurosurgery, Lariboisière Hospital, Paris
| | - Paolo di Russo
- 1Department of Neurosurgery, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
- 2Laboratory of Experimental and Skull Base Neurosurgery, Department of Neurosurgery, Lariboisière Hospital, Paris
| | - Valentina Tardivo
- 1Department of Neurosurgery, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
- 2Laboratory of Experimental and Skull Base Neurosurgery, Department of Neurosurgery, Lariboisière Hospital, Paris
| | - Thibault Passeri
- 1Department of Neurosurgery, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
- 3University of Paris; and
| | - Breno Câmara
- 1Department of Neurosurgery, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Nicolas Penet
- 1Department of Neurosurgery, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
- 2Laboratory of Experimental and Skull Base Neurosurgery, Department of Neurosurgery, Lariboisière Hospital, Paris
- 3University of Paris; and
| | - Rosaria Abbritti
- 1Department of Neurosurgery, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Lorenzo Giammattei
- 1Department of Neurosurgery, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
- 2Laboratory of Experimental and Skull Base Neurosurgery, Department of Neurosurgery, Lariboisière Hospital, Paris
- 3University of Paris; and
| | - Hamid Mammar
- 4Proton Therapy Center, Institut Curie, Orsay, France
| | - Anne Laure Bernat
- 1Department of Neurosurgery, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
- 3University of Paris; and
| | - Emmanuel Mandonnet
- 1Department of Neurosurgery, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
- 3University of Paris; and
| | - Sébastien Froelich
- 1Department of Neurosurgery, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris
- 2Laboratory of Experimental and Skull Base Neurosurgery, Department of Neurosurgery, Lariboisière Hospital, Paris
- 3University of Paris; and
| |
Collapse
|
19
|
Ceylan S, Emengen A, Caklili M, Ergen A, Yılmaz E, Uzuner A, Icli D, Cabuk B, Anik I. Operative nuances and surgical limits of the endoscopic approach to clival chordomas and chondrosarcomas: A single-center experience of 72 patients. Clin Neurol Neurosurg 2021; 208:106875. [PMID: 34388599 DOI: 10.1016/j.clineuro.2021.106875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/24/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Gross total resection (GTR) is the mainstay therapy for chordomas and chondrosarcomas to have the best prognosis. The aims of this study were to specify the limits of EEA, emphasize the need for additional combined approaches for tumors beyond these limitations for high resection rates, discuss the prognostic factors and operative nuances that affect GTR, and present the causes and characteristics of early and late recurrences. METHODS We retrospectively analyzed the endoscopic endonasal surgeries in the Pituitary Research Center and Neurosurgery Department of the Kocaeli University Faculty of Medicine, Turkey between January 2004 and December 2019. We retrospectively reviewed the medical data, radiological images, and surgical videos of patients, and 72 patients with chordoma and chondrosarcoma were included in the study. RESULTS Based on pathology reports, 72 patients (seven pediatric) were identified, to whom 91 endoscopic operations were performed. We determined the surgical limitations for each clival segment as superior, middle, and inferior. Then, we divided these into three subgroups according to whether the tumor shows dural invasion (extradural chordoma, large extradural - minimal intradural component, and minimal extradural - large intradural component). The tumors of 19 (26.4%), 25 (26.4%), and nine (12.5%) patients originated from the superior, middle, and inferior clivus, respectively. Nineteen (26.4%) patients had panclival involvement. GTR was performed in 47 (65.3%) the patients. The GTR rate in patients with panclival tumors was 47.3% (9/19). The experience, lateralization, dural involvement, and origin of the clivus affecting GTR were analyzed. Extradural - intradural extensions were verified as negative predictor factors for GTR, whereas tumors located in the superior (OR: 16.710, p=0.030) and middle (OR: 11.154, p=0.023) segments were positive predictive factors for GTR. CONCLUSION An increasing experience in endoscopic surgery significantly increases the GTR rates by widening the surgical limitations. Due to dense bone infiltration and adhesion to critical neurovascular structures, recurrence rates are high despite performing GTR. Although surgery and adjuvant treatments improve the 5-year survival of patients, the mortality rates remain high. Therefore, surgery of these tumors should be performed by experienced centers. In addition to surgical and adjuvant therapies, targeted molecular and translational biological therapies are also needed for chordomas and chondrosarcomas in the future.
Collapse
Affiliation(s)
- Savas Ceylan
- Kocaeli University, Neurosurgery Department, Pituitary Research Center, Kocaeli, Turkey.
| | - Atakan Emengen
- Kocaeli State Hospital, Neurosurgery Department, Kocaeli, Turkey
| | - Melih Caklili
- Taksim Education and Research Hospital, Neurosurgery Department, Istanbul, Turkey
| | - Anil Ergen
- Kocaeli University, Neurosurgery Department, Pituitary Research Center, Kocaeli, Turkey
| | - Eren Yılmaz
- Kocaeli University, Neurosurgery Department, Pituitary Research Center, Kocaeli, Turkey
| | - Ayse Uzuner
- Kocaeli University, Neurosurgery Department, Pituitary Research Center, Kocaeli, Turkey
| | - Dilek Icli
- Kocaeli University, Department of Anesthesiology and Reanimation, Kocaeli, Turkey
| | - Burak Cabuk
- Kocaeli University, Neurosurgery Department, Pituitary Research Center, Kocaeli, Turkey
| | - Ihsan Anik
- Kocaeli University, Neurosurgery Department, Pituitary Research Center, Kocaeli, Turkey
| |
Collapse
|
20
|
Chibbaro S, Signorelli F, Milani D, Cebula H, Scibilia A, Bozzi MT, Messina R, Zaed I, Todeschi J, Ollivier I, Mallereau CH, Dannhoff G, Romano A, Cammarota F, Servadei F, Pop R, Baloglu S, Lasio GB, Luca F, Goichot B, Proust F, Ganau M. Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience. Cancers (Basel) 2021; 13:cancers13143603. [PMID: 34298816 PMCID: PMC8304085 DOI: 10.3390/cancers13143603] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/22/2021] [Accepted: 07/10/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Giant pituitary adenomas are highly invasive tumors whose treatment is challenging. Surgery is their management mainstay. However, there is no consensus about the type of approach. Open transcranial, microscopic, and endoscopic trans-sphenoidal approaches have all been employed, alone or in combination. Extended endoscopic endonasal techniques may represent a versatile and safe one-stage approach. Our research aimed at evaluating prospectively their applicability, effectiveness, and safety in a multicenter series, to acquire further evidence toward its use in the treatment of those challenging lesions. Ninety-six patients were recruited and followed-up for 52.4 months on average. Most of them (81.2%) presented with visual deficits and >50% had various degrees of adenohypophysis insufficiency. Resection of at least 75% of initial volume was achieved in all cases, with 98.7% visual improvement, >50% endocrine deficit recovery and a permanent complication rate of 4.2%, indicating extended endoscopic endonasal approaches as a valuable treatment option. Abstract Purpose: To evaluate factors influencing clinical and radiological outcome of extended endoscopic endonasal transtuberculum/transplanum approach (EEA-TTP) for giant pituitary adenomas (GPAs). Methods: We recruited prospectively all consecutive GPAs patients undergoing EEA-TTP between 2015 and 2019 in 5 neurosurgical centers. Preoperative clinical and radiologic features, visual and hormonal outcomes, extent of resection (EoR), complications and recurrence rates were recorded and analyzed. Results: Of 1169 patients treated for pituitary adenoma, 96 (8.2%) had GPAs. Seventy-eight (81.2%) patients had visual impairment, 12 (12.5%) had headaches, 3 (3.1%) had drowsiness due to hydrocephalus, and 53 (55.2%) had anterior pituitary insufficiency. EoR was gross or near-total in 46 (47.9%) and subtotal in 50 (52.1%) patients. Incomplete resection was associated with lateral suprasellar, intraventricular and/or cavernous sinus extension and with firm/fibrous consistence. At the last follow-up, all but one patient (77, 98.7%) with visual deficits improved. Headache improved in 8 (88.9%) and anterior pituitary function recovered in 27 (50.9%) patients. Recurrence rate was 16.7%, with 32 months mean recurrence-free survival. Conclusions: EEA-TTP is a valid option for GPAs and seems to provide better outcomes, lower rate of complications and higher EoR compared to one- or multi-stage microscopic, non-extended endoscopic transsphenoidal, and transcranial resections.
