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Nistal D, Lee A, Ruzevick J. Pediatric Orbital and Skull Base Pathology. Oral Maxillofac Surg Clin North Am 2024; 36:333-342. [PMID: 38522979 DOI: 10.1016/j.coms.2024.02.003] [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] [Indexed: 03/26/2024]
Abstract
Pediatric orbital and skull base pathologies encompass a spectrum of inflammatory, sporadic, syndromic, and neoplastic processes that require a broad and complex clinical approach for both medical and surgical treatment. Given their complexity and often multicompartment involvement, a multidisciplinary approach for diagnosis, patient and family counseling, and ultimately treatment provides the best patient satisfaction and clinical outcomes. Advances in minimally invasive surgical approaches, including endoscopic endonasal and transorbital approaches allows for more targeted surgical approaches through smaller corridors beyond more classic transcranial or transracial approaches.
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Affiliation(s)
- Dominic Nistal
- Department of Neurological Surgery, University of Washington, 1959 Northeast Pacific Street, Box 356470, Seattle, WA 98195, USA
| | - Amy Lee
- Department of Neurological Surgery, University of Washington, 1959 Northeast Pacific Street, Box 356470, Seattle, WA 98195, USA; Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Jacob Ruzevick
- Department of Neurological Surgery, University of Washington, 1959 Northeast Pacific Street, Box 356470, Seattle, WA 98195, USA; Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
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Ioakeim-Ioannidou M, Niemierko A, Kim DW, Tejada A, Urell T, Leahy S, Adams J, Fullerton B, Nielsen GP, Hung YP, Shih AR, Patino M, Buch K, Rincon S, Kelly H, Cunnane MB, Tolia M, Widemann BC, Wedekind MF, John L, Ebb D, Shin JH, Cote G, Curry W, MacDonald SM. Surgery and proton radiation therapy for pediatric base of skull chordomas: Long-term clinical outcomes for 204 patients. Neuro Oncol 2023; 25:1686-1697. [PMID: 37029730 PMCID: PMC10484173 DOI: 10.1093/neuonc/noad068] [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: 12/25/2022] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Data on clinical outcomes for base of skull (BOS) chordomas in the pediatric population is limited. We report patient outcomes after surgery and proton radiotherapy (PRT). METHODS Pediatric patients with BOS chordomas were treated with PRT or combined proton/photon approach (proton-based; for most, 80% proton/20% photon) at the Massachusetts General Hospital from 1981 to 2021. Endpoints of interest were overall survival (OS), disease-specific survival, progression-free survival (PFS), freedom from local recurrence (LC), and freedom from distant failure (DC). RESULTS Of 204 patients, median age at diagnosis was 11.1 years (range, 1-21). Chordoma location included 59% upper and/or middle clivus, 36% lower clivus, 4% craniocervical junction, and 1% nasal cavity. Fifteen (7%) received pre-RT chemotherapy. Forty-seven (23%) received PRT, and 157 (77%) received comboRT. Median total dose was 76.7 Gy (RBE) (range, 59.3-83.3). At a median follow-up of 10 years (interquartile range, 5-16 years), 56 recurred. Median OS and PFS were 26 and 25 years, with 5-, 10-, and 20-year OS and PFS rates of 84% and 74%, 78% and 69%, and 64% and 64%, respectively. Multivariable actuarial analyses showed poorly differentiated subtype, radiographical progression prior to RT, larger treatment volume, and lower clivus location to be prognostic factors for worse OS, PFS, and LC. RT was well tolerated at a median follow-up of 9 years (interquartile range, 4-16 years). Side effects included 166 patients (80%) with mild/moderate acute toxicities, 24 (12%) patients with late toxicities, and 4 (2%) who developed secondary radiation-related malignancies. CONCLUSION This is the largest cohort of BOS chordomas in the literature, pediatric and/or adult. High-dose PRT following surgical resection is effective with low rates of late toxicity.