Collapse
Affiliation(s)
- Salvatore Chibbaro
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Francesco Signorelli
- Neurosurgery Unit, Department of Basic Medical Sciences, Neurosciences, Sense Organs, University “Aldo Moro”, 70124 Bari, Italy;
- Correspondence: ; Tel.: +39-0805592900
| | - Davide Milani
- Neurosurgery Unit, Humanitas Research Hospital, 20089 Milano, Italy; (D.M.); (F.S.); (G.B.L.)
| | - Helene Cebula
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Antonino Scibilia
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Maria Teresa Bozzi
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Raffaella Messina
- Neurosurgery Unit, Department of Basic Medical Sciences, Neurosciences, Sense Organs, University “Aldo Moro”, 70124 Bari, Italy;
| | - Ismail Zaed
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
- Neurosurgery Unit, Humanitas Research Hospital, 20089 Milano, Italy; (D.M.); (F.S.); (G.B.L.)
| | - Julien Todeschi
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Irene Ollivier
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Charles Henry Mallereau
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Guillaume Dannhoff
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Antonio Romano
- Neurosurgery Department, Parma and Reggio Emilia Hospital, University of Parma, 43126 Parma, Italy;
| | - Francesco Cammarota
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Franco Servadei
- Neurosurgery Unit, Humanitas Research Hospital, 20089 Milano, Italy; (D.M.); (F.S.); (G.B.L.)
| | - Raoul Pop
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Seyyid Baloglu
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Giovanni Battista Lasio
- Neurosurgery Unit, Humanitas Research Hospital, 20089 Milano, Italy; (D.M.); (F.S.); (G.B.L.)
| | - Florina Luca
- Endocrinology Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (F.L.); (B.G.)
| | - Bernard Goichot
- Endocrinology Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (F.L.); (B.G.)
| | - Francois Proust
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Mario Ganau
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
- Neurosurgery Department, Oxford University Hospital, Oxford OX3 9DU, UK
| |
Collapse
|
21
|
Cavallo LM, Mazzatenta D, d'Avella E, Catapano D, Fontanella MM, Locatelli D, Luglietto D, Milani D, Solari D, Vindigni M, Zenga F, Zona G, Cappabianca P. The management of clival chordomas: an Italian multicentric study. J Neurosurg 2021; 135:93-102. [PMID: 32886913 DOI: 10.3171/2020.5.jns20925] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the last 2 decades, the endoscopic endonasal approach in the treatment of clival chordomas has evolved to be a viable strategy to achieve maximal safe resection of this tumor. Here, the authors present a multicentric national study, intending to analyze the evolution of this approach over a 20-year time frame and its contribution in the treatment of clival chordomas. METHODS Clival chordoma cases surgically treated between 1999 and 2018 at 10 Italian neurosurgical departments were included in this retrospective study. Clinical, radiological, and surgical findings, adjuvant therapy, and outcomes were evaluated and compared according to classification in the treatment eras from 1999 to 2008 and from 2009 to 2018. RESULTS One hundred eighty-two surgical procedures were reviewed, with an increase in case load since 2009. The endoscopic endonasal transclival approach (EETA) was performed in 151 of 182 cases (83.0%) and other approaches were performed in 31 cases (17%). There was an increment in the use of EETA, neuronavigation, and Doppler ultrasound after 2008. The overall postoperative complication rate was 14.3% (26 of 182 cases) consisting of 9 CSF leaks (4.9%), 7 intracranial hemorrhages (3.8%), 5 cases of meningitis (2.7%), and 5 cerebral ischemic injuries (2.7%). Gross-total resection (GTR) was achieved in 93 of 182 cases (51.1%). Extent of resection (EOR) improved in the second era of the study. Signs and/or symptoms at presentation worsened in 27 cases (14.8%), and the Katz Index worsened in 10 cases (5.5%). Previous treatment, dural involvement, EETA, and intraoperative Doppler ultrasound correlated with GTR. Patients received adjuvant proton beam radiation in 115 of 182 cases (63.2%), which was administered more in the latter era. Five-year progression-free survival (PFS) and overall survival (OS) were 62.3% and 73.5%, respectively. GTR, EETA, proton beam therapy, and the chondroid subtype correlated with a better survival rate. The mean follow-up was 62 months. CONCLUSIONS Through multicentric data collection, this study encompasses the largest series in the literature of clival chordomas surgically treated through an EETA. An increase in the use of this approach was found among Italian neurosurgical departments together with an improved extent of resection over time. The satisfactory rate of GTR was marked by low surgical morbidity and the preservation of patient quality of life. Surgical outcome was reinforced, in terms of PFS and OS, by the use of proton beam therapy, which was increasingly performed along the period of study.
Collapse
Affiliation(s)
- Luigi Maria Cavallo
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples
| | - Diego Mazzatenta
- 2Department of Biomedical and Neuromotor Sciences, University of Bologna, IRCCS Institute of Neurological Sciences of Bologna, "Bellaria" Hospital, Bologna
| | - Elena d'Avella
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples
| | - Domenico Catapano
- 3Division of Neurosurgery, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo
| | | | - Davide Locatelli
- 5Division of Neurosurgery, Università degli Studi dell'Insubria, Ospedale di Circolo e Fondazione Macchi, Varese
| | | | - Davide Milani
- 7Division of Neurosurgery, Humanitas Research Hospital, Rozzano
| | - Domenico Solari
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples
| | - Marco Vindigni
- 8Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine
| | - Francesco Zenga
- 9Department of Neuroscience, "Rita Levi Montalcini", Neurosurgery Unit, University of Turin; and
| | - Gianluigi Zona
- 10Neurosurgery and Neurotraumatology, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Paolo Cappabianca
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples
| |
Collapse
|
22
|
di Russo P, Fava A, Giammattei L, Passeri T, Okano A, Abbritti R, Penet N, Bernat AL, Labidi M, Froelich S. The Rostral Mucosa: The Door to Open and Close for Targeted Endoscopic Endonasal Approaches to the Clivus. Oper Neurosurg (Hagerstown) 2021; 21:150-159. [PMID: 34038940 DOI: 10.1093/ons/opab141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Extended endoscopic endonasal approaches (EEAs) have progressively widened the armamentarium of skull base surgeons. In order to reduce approach-related morbidity of EEAs and closure techniques, the development of alternative strategies that minimize the resection of normal tissue and alleviate the use of naso-septal flap (NSF) is needed. We report on a novel targeted approach to the clivus, with incision and closure of the mucosa of the rostrum, as the initial and final step of the approach. OBJECTIVE To present an alternative minimally invasive approach and reconstruction technique for selected clival chordomas. METHODS Three cases of clival chordomas illustrating this technique are provided, together with an operative video. RESULTS The mucosa of the rostrum is incised and elevated from the underlying bone, as first step of surgery. Following tumor resection with angled scope and instruments, the mucosa of the sphenoid sinus (SS) is removed and the tumor cavity and SS are filled with abdominal fat. The mucosal incision of the rostrum is then sutured. A hangman knot is prepared outside the nasal cavity and tightened after the first stitch and a running suture is performed. CONCLUSION We propose, in this preliminary report, a new targeted approach and reconstruction strategy, applying to EEAs the classic concept of skin incision and closure for transcranial approaches. With further development in the instrumentations and visualization tools, this technique may become a valuable minimally invasive endonasal approach for selected lesions.
Collapse
Affiliation(s)
- Paolo di Russo
- Department of Neurosurgery, Lariboisiere Hospital, Paris, France
| | - Arianna Fava
- Department of Neurosurgery, Lariboisiere Hospital, Paris, France
| | - Lorenzo Giammattei
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris, Paris, France
| | - Thibault Passeri
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris, Paris, France
| | - Atsushi Okano
- Department of Neurosurgery, Lariboisiere Hospital, Paris, France
| | - Rosaria Abbritti
- Department of Neurosurgery, Lariboisiere Hospital, Paris, France
| | - Nicolas Penet
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris, Paris, France
| | | | - Moujahed Labidi
- Department of Neurosurgery, Lariboisiere Hospital, Paris, France
| | - Sebastien Froelich
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris, Paris, France
| |
Collapse
|
23
|
Gull HH, Karadag C, Senger B, Sorg RV, Möller P, Mellert K, Steiger HJ, Hänggi D, Cornelius JF. Ciprofloxacin enhances phototoxicity of 5-aminolevulinic acid mediated photodynamic treatment for chordoma cell lines. Photodiagnosis Photodyn Ther 2021; 35:102346. [PMID: 34038764 DOI: 10.1016/j.pdpdt.2021.102346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/21/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chordoma are uncommon aggressive tumors of the skeleton. Surgical resection is often subtotal and adjuvant treatment possibilities are limited as chordomas are highly chemo- and radioresistant. In the present study we examined the impact of 5-ALA PDT on different human chordoma cell lines. Furthermore, we investigated the variation of two parameters: (1.) 5-ALA incubation time and (2.) supplemental use of ciprofloxacin as iron chelator. METHODS Experiments were realized in vitro with three different human chordoma cell lines: U-CH2, U-CH2B and U-CH14. After pre-incubation for 24 h with various concentrations of ciprofloxacin (1.5 - 5.0 μg/ml), different amounts of 5-ALA (15 - 50 μg/ml) were applied to the cells either for a brief (4 h) or a long (6 h) incubation time. Subsequently cells were exposed to photodynamic radiation. Cell viability was exploited by WST-1 assay. Thus, for each of the three cell lines, two drug combinations (ciprofloxacin plus 5-ALA and 5-ALA only) and two incubation times (short, 4 h and long, 6 h) were tested. Negative control groups were also examined. RESULTS Supplemental use of ciprofloxacin led to increased cell death in each of the cell lines. Different 5-ALA incubation times (4 h vs. 6 h) showed no significant differences in cell viability except for U-CH2. CONCLUSION Ciprofloxacin as an ordinary applied antibiotic, enhanced the effect of 5-ALA PDT on different human chordoma cell lines in vitro. The impact was dependent on the dose of ciprofloxacin-5-ALA. There were no notable differences for the tested 5-ALA incubation times. In human chordoma cell lines 5-ALA PDT may effectively be amended by ciprofloxacin.
Collapse
Affiliation(s)
- Hanah Hadice Gull
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Germany.
| | - Cihat Karadag
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Brigitte Senger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Rüdiger V Sorg
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Peter Möller
- Institute of Pathology, University Hospital, Ulm, Germany
| | - Kevin Mellert
- Institute of Pathology, University Hospital, Ulm, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Jan Frederick Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
| |
Collapse
|
24
|
Yan R, Fang X. The endoscopic prelacrimal recess approach to the paramedian middle cranial base: An anatomical study. J Clin Neurosci 2021; 88:251-258. [PMID: 33992193 DOI: 10.1016/j.jocn.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Endoscopic endonasal approach to paramedian cranial base implies sacrifice of the nasal structures. OBJECTIVE The present study aimed to illustrate the anatomy and provide critical anatomical landmarks for the endoscopic prelacrimal recess approach (PLRA) to the paramedian middle cranial base. METHODS Anatomical dissections were performed in 10 cadaveric specimens. RESULTS Successful access to the paramedian middle cranial base was achieved in all dissections via the PLRA with the removal of the pterygoid process. For the dissection of the infratemporal fossa and pterygopalatine fossa, the buccal nerve and infraorbital neurovascular bundle can serve as important anatomic landmarks to identify the detailed structures. In the upper parapharyngeal space, the stylopharyngeal aponeurosis can present as anatomical barriers to protect the parapharyngeal segment of the internal carotid artery (PPICA); while the levator veli palatini muscle can be considered as a landmark to locate the PPICA. For the dissection of the Eustachian tube (ET), the isthmus of the ET and ET sulcus can serve as useful landmarks to identify the posterior genu of the ICA and horizontal segment of the petrous ICA respectively. CONCLUSION The PLRA to the paramedian middle cranial base is anatomically feasible and can facilitate preservation of the integrity of nasal structures. The buccal nerve, infraorbital neurovascular bundle, levator veli palatini muscle, stylopharyngeal aponeurosis, the isthmus of the ET, and ET sulcus can serve as critical anatomic landmarks in their respective region and may facilitate the application of this approach.
Collapse
Affiliation(s)
- Renchun Yan
- Department of Otorhinolaryngology Head and Neck Surgery, No 2 Zheshan West Road, WuHu, China
| | - Xinyun Fang
- Department of Neurosurgery, The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College, No 2 Zheshan West Road, WuHu, China.
| |
Collapse
|
25
|
Oyama K, Watanabe K, Hanakita S, Champagne PO, Passeri T, Voormolen EH, Bernat AL, Penet N, Fukushima T, Froelich S. The orbitopterygoid corridor as a deep keyhole for endoscopic access to the paranasal sinuses and clivus. J Neurosurg 2021; 134:1480-1489. [PMID: 32534497 DOI: 10.3171/2020.3.jns2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/31/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The anteromedial triangle (AMT) is the triangle formed by the ophthalmic (V1) and maxillary (V2) nerves. Opening of this bony space offers a limited access to the sphenoid sinus (SphS). This study aims to demonstrate the utility of the orbitopterygopalatine corridor (OPC), obtained by enlarging the AMT and transposing the contents of the pterygopalatine fossa (PPF) and V2, as an entrance to the SphS, maxillary sinus (MaxS), and nasal cavity. METHODS Five formalin-injected cadaveric specimens were used for this study (10 approaches). A classic pterional approach was performed. An OPC was created through the inferior orbital fissure, between the orbit and the PPF, by transposing the PPF inferiorly. The extent of the OPC was measured using neuronavigation and manual measurements. Two illustrative cases using the OPC to access skull base tumors are presented in the body of the article. RESULTS Via the OPC, the SphS, MaxS, ethmoid sinus (EthS), and nasal cavity could be accessed. The use of endoscopic assistance through the OPC achieved better visualization of the EthS, SphS, MaxS, clivus, and nasal cavity. A significant gain in the area of exposure could be achieved using the OPC compared to the AMT (22.4 mm2 vs 504.1 mm2). CONCLUSIONS Opening of the AMT and transposition of V2 and the contents of the PPF creates the OPC, a potentially useful deep keyhole to access the paranasal sinuses and clival region through a middle fossa approach. It is a valuable alternative approach to reach deep-seated skull base lesions infiltrating the cavernous sinus and middle cranial fossa and extending into the paranasal sinus.
Collapse
Affiliation(s)
- Kenichi Oyama
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Kentaro Watanabe
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Shunya Hanakita
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Pierre-Olivier Champagne
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Thibault Passeri
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Eduard H Voormolen
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Anne Laure Bernat
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Nicolas Penet
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Takanori Fukushima
- 2Department of Neurological Surgery, Duke University, Durham, North Carolina
| | - Sébastien Froelich
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| |
Collapse
|
26
|
Mononostril endoscopic endonasal approach for pituitary surgery. Acta Neurochir (Wien) 2021; 163:655-659. [PMID: 32862300 DOI: 10.1007/s00701-020-04542-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Most surgical teams currently consider that endoscopy has become the "gold standard" technique for the transsphenoidal approach to pituitary surgery. Pituitary adenomas are commonly benign tumours and should benefit from the least invasive approach. METHOD In Foch Hospital, from 2006 to 2020, 2835 patients with pituitary adenomas were treated with a mononostril endoscopic endonasal approach. Here we describe the fine details of the nasal, sphenoidal and sellar steps of this technique. CONCLUSION Complete preservation of the nasal corridor, luxation of the nasal septum and tailored sellar bone resection are essential for safe resection of pituitary adenomas.
Collapse
|
27
|
La Corte E, Broggi M, Raggi A, Schiavolin S, Acerbi F, Danesi G, Farinotti M, Felisati G, Maccari A, Pollo B, Saini M, Toppo C, Valvo F, Ghidoni R, Bruzzone MG, DiMeco F, Ferroli P. Peri-operative prognostic factors for primary skull base chordomas: results from a single-center cohort. Acta Neurochir (Wien) 2021; 163:689-697. [PMID: 31950268 DOI: 10.1007/s00701-020-04219-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Skull base chordomas (SBC) are rare malignant tumors and few factors have been found to be reliable markers for clinical decision making and survival prognostication. The aim of the present work was to identify specific prognostic factors potentially useful for the management of SBC patients. METHODS A retrospective review of all the patients diagnosed and treated for SBC at the Fondazione IRCCS Istituto Neurologico "Carlo Besta" between January 1992 and December 2017 has been performed. Survival analysis was performed and a logistic regression model was used. Statistically significant predictors were rated based on their log odds in order to preliminarily build a personalized grading scale-the Peri-Operative Chordoma Scale (POCS). RESULTS Fifty-nine primary chordoma patients were included. The average follow-up from the first treatment was 82.6 months (95% CI, 65.5-99.7). POCS was built over PFS and MR contrast enhancement (intense vs mild/no, value 4), preoperative motor deficit (yes vs no, value 3), and the development of any postoperative complications (yes vs no, value 2). POCS ranges between 0 and 9, with higher scores being associated with reduced likelihood of survival and progression-free state. CONCLUSIONS Our results show that preoperative clinical symptoms (motor deficits), surgical features (extent of tumor resection and surgeon's experience), development of postoperative complications, and KPS decline represent significant prognostic factors. The degree of MR contrast enhancement significantly correlated to both OS and PFS. We also preliminarily developed the POCS as a prognostic grading scale which may help neurosurgeons in the personalized management of patients undergoing potential adjuvant therapies.
Collapse
|
28
|
Scibilia A, Cebula H, Esposito F, Angileri FF, Raffa G, Todeschi J, Koch G, Clavert P, Debry C, Germanò A, Proust F, Chibbaro S. Endoscopic Endonasal Approach to the Ventral-Medial Portion of Posterior Paramedian Skull Base: A Morphometric Perspective of Surgical and Radiologic Anatomy. World Neurosurg 2021; 149:e687-e695. [PMID: 33540106 DOI: 10.1016/j.wneu.2021.01.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/24/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aims to provide morphometric analysis of endoscopic endonasal approach (EEA) to the ventral-medial portion of posterior paramedian skull base. Furthermore, it aims to investigate the surgical exposure obtained through EEA with and without eustachian tube (ET) removal, emphasizing the role of contralateral nostril (CN) access. METHODS Five fresh adult head specimens were prepared for dissection. A predissection and a postdissection computed tomography study was performed. A surgically oriented classification into 4 regions was used: 1) tubercular region; 2) occipital condyle region; 3) parapharyngeal space (PPhS) region; and 4) jugular foramen (JF) region. The Student t-test was used to compare angulations and measures of EEA with access from the ipsilateral and CN, respectively, with and without ET removal. RESULTS EEA to the ventral-medial portion of posterior paramedian skull base encompasses 2 medial trajectories (transtubercular and transcondylar) and 2 lateral pathways to the PPhS and JF. The CN access, without removal of the ET, allows a complete exposure of the petrous and intrajugular portion of the JF and superior PPhS without exposition of the parapharyngeal segment of internal carotid artery. The ipsilateral nostril approach with ET removal allows to obtain a wider exposure, reaching the medial sigmoid part of the JF. No significant differences exist in regard to transtubercular and transcondylar approaches. CONCLUSIONS This study suggests that EEA to posterior paramedian skull base allows the realization of a corridor directed to the jugular tubercle, occipital condyle, medial PPhS, and ventral-medial JF. The CN approach with ET preservation can expose the petrous and intrajugular parts of the JF and PPhS. Case series are needed to demonstrate benefits and drawbacks of these approaches.
Collapse
Affiliation(s)
- Antonino Scibilia
- Division of Neurosurgery, University of Messina, Messina, Italy; Division of Neurosurgery, University of Strasbourg, Strasbourg, France
| | - Hélène Cebula
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
| | - Felice Esposito
- Division of Neurosurgery, University of Messina, Messina, Italy; Division of Neurosurgery, Federico II University of Naples, Naples, Italy.
| | | | - Giovanni Raffa
- Division of Neurosurgery, University of Messina, Messina, Italy
| | - Julien Todeschi
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
| | - Guillame Koch
- Department of Normal Human Anatomy, University of Strasbourg, Strasbourg, France
| | - Philippe Clavert
- Department of Normal Human Anatomy, University of Strasbourg, Strasbourg, France
| | - Christian Debry
- Division of ENT Surgery, University of Strasbourg, Strasbourg, France
| | | | - François Proust
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
| | | |
Collapse
|
29
|
Li H, Zhang H, Hu L, Wang H, Wang D. Endoscopic endonasal resection and radiotherapy as treatment for skull base chordomas. Acta Otolaryngol 2020; 140:789-794. [PMID: 32804560 DOI: 10.1080/00016489.2020.1748225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of endonasal endoscopic surgery and radiotherapy in the treatment of skull base chordomas remains unclear. OBJECTIVE We investigated the effect of endonasal endoscopic surgery and radiotherapy as treatment for skull base chordomas. METHOD We investigated 46 patients (2006-2018) treated at the Affiliated Eye Ear Nose and Throat Hospital, Fudan University. We documented demographics, clinical presentation, operative resection, complications, postoperative radiotherapy, follow-up time, and survival in all patients. RESULT Complete tumour resection was performed in 18 (39.1%), subtotal tumour resection in 16 (34.8%), and partial tumour resection in 12 (26.1%) patients. Most common clinical manifestations included nasal obstruction (41%), headaches (30%), and visual impairment (20%). The median duration of progression-free survival (PFS) and overall survival (OS) was 21.5 and 33.5 months, respectively. Primary vs. recurrent disease (p = .043), partial resection (PR) vs. subtotal resection (STR) (p = .006), STR vs. gross total resection (GTR) (p = .020), GTR vs. PR (p = .001), and complicated vs. uncomplicated status (p = .002) were significantly associated with PFS. Primary vs. recurrent disease (p = .002), PR vs. STR (p = .001), GTR vs. PR (p = .001), surgery alone vs. surgery concomitant with radiotherapy (p = .048), and complicated vs. uncomplicated status (p = .017) were significantly associated with OS. CONCLUSION Surgery is the primary treatment for chordoma; higher tumour resection rates are associated with higher OS and PFS. Surgeons should aim to resect as much tumour as is safely possible. Postoperative radiotherapy is useful adjuvant treatment to improve OS, and IMRT serves as an effective alternative to PBRT.The optimal radiotherapeutic technique is determined by cost, accessibility, availability of the modality, and tumour volume.
Collapse
Affiliation(s)
- Hongbing Li
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Huankang Zhang
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Li Hu
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
- Department of Research Centre, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Huan Wang
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Dehui Wang
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China
| |
Collapse
|
30
|
Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Edem I, DeMonte F, Raza SM. Advances in the management of primary bone sarcomas of the skull base. J Neurooncol 2020; 150:393-403. [PMID: 32306199 DOI: 10.1007/s11060-020-03497-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
Skull base primary malignancies represent a heterogeneous group of histologic diagnoses and sarcomas of the skull base are specific malignant tumors that arise from mesenchymal cells and can be classified by site of origin into bony and soft tissue sarcomas. The most common bony sarcomas include: chondrosarcoma, osteosarcoma, chordoma, Ewing's sarcoma. Given the relative rarity of each histologic diagnosis, especially in the skull base, there is limited published data to guide the management of patients with skull base sarcomas. An electronic search of the literature was performed to obtain key publications in the management of bony sarcomas of the skull base published within the last decade. This article is thus a review of the multi-disciplinary management principles of primary bony sarcomas of the skull base. Of note, there have been several recent advancements in the realm of skull base sarcoma management that have resulted in improved survival. These include advances in: imaging and diagnostic techniques, surgical techniques that incorporate oncologic surgical principles, conformal radiation paradigms and targeted systemic therapies. Early access to coordinated multi-disciplinary subspecialty care immediately at suspicion of diagnosis has further improved outcomes. There are several ongoing trials in the realms of radiation therapy and systemic therapy that will hopefully provide further insight about the optimal management of bony sarcomas of the skull base.
Collapse
Affiliation(s)
- Idara Edem
- Departments of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Franco DeMonte
- Departments of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shaan M Raza
- Departments of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Departments of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Rm FC7.2000, Unit 442, Houston, TX, 77030, USA.
| |
Collapse
|
32
|
Beer-Furlan A, Vellutini EDAS, Balsalobre L, Stamm AC. Endoscope-Assisted Middle Fossa Approach: Optimizing the Surgical Corridor for the Resection of Multicompartmental Chordomas. J Neurol Surg B Skull Base 2020; 82:e172-e178. [PMID: 34306933 DOI: 10.1055/s-0040-1702218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/10/2020] [Indexed: 10/24/2022] Open
Abstract
Background Skull base chordomas are a major therapeutic challenge. The surgical management involves selecting an approach that will offer the patient the best chance of largest/complete removal while minimizing morbidity and mortality. Methods Medical records and imaging review of two skull base chordomas involving the middle fossa and posterior fossa that were successfully treated with an endoscope-assisted middle fossa approach. Results The use of angled endoscopes provided better identification of anatomical landmarks and improved tumor resection when compared with the microscopic surgical exposure. The approach selection, anatomical landmarks, and technical aspects of the intraoperative setting of the endoscope-assisted approach are discussed. Conclusion Endoscopic assistance in the middle fossa approach is a safe and valuable tool for maximizing the reach of the surgical corridor when treating skull base chordomas.
Collapse
Affiliation(s)
- André Beer-Furlan
- São Paulo Skull Base Center, São Paulo, Brazil.,DFVneuro Neurosurgical Group, São Paulo, Brazil.,Department of Neurological Surgery, Rush University, Chicago, United States
| | | | - Leonardo Balsalobre
- São Paulo Skull Base Center, São Paulo, Brazil.,Department of Otolaryngology, São Paulo ENT Center, Hospital Professor Edmundo Vasconcelos, São Paulo, Brazil
| | - Aldo Cassol Stamm
- São Paulo Skull Base Center, São Paulo, Brazil.,Department of Otolaryngology, São Paulo ENT Center, Hospital Professor Edmundo Vasconcelos, São Paulo, Brazil
| |
Collapse
|
33
|
Cavallo LM, Somma T, Solari D, Iannuzzo G, Frio F, Baiano C, Cappabianca P. Endoscopic Endonasal Transsphenoidal Surgery: History and Evolution. World Neurosurg 2020; 127:686-694. [PMID: 31266131 DOI: 10.1016/j.wneu.2019.03.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/05/2019] [Indexed: 12/30/2022]
Abstract
In previous decades, extensive and disfiguring transfacial and/or transcranial approaches were used to reach the sellar and parasellar areas. However, these surgical routes were burdened by severe complications and high mortality rates. Recently, the development of endoscopic endonasal techniques has revolutionized the surgical strategies for approaching the sella and adjacent areas and increased the development of transsphenoidal surgery. With these techniques, surgeons have been able to overcome the visual limitations of the open surgical approaches and access areas previously hidden from view. After the contributions of the Pittsburgh duo, Carrau and Jho, pioneers of pure endoscopic surgery, our school began to implement this technique, introducing technical innovations and variations, describing the anatomical details and defining new routes, and playing a key role in its widespread clinical application.
Collapse
Affiliation(s)
- Luigi M Cavallo
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Teresa Somma
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Gianpiero Iannuzzo
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Federico Frio
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Cinzia Baiano
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| |
Collapse
|
34
|
Yoo SK, Strickland BA, Zada G, Bian SX, Garsa A, Ye JC, Yu C, Weiss MH, Wrobel BB, Giannotta S, Chang EL. Use of Salvage Surgery or Stereotactic Radiosurgery for Multiply Recurrent Skull Base Chordomas: A Single-Institution Experience and Review of the Literature. J Neurol Surg B Skull Base 2020; 82:161-174. [PMID: 33777630 DOI: 10.1055/s-0039-3402019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022] Open
Abstract
Introduction Chordomas are locally destructive neoplasms characterized by appreciable recurrence rates after initial multimodality treatment. We examined the outcome of salvage treatment in recurrent/progressive skull base chordomas. Methods This is a retrospective review of recurrent/progressive skull base chordomas at a tertiary urban academic medical center. The outcomes evaluated were overall survival, progression-free survival (PFS), and incidence of new toxicity. Results Eighteen consecutive patients who underwent ≥1 course of treatment (35.3% salvage surgery, 23.5% salvage radiation, and 41.2% both) were included. The median follow-up was 98.6 months (range 16-215 months). After initial treatment, the median PFS was 17.7 months (95% confidence interval [CI]: 4.9-22.6 months). Following initial therapy, age ≥ 40 had improved PFS on univariate analysis ( p = 0.03). All patients had local recurrence, with 15 undergoing salvage surgical resections and 16 undergoing salvage radiation treatments (mostly stereotactic radiosurgery [SRS]). The median PFS was 59.2 months (95% CI: 4.0-99.3 months) after salvage surgery, 58.4 months (95% CI: 25.9-195 months) after salvage radiation, and 58.4 months (95% CI: 25.9.0-98.4 months) combined. Overall survival for the total cohort was 98.7% ± 1.7% at 2 years and 92.8% ± 5.5% at 5 years. Salvage treatments were well-tolerated with two patients (11%) reporting tinnitus and one patient each (6%) reporting headaches, visual field deficits, hearing loss, anosmia, dysphagia, or memory loss. Conclusion Refractory skull base chordomas present a challenging treatment dilemma. Repeat surgical resection or SRS seems to provide adequate salvage therapy that is well-tolerated when treated at a tertiary center offering multimodality care.
Collapse
Affiliation(s)
- Stella K Yoo
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
| | - Ben A Strickland
- Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
| | - Shelly X Bian
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
| | - Adam Garsa
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
| | - Jason C Ye
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
| | - Cheng Yu
- Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
| | - Martin H Weiss
- Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
| | - Bozena B Wrobel
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California, United States
| | - Steven Giannotta
- Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California, United States
| |
Collapse
|
35
|
Raza SM, Bell D, Freeman JL, Grosshans DR, Fuller GN, DeMonte F. Multimodality Management of Recurrent Skull Base Chordomas: Factors Impacting Tumor Control and Disease-Specific Survival. Oper Neurosurg (Hagerstown) 2019; 15:131-143. [PMID: 29040778 DOI: 10.1093/ons/opx201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/29/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Limited data exist to guide the management of recurrent chordomas arising in the skull base. OBJECTIVE To determine factors affecting tumor control rates and disease-specific survival (DSS) in recurrent disease. METHODS A retrospective review was performed of 29 patients with 55 recurrences treated at our institution. Tumor and treatment factors were assessed for impact on freedom from progression (FFP; primary outcome) and DSS (secondary outcome). RESULTS Postradiotherapy disease failure was much more difficult to manage vs progression after surgery alone (15.9 vs 41.4 mo, P = .094). Distant metastases and, specifically, leptomeningeal disease at presentation were associated with poorer DSS and FFP (P < .05). For local progression after surgery alone, repeat resection (P < .05) improved median FFP. With postradiotherapy local failure, repeat resection did not confer any benefit (13.5 vs 17.6 mo, P > .05), while a trend towards improved FFP was seen with stereotactic radiosurgery (28.3 vs 16.2 mo, P = .233). For distant metastases, site-directed therapy (surgery or radiation) allowed for site control (P < .05) but did not affect FFP or DSS. Presentation with early progression <6 mo from previous treatment portended significantly worse DSS (19.3 vs 77.6 mo, P < .05). CONCLUSION There is a need for treatment of recurrent disease to be tailored to the pattern of tumor recurrence and previously received treatments. Postradiotherapy progression poses particular challenges given the apparent limited role of repeat resection alone. Stereotactic radiosurgery may have a role in this setting. While patients with systemic metastases appear to respond well to site-directed therapy, those with leptomeningeal disease have a dismal prognosis.
Collapse
Affiliation(s)
- Shaan M Raza
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diana Bell
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jacob L Freeman
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David R Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregory N Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
36
|
La Corte E, Dei Cas M, Raggi A, Patanè M, Broggi M, Schiavolin S, Calatozzolo C, Pollo B, Pipolo C, Bruzzone MG, Campisi G, Paroni R, Ghidoni R, Ferroli P. Long and Very-Long-Chain Ceramides Correlate with A More Aggressive Behavior in Skull Base Chordoma Patients. Int J Mol Sci 2019; 20:ijms20184480. [PMID: 31514293 PMCID: PMC6769603 DOI: 10.3390/ijms20184480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Skull base chordomas are rare tumors arising from notochord. Sphingolipids analysis is a promising approach in molecular oncology, and it has never been applied in chordomas. Our aim is to investigate chordoma behavior and the role of ceramides. METHODS Ceramides were extracted and evaluated by liquid chromatography and mass spectrometry in a cohort of patients with a skull base chordoma. Clinical data were also collected and correlated with ceramide levels. Linear regression and correlation analyses were conducted. RESULTS Analyzing the association between ceramides level and MIB-1, total ceramides and dihydroceramides showed a strong association (r = 0.7257 and r = 0.6733, respectively) with MIB-1 staining (p = 0.0033 and p = 0.0083, respectively). Among the single ceramide species, Cer C24:1 (r = 0.8814, p ≤ 0.0001), DHCer C24:1 (r = 0.8429, p = 0.0002) and DHCer C18:0 (r = 0.9426, p ≤ 0.0001) showed a significant correlation with MIB-1. CONCLUSION Our lipid analysis showed ceramides to be promising tumoral biomarkers in skull base chordomas. Long- and very-long-chain ceramides, such as Cer C24:1 and DHCer C24:1, may be related to a prolonged tumor survival and aggressiveness, and the understanding of their effective biological role will hopefully shed light on the mechanisms of chordoma radio-resistance, tendency to recur, and use of agents targeting ceramide metabolism.
Collapse
Affiliation(s)
- Emanuele La Corte
- PhD School in Molecular and Translational Medicine, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Michele Dei Cas
- PhD School in Molecular and Translational Medicine, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Monica Patanè
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Chiara Calatozzolo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Giuseppe Campisi
- PhD School in Molecular and Translational Medicine, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Rita Paroni
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Riccardo Ghidoni
- PhD School in Molecular and Translational Medicine, Department of Health Sciences, University of Milan, 20142 Milan, Italy.
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, University of Milan, 20142 Milan, Italy.
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| |
Collapse
|
37
|
Hulou MM, Garcia CR, Slone SA, Dugan A, Lei F, Huang B, Pittman T, Villano JL. Comprehensive Review of Cranial Chordomas Using National Databases in the USA. Clin Oncol (R Coll Radiol) 2019; 31:e149-e159. [PMID: 31303332 PMCID: PMC11106723 DOI: 10.1016/j.clon.2019.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/01/2019] [Accepted: 04/15/2019] [Indexed: 02/08/2023]
Abstract
AIMS The management of cranial chordomas is controversial. We provide a comprehensive review of the evolving patterns of care of cranial chordomas in the USA. MATERIALS AND METHODS We analysed the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2014 for clinical characteristics and long-term survival, and the National Surgical Quality Improvement Program (NSQIP) dataset between 2005 and 2016 for perioperative characteristics and surgical morbidity. RESULTS In total, 936 patients were identified from the NCDB, 405 patients from SEER and 64 patients from the NSQIP. Most patients were men (56.2, 54.8 and 57.8% in NCDB, SEER and NSQIP, respectively) and White (80.9 and 83.2% in NCDB and SEER, respectively). Surgery was the preferred treatment modality (87.3% in NCDB and 86.2% in SEER). Surgery was carried out alone (41.8% in NCDB and 40.7% in SEER) or in combination with radiation (42.1% in NCDB and 45.4% in SEER). Proton therapy was the most common type of radiation (32.2% in NCDB), particularly after 2011. The median operative time, median hospital length and postoperative morbidity were significantly higher in chordoma patients compared with patients who underwent other skull-base procedures. The 5-year survival rate was 79.8% in NCDB and 76.9% in SEER. There was a trend towards longer survival in patients receiving surgery and radiation, which has been increasingly used since 2004. Patients younger than 60 years had a decreased risk of mortality. CONCLUSIONS Our analysis reflects patterns of care in the USA. The use of surgery and radiation is increasing, with a trend towards longer survival. Surgery is complicated with long operative time, hospital stay and a higher rate of complications.
Collapse
Affiliation(s)
- M M Hulou
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
| | - C R Garcia
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - S A Slone
- Department of Statistics, University of Kentucky, Lexington, Kentucky, USA
| | - A Dugan
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - F Lei
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - B Huang
- Division of Cancer Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - T Pittman
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
| | - J L Villano
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA; Department of Medicine, University of Kentucky, Lexington, Kentucky, USA; Department of Neurology, University of Kentucky, Lexington, Kentucky, USA.
| |
Collapse
|
38
|
Comparative Analysis of the Subtonsillar, Far-Lateral, Extreme-Lateral, and Endoscopic Far-Medial Approaches to the Lower Clivus: An Anatomical Cadaver Study. World Neurosurg 2019; 127:e1083-e1096. [DOI: 10.1016/j.wneu.2019.04.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 11/22/2022]
|
39
|
Zhou J, Jiang Y, Zhang H, Chen L, Luo P, Li L, Zhao J, Lv F, Zou D, Zhang Y, Jing Z. Clinicopathological implications of TIM3 + tumor-infiltrating lymphocytes and the miR-455-5p/Galectin-9 axis in skull base chordoma patients. Cancer Immunol Immunother 2019; 68:1157-1169. [PMID: 31197461 PMCID: PMC11028388 DOI: 10.1007/s00262-019-02349-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 05/24/2019] [Indexed: 12/14/2022]
Abstract
Chordoma is difficult to eradicate due to high local recurrence rates. The immune microenvironment is closely associated with tumor prognosis; however, its role in skull base chordoma is unknown. The expression of Galectin-9 (Gal9) and tumor-infiltrating lymphocyte (TIL) markers was assessed by immunohistochemistry. Kaplan-Meier and multivariate Cox analyses were used to assessing local recurrence-free survival (LRFS) and overall survival (OS) of patients. MiR-455-5p was identified as a regulator of Gal9 expression. Immunopositivity for Gal9 was associated with tumor invasion (p = 0.019), Karnofsky performance status (KPS) score (p = 0.017), and total TIL count (p < 0.001); downregulation of miR-455-5p was correlated with tumor invasion (p = 0.017) and poor prognosis; and the T-cell immunoglobulin and mucin-domain 3 (TIM3)+ TIL count was associated with chordoma invasion (p = 0.010) and KPS score (p = 0.037). Furthermore, multivariate analysis indicated that only TIM3+ TIL density was an independent prognostic factor for LRFS (p = 0.010) and OS (p = 0.016). These results can be used to predict clinical outcome and provide a basis for immune therapy in skull base chordoma patients.
Collapse
Affiliation(s)
- Jinpeng Zhou
- Department of Neurosurgery, The First Hospital of China Medical University, No. 155 North Nanjing Street, Heping District, Shenyang, 110001, China
| | - Yang Jiang
- Department of Neurosurgery, The First Hospital of China Medical University, No. 155 North Nanjing Street, Heping District, Shenyang, 110001, China
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
| | - Haiying Zhang
- International Education College, Liaoning University of Traditional Chinese Medicine, No. 79, Chongshan East Road, Huanggu District, Shenyang, 110032, China
| | - Lian Chen
- Department of Neurosurgery, The First Hospital of China Medical University, No. 155 North Nanjing Street, Heping District, Shenyang, 110001, China
| | - Peng Luo
- Department of Neurosurgery, The First Hospital of China Medical University, No. 155 North Nanjing Street, Heping District, Shenyang, 110001, China
| | - Long Li
- Department of Neurosurgery, The First Hospital of China Medical University, No. 155 North Nanjing Street, Heping District, Shenyang, 110001, China
| | - Junshuang Zhao
- Department of Neurosurgery, The First Hospital of China Medical University, No. 155 North Nanjing Street, Heping District, Shenyang, 110001, China
| | - Fei Lv
- The First Laboratory of Cancer Institute, The First Hospital of China Medical University, No. 155 North Nanjing Street, Heping District, Shenyang, 110001, China
| | - Dan Zou
- The First Laboratory of Cancer Institute, The First Hospital of China Medical University, No. 155 North Nanjing Street, Heping District, Shenyang, 110001, China
| | - Ye Zhang
- The First Laboratory of Cancer Institute, The First Hospital of China Medical University, No. 155 North Nanjing Street, Heping District, Shenyang, 110001, China.
| | - Zhitao Jing
- Department of Neurosurgery, The First Hospital of China Medical University, No. 155 North Nanjing Street, Heping District, Shenyang, 110001, China.
| |
Collapse
|
40
|
The Evolution of Endoscopic Skull Base Surgery Outcomes: Defining the Edge of the Envelope. World Neurosurg 2019. [DOI: 10.1016/j.wneu.2019.01.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
41
|
Solari D, Zenga F, Angileri FF, Barbanera A, Berlucchi S, Bernucci C, Carapella C, Catapano D, Catapano G, Cavallo LM, D'Arrigo C, de Angelis M, Denaro L, Desogus N, Ferroli P, Fontanella MM, Galzio RJ, Gianfreda CD, Iacoangeli M, Lauretti L, Locatelli D, Locatelli M, Luglietto D, Mazzatenta D, Menniti A, Milani D, Nasi MT, Romano A, Ruggeri AG, Saladino A, Santonocito O, Schwarz A, Skrap M, Stefini R, Volpin L, Wembagher GC, Zoia C, Zona G, Cappabianca P. A Survey on Pituitary Surgery in Italy. World Neurosurg 2019; 123:e440-e449. [DOI: 10.1016/j.wneu.2018.11.186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
|
42
|
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; 33:388-393. [PMID: 30741028 DOI: 10.1080/02688697.2019.1567683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Clival Chordomas are locally aggressive tumours which pose a significant treatment challenge. Endoscopic endonasal approach for clival chordomas is correlated with higher resection rates and lower morbidity rates in comparison to open approaches. We present our initial single institution experience and short-term patient outcomes following endoscopic endonasal approach for resection of clival chordomas. Materials and methods: This is a retrospective analysis of ten patients undergoing endoscopic endonasal approach for clival chordomas in our neurosurgical unit over a 6 year period between August 2010 and September 2016. The procedures were performed using two surgeons, four hands, binostril endoscopic endonasal approach with a Karl Storz® endoscope and intraoperative BrainLab® image guidance. Results: Overall 15 endoscopic endonasal approach resections of clival chordoma were performed in 10 patients with median follow up period of 39.5 months (range 9-76). Gross total resection was achieved in 4 cases (40%), near total resection in 4 cases (40%) and subtotal resection in 2 cases (20%). 5 cases (50%) required revision resections. Cerebrospinal fluid leak occurred in 2 patients. 1 case of meningitis occurred in a patient with revision surgery. There were no new neurological deficits post operatively with 3 patients demonstrating resolution of diplopia post operatively. No recurrence occurred following gross total resection. 1 out of 4 cases of near total resection showed evidence of progression during the follow up period. Both cases of subtotal resection demonstrated evidence of progression with one dying of unrelated cause during the follow up period. Conclusion: Endoscopic endonasal approach represents a safe technique for debulking and resection of clival chordomas. Due to the rarity of clival chordomas, it is important that patients with this pathology are managed in high volume skull base centres where a multi-disciplinary team approach is available.
Collapse
Affiliation(s)
- Jawad Yousaf
- a Department of Neurosurgery, Birmingham University Hospital , Birmingham , England
| | - Fardad T Afshari
- a Department of Neurosurgery, Birmingham University Hospital , Birmingham , England
| | - Shahzada K Ahmed
- b Department of ENT, Birmingham University Hospital , Birmingham , England
| | - Swarupsinh V Chavda
- c Department of Radiology, Birmingham University Hospital , Birmingham , England
| | - Paul Sanghera
- d Hall-Edwards Radiotherapy Group, Birmingham University Hospital , Birmingham , England
| | - Alessandro Paluzzi
- a Department of Neurosurgery, Birmingham University Hospital , Birmingham , England
| |
Collapse
|
43
|
Schwartz TH, Morgenstern PF, Anand VK. Lessons learned in the evolution of endoscopic skull base surgery. J Neurosurg 2019; 130:337-346. [PMID: 30717035 DOI: 10.3171/2018.10.jns182154] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/01/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVEEndoscopic skull base surgery (ESBS) is a relatively recent addition to the neurosurgical armamentarium. As with many new approaches, there has been significant controversy regarding its value compared with more traditional approaches to ventral skull base pathology. Although early enthusiasm for new approaches that appear less invasive is usually high, these new techniques require rigorous study to ensure that widespread implementation is in the best interest of patients.METHODSThe authors compared surgical results for ESBS with transcranial surgery (TCS) for several different pathologies over two different time periods (prior to 2012 and 2012-2017) to see how results have evolved over time. Pathologies examined were craniopharyngioma, anterior skull base meningioma, esthesioneuroblastoma, chordoma, and chondrosarcoma.RESULTSESBS offers clear advantages over TCS for most craniopharyngiomas and chordomas. For well-selected cases of planum sphenoidale and tuberculum sellae meningiomas, ESBS has similar rates of resection with higher rates of visual improvement, and more recent results with lower CSF leaks make the complication rates similar between the two approaches. TCS offers a higher rate of resection with fewer complications for olfactory groove meningiomas. ESBS is preferred for lower-grade esthesioneuroblastomas, but higher-grade tumors often still require a craniofacial approach. There are few data on chondrosarcomas, but early results show that ESBS appears to offer clear advantages for minimizing morbidity with similar rates of resection, as long as surgeons are familiar with more complex inferolateral approaches.CONCLUSIONSESBS is maturing into a well-established approach that is clearly in the patients' best interest when applied by experienced surgeons for appropriate pathology. Ongoing critical reevaluation of outcomes is essential for ensuring optimal results.
Collapse
Affiliation(s)
- Theodore H Schwartz
- Departments of1Neurological Surgery and
- 2Otorhinolaryngology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York; and
- 3Department of Neuroscience, Weill Cornell Medical College, New York, New York
| | | | - Vijay K Anand
- 2Otorhinolaryngology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York; and
| |
Collapse
|
44
|
Endoscopic Endonasal Approaches for Treatment of Craniovertebral Junction Tumours. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:209-224. [PMID: 30610324 DOI: 10.1007/978-3-319-62515-7_30] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tumours involving the craniovertebral junction (CVJ) are challenging because of their local invasiveness and high recurrence rates, as well as their proximity to critical neurovascular structures and the difficulty of reconstructing the resulting skull base defect at this site. Several surgical techniques are currently available to access these lesions, including the far lateral, extreme lateral, direct lateral, transcervical, transoral and transnasal approaches. In this paper, application of the endoscopic endonasal approach (EEA) in the treatment of CVJ tumours is analysed. The indications, contraindications, preoperative workup, step-by-step surgical technique, skull base reconstruction options and postoperative management are described. The advantages and limitations of the EEA are also discussed. Finally, a systematic review of the literature is provided to elucidate the levels of evidence supporting the use of the EEA in this field. Employment of this approach to the CVJ has contributed to high success rates in achieving gross total resection of tumours and improvement in neurological symptoms. Intraoperative and postoperative complication rates are acceptable, with cerebrospinal fluid leakage being the major concern (with a 17-25% incidence). Moreover, in comparison with traditional approaches to the CVJ, the EEA provides lower rates of postoperative dysphagia and respiratory complications. Use of the EEA for treatment of CVJ tumours appears to be a rational alternative to the conventional transoral, transcranial and transcervical approaches in selected cases. Multidisciplinary teamwork including different specialists-such as medical and radiation oncologists, radiologists, otorhinolaryngologists and neurosurgeons-is strongly recommended for the purpose of offering the best treatment strategy for the patient.
Collapse
|
45
|
Chibbaro S, Ganau M, Cebula H, Nannavecchia B, Todeschi J, Romano A, Debry C, Proust F, Olivi A, Gaillard S, Visocchi M. The Endonasal Endoscopic Approach to Pathologies of the Anterior Craniocervical Junction: Analytical Review of Cases Treated at Four European Neurosurgical Centres. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:187-195. [PMID: 30610322 DOI: 10.1007/978-3-319-62515-7_28] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Supported by preliminary anatomical and clinical studies exploring the feasibility and usefulness of approaching many ventral pathologies of the craniocervical junction (CCJ) using the endoscopic endonasal approach, four European centres have joined forces to accumulate and share their growing surgical experience of this advanced technique. By describing the steps that led to the development and continuous refinement of this approach to the CCJ, this article delves deeply into an analysis of the cases operated on since 2010 at these four institutions, and discusses in detail the operative nuances that so far have allowed achievement of successful outcomes with excellent perioperative patient comfort and satisfactory long-term quality of life.
Collapse
Affiliation(s)
- Salvatore Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France.
| | - Mario Ganau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Helene Cebula
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | | | - Julien Todeschi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Antonio Romano
- Department of Neurosurgery, Parma University Hospital, Parma, Italy
| | | | - Francois Proust
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Alessandro Olivi
- Institute of Neurosurgery, Catholic University of Rome, Rome, Italy
| | | | | |
Collapse
|
46
|
Nguyen B, Blasco M, Svider PF, Lin HS, Liu JK, Eloy JA, Folbe AJ. Recurrence of Ventral Skull Base Lesions Attributed to Tumor Seeding: A Systematic Review. World Neurosurg 2018; 124:S1878-8750(18)32927-9. [PMID: 30605757 DOI: 10.1016/j.wneu.2018.12.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate ventral skull base lesion recurrences along surgical access pathways attributed to iatrogenic seeding. METHODS A systematic review of the literature was performed searching for recurrence of ventral skull base lesions attributed to iatrogenic implantation. Studies were assessed for level of evidence. Primary intervention, pathology, and other clinical factors were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. RESULTS Among 69 patients with recurrent skull base lesions attributed to seeding, the most common pathologies were craniopharyngioma (52.2%), chordoma (33.3%), adenocarcinoma (4.3%), adenoid cystic carcinoma (2.9%), and squamous cell carcinoma (2.9%). Median time to recurrence was 36 months. Time to recurrence was significantly longer for craniopharyngiomas than for chordomas (42 months vs. 24 months, P ≤ 0.05). Surgical approaches included craniotomy (62.0%), transseptal (11.3%), transfacial (12.7%), and transpalatal (4.2%). Mean time to recurrence after craniotomy was 69 months. Endoscopic/endoscopic-assisted approaches were used in 5 cases (7.0%). Commonly reported recurrence sites included subarachnoid (29.6%), dura (21.1%), incision (12.7%), septum (7.0%), and ethmoid sinuses (4.2%). CONCLUSIONS The potential for iatrogenic tumor seeding exists for numerous skull base lesions, most notably craniopharyngioma and chordomas. Routine surveillance may be necessary owing to significant latency intervals to ectopic recurrence. Although transnasal endoscopic techniques have been extensively employed in recent decades, only a handful of reported cases involve lesions originally treated with this approach. Further direct comparison of traditional approaches with endoscopic approaches may be invaluable in further elucidating the role of surgical technique in tumor implantation and recurrence.
Collapse
Affiliation(s)
- Brandon Nguyen
- Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, USA; Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
| | - Michael Blasco
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ho-Sheng Lin
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA; John D. Dingell VA Medical Center, Detroit, Michigan, USA; Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Adam J Folbe
- Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, USA; Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| |
Collapse
|
47
|
Stacchiotti S, Gronchi A, Fossati P, Akiyama T, Alapetite C, Baumann M, Blay JY, Bolle S, Boriani S, Bruzzi P, Capanna R, Caraceni A, Casadei R, Colia V, Debus J, Delaney T, Desai A, Dileo P, Dijkstra S, Doglietto F, Flanagan A, Froelich S, Gardner PA, Gelderblom H, Gokaslan ZL, Haas R, Heery C, Hindi N, Hohenberger P, Hornicek F, Imai R, Jeys L, Jones RL, Kasper B, Kawai A, Krengli M, Leithner A, Logowska I, Martin Broto J, Mazzatenta D, Morosi C, Nicolai P, Norum OJ, Patel S, Penel N, Picci P, Pilotti S, Radaelli S, Ricchini F, Rutkowski P, Scheipl S, Sen C, Tamborini E, Thornton KA, Timmermann B, Torri V, Tunn PU, Uhl M, Yamada Y, Weber DC, Vanel D, Varga PP, Vleggeert-Lankamp CLA, Casali PG, Sommer J. Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group. Ann Oncol 2018; 28:1230-1242. [PMID: 28184416 PMCID: PMC5452071 DOI: 10.1093/annonc/mdx054] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chordomas are rare, malignant bone tumors of the skull-base and axial skeleton. Until recently, there was no consensus among experts regarding appropriate clinical management of chordoma, resulting in inconsistent care and suboptimal outcomes for many patients. To address this shortcoming, the European Society of Medical Oncology (ESMO) and the Chordoma Foundation, the global chordoma patient advocacy group, convened a multi-disciplinary group of chordoma specialists to define by consensus evidence-based best practices for the optimal approach to chordoma. In January 2015, the first recommendations of this group were published, covering the management of primary and metastatic chordomas. Additional evidence and further discussion were needed to develop recommendations about the management of local-regional failures. Thus, ESMO and CF convened a second consensus group meeting in November 2015 to address the treatment of locally relapsed chordoma. This meeting involved over 60 specialists from Europe, the United States and Japan with expertise in treatment of patients with chordoma. The consensus achieved during that meeting is the subject of the present publication and complements the recommendations of the first position paper.
Collapse
Affiliation(s)
| | - A Gronchi
- Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - P Fossati
- CNAO National Center for Oncological Hadrontherapy, Pavia.,Department of Radiotherapy, IEO-European Institute of Oncology, Milan, Italy
| | - T Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - C Alapetite
- Department of Radiotherapy, Institut Curie, Paris.,Institut Curie-Centre de Protonthérapie d'Orsay (ICPO), Orsay, France
| | - M Baumann
- Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J Y Blay
- Cancer Medicine Department, Centre Léon Bérard, Lyon
| | - S Bolle
- Department of Radiotherapy, Gustave Roussy, Villejuif Cedex, France
| | - S Boriani
- Department of Degenerative and Oncological Spine Surgery, Rizzoli Institute Bologna, Bologna
| | - P Bruzzi
- Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova
| | - R Capanna
- University Clinic of Orthopedics and Traumatology AO Pisa, Pisa
| | - A Caraceni
- Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - R Casadei
- Orthopedic Department, Rizzoli Institute Bologna, Bologna, Italy
| | - V Colia
- Departments of Cancer Medicine
| | - J Debus
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - T Delaney
- Department of Radiation Oncology, Francis H. Burr Proton Therapy Center, Massachusetts General Hospital, Boston, USA
| | - A Desai
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital, Birmingham
| | - P Dileo
- Department of Oncology, University College London Hospitals (UCLH), London, UK
| | - S Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - F Doglietto
- Institute of Neurosurgery, University of Brescia, Brescia, Italy
| | - A Flanagan
- University College London Cancer Institute, London.,Histopathology Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - S Froelich
- Department of Neurosurgery, Paris Diderot University, Hôpital Lariboisière, Paris, France
| | - P A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Z L Gokaslan
- Department of Neurosurgery, Brown University School of Medicine, Providence, USA
| | - R Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C Heery
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, Bethesda, USA
| | - N Hindi
- Department of Cancer Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - P Hohenberger
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - F Hornicek
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - R Imai
- National Institute of Radiological Sciences, Research Center Hospital for Charged Particle Therapy, Chiba, Japan
| | - L Jeys
- Department of Orthopaedics, Royal Orthopaedic Hospital Birmingham, Birmingham
| | - R L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - B Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - A Kawai
- Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center, Tokio, Japan
| | - M Krengli
- Radiotherapy Department, University of Piemonte Orientale, Novara, Italy
| | - A Leithner
- Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Graz, Austria
| | - I Logowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - J Martin Broto
- Department of Cancer Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - D Mazzatenta
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna
| | - C Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - P Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - O J Norum
- Department of Tumor Orthopedic Surgery, The Norwegian Radium Hospital, Oslo, Norway
| | - S Patel
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, USA
| | - N Penel
- Cencer Medicine Department, Oscar Lambret Cancer Centre, Lille, France
| | - P Picci
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna
| | - S Pilotti
- Laboratory of Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - S Radaelli
- Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - F Ricchini
- Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - S Scheipl
- Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Graz, Austria
| | - C Sen
- Department of Neurosurgery, NYU Langone Medical Center, New York
| | - E Tamborini
- Laboratory of Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - K A Thornton
- Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - B Timmermann
- Particle Therapy Department, West German Proton Therapy Centre Essen, University Hospital Essen, Essen, Germany
| | - V Torri
- Oncology Unit, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - P U Tunn
- Department of Orthopaedic Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - M Uhl
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Y Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D C Weber
- Paul Scherrer Institut PSI, Villigen, Switzerland
| | - D Vanel
- Department of Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - P P Varga
- National Center for Spinal Disorders, Budapest, Hungary
| | | | | | - J Sommer
- Chordoma Foundation, Durham, USA
| |
Collapse
|
48
|
Abstract
OBJECTIVES This study evaluates the impact combined endonasal endoscopic resection and radiotherapy for skull base chordomas. METHODS Thirty-two patients with skull base chordomas between July 2006 and June 2015 were divided into 2 groups: the surgery alone group and the surgery with radiation therapy group. RESULTS Gross total resection was achieved in 9 (28.1%) patients with skull base chordoma, subtotal resection was achieved in 16 (50.0%) patients, and partial resection was achieved in 7 (21.9%) patients. The progression-free survival (PFS) rate at 3 and 5 years was 44.0% and 16.5%, respectively. The overall survival (OS) rate at 3 and 5 years was 79.4% and 69.5%, respectively. Kadish staging predicted PFS and OS with statistical significance when the extent of resection was categorized into gross total resection, subtotal resection, and partial resection (P = 0.035 and P = 0.003, respectively). There was a significant OS advantage for the surgery plus radiation group compared with the surgery alone group (P = 0.035). CONCLUSION Gross total resection can achieve very good results for the treatment of skull base chordomas. Postoperative adjuvant radiation therapy is recommended for all skull base chordomas, as it offered a higher OS rate.
Collapse
|
49
|
Fernandes Cabral DT, Zenonos GA, Fernandez-Miranda JC, Wang EW, Gardner PA. Iatrogenic seeding of skull base chordoma following endoscopic endonasal surgery. J Neurosurg 2017; 129:947-953. [PMID: 29271711 DOI: 10.3171/2017.6.jns17111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Iatrogenic tumor seeding after open surgery for chordoma has been well described in the literature. The incidence and particularities related to endoscopic endonasal surgery (EES) have not been defined. METHODS The authors retrospectively reviewed their experience with EES for clival chordoma, focusing on cases with iatrogenic seeding. The clinical, radiographic, pathological, and molecular characterization data were reviewed. RESULTS Among 173 EESs performed for clival chordomas at the authors' institution between April 2003 and May 2016, 2 cases complicated by iatrogenic seeding (incidence 1.15%) were identified. The first case was a 10-year-old boy, who presented 21 months after an EES for a multiply recurrent clival chordoma with a recurrence along the left inferior turbinate, distinct from a right petrous apex recurrence. Both appeared as a T2-hypertintense, T1-isointense, and heterogeneously enhancing lesion on MRI. Resection of the inferior turbinate recurrence and debulking of the petrous recurrence were both performed via a purely endoscopic endonasal approach. Unfortunately, the child died 2 years later due progression of disease at the primary site, but with no sign of progression at the seeded site. The second patient was a 79-year-old man with an MRI-incompatible pacemaker who presented 19 months after EES for his clival chordoma with a mass involving the floor of the left nasal cavity that was causing an oro-antral fistula. On CT imaging, this appeared as a homogeneously contrast-enhancing mass eroding the hard palate inferiorly, the nasal septum superiorly, and the nasal process of the maxilla, with extension into the subcutaneous tissue. This was also treated endoscopically (combined transnasal-transoral approach) with resection of the mass, and repair of the fistula by using a palatal and left lateral wall rotational flap. Adjuvant hypofractionated stereotactic CyberKnife radiotherapy was administered using 35 Gy in 5 fractions. No recurrence was appreciated endoscopically or on imaging at the patient's last follow-up, 12 months after this last procedure. In both cases, pathological investigation of the original tumors revealed a fairly aggressive biology with 1p36 deletions, and high Ki-67 levels (10%-15%, and > 20%, respectively). The procedures were performed by a team of right-handed surgeons (otolaryngology and neurosurgery), using a 4-handed technique (in which the endoscope and suction are typically passed through the right nostril, and other instruments are passed through the left nostril without visualization). CONCLUSIONS Although uncommon, iatrogenic seeding occurs during EES for clival chordomas, probably because of decreased visualization during tumor removal combined with mucosal trauma and exposure of subepithelial elements (either inadvertently or because of mucosal flaps). In addition, tumors with more aggressive biology (1p36 deletions, elevated Ki-67, or both) are probably at a higher risk and require increased vigilance on surveillance imaging and endoscopy. Further prospective studies are warranted to evaluate the authors' proposed strategies for decreasing the incidence of iatrogenic seeding after EES for chordomas.
Collapse
Affiliation(s)
| | | | | | - Eric W Wang
- 2Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | |
Collapse
|
50
|
Cornelius JF, Eismann L, Ebbert L, Senger B, Petridis AK, Kamp MA, Sorg RV, Steiger HJ. 5-Aminolevulinic acid-based photodynamic therapy of chordoma: In vitro experiments on a human tumor cell line. Photodiagnosis Photodyn Ther 2017; 20:111-115. [PMID: 28951177 DOI: 10.1016/j.pdpdt.2017.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/14/2017] [Accepted: 09/17/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chordomas are very rare tumors of the skull base and the sacrum. They show infiltrating and destructive growth and are known to be chemo- and radio-resistant. After surgical resection, the recurrence rate is high and overall survival limited. As current adjuvant treatments are ineffective, new treatment concepts are urgently needed. 5-aminolevulinic acid-based photodynamic therapy (5-ALA based PDT) showed promising results for malignant gliomas. However, it is unknown so far, whether chordomas accumulate protoporphyrin IX (PPIX) after application of 5-ALA and whether they are sensitive to subsequent 5-ALA based PDT. METHODS The immortalized human chordoma cells U-CH2 were used as in vitro model. After incubation for 4h or 6h with different 5-ALA concentrations, PPIX accumulation was determined by flow cytometry. To assess sensitivity to PDT, chordoma cells were incubated at 30.000cells/well (high cell density) or 15.000cells/well (low cell density) with graded doses of 5-ALA (0-50μg/ml) in 96-well plates and subsequently exposed to laser light of 635nm wavelength (18.75J/cm2). Cell survival was measured 24h after exposure to laser light using the WST-1 assay. RESULTS U-CH2 cells dose-dependently accumulated PPIX (ANOVA; p<0.0001). PPIX fluorescence was significantly higher, when cells were incubated with 5-ALA for 6h compared to 4h at higher 5-ALA concentrations (ANOVA/Bonferroni; p≤0.05 for≥30μg/ml 5-ALA). For both cell densities, a 5-ALA dose-dependent decline in viability was observed (ANOVA; p<0.0001). Viability was significantly lower at higher 5-ALA concentrations, when 30.000 cells/wells were treated compared to 15.000cells/well (ANOVA/Bonferroni; p≤0.001 for≥30μg/ml 5-ALA). LD50 was 30.25μg/ml 5-ALA. CONCLUSION The human UCH-2 cell line was a very useful in vitro model to study different effects of 5-ALA based PDT. For the first time, it could be shown that human chordoma cells may be destroyed by 5-ALA/PDT.
Collapse
Affiliation(s)
- Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Lennert Eismann
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany; Neuro-oncological Research Laboratory, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Lara Ebbert
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Brigitte Senger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany; Neuro-oncological Research Laboratory, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Athanasios K Petridis
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Marcel Alexander Kamp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Rüdiger V Sorg
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Hans Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| |
Collapse
|