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Affiliation(s)
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel W Kim
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Athena Tejada
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tobias Urell
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shannon Leahy
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Judy Adams
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Barbara Fullerton
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Angela R Shih
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Manuel Patino
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen Buch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandra Rincon
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hilary Kelly
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mary Beth Cunnane
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria Tolia
- Department of Radiotherapy, School of Medicine, University of Crete, Heraklion, Greece
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Mary F Wedekind
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Liny John
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - David Ebb
- Department of Pediatric Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory Cote
- Department of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William Curry
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Alsharif TH, Gronfula AG, Alghdali LH, Hejazi M, Alanazi A, Wali SM, Alyousef M. Outcomes of Endoscopic Resection in Pediatric Skull Base Chordoma: A Systematic Review. Cureus 2023; 15:e41487. [PMID: 37551221 PMCID: PMC10404338 DOI: 10.7759/cureus.41487] [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] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
The endoscopic approach has been recommended as a primary option for treating chordomas, and it is associated with better resection rates and fewer surgical complications than transcranial surgery. This review aimed to assess the long-term consequences and evidence in the current literature regarding the endoscopic approach's efficacy in treating skull-base chordoma in children. A systematic review was conducted based on the PubMed, Web of Science, and EMBASE databases to examine the clinical outcomes of endoscopic endonasal surgery for pediatric skull base chordoma tumors. The review included studies published in English that employed specific research designs and reported on pediatric patients with skull base chordoma. Of the 268 studies initially considered, 25 met our eligibility criteria and were included in the final analysis. The average age of the patients was 11.5 years, with approximately equal number of males and females. The endoscopic endonasal approach (EEA) was the most commonly used modality. Gross total resection (GTR) was achieved in 62.7% of patients, while 18.09% had a subtotal resection (STR), and 13.83% had near-total resection only. Most patients showed significant to moderate improvement from their baseline condition and had no recurrence during their follow-up. Our findings further endorse that the endoscopic approach is a viable primary treatment option for pediatric skull base chordoma.
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Affiliation(s)
| | - Amin G Gronfula
- Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Lamees H Alghdali
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Mayasim Hejazi
- Emergency Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Sahal M Wali
- Surgery, King Abdulaziz University Hospital, Jeddah, SAU
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Reardon T, Marsh C, Rippe P, Ruzys D, Ayres B, Cline D, Fiani B. Clinical management of pediatric chordomas: a comprehensive review. Acta Neurol Belg 2021; 121:1407-1414. [PMID: 34648142 DOI: 10.1007/s13760-021-01821-z] [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: 08/29/2021] [Accepted: 10/03/2021] [Indexed: 11/26/2022]
Abstract
Chordomas are malignant tumors derived from remnants of the notochord. These are extremely rare in pediatric patients, accounting for approximately 5% of all chordomas, with most lesions occupying the cranium. Chordomas also can occupy all levels of the spine, demonstrating a broad spectrum of neurologic presentation. Optimal treatment aims for gross total resection with accompanying radiation therapy to prevent recurrence. Their aggressive and infiltrative nature makes clinical management challenging, involving multiple disciplines and close monitoring to ensure optimal outcomes. This comprehensive review aims to cover the genetics, demographics, pathogenesis, neurologic sequelae, radiological considerations, chemotherapeutic management, surgical management, and post-operative considerations of pediatric chordoma patients.
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Affiliation(s)
- Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA.
| | - Caleb Marsh
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA
| | - Preston Rippe
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA
| | - Donatas Ruzys
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA
| | - Benjamin Ayres
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA
| | - David Cline
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA
| | - Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
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Liu MA, Gendreau JL, Loya JJ, Brown NJ, Keith A, Sahyouni R, Abraham ME, Gonda D, Levy ML. Management of pediatric clival chordoma with extension to the craniocervical junction and occipito-cervical fusion: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21434. [PMID: 36060426 PMCID: PMC9435547 DOI: 10.3171/case21434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chordomas are rare malignant neoplasms that develop from the primitive notochord with < 5% of the tumors occurring in pediatric patients younger than the age of 20. Of these pediatric chordomas, those affecting the craniocervical junction (C1–C2) are even more rare; therefore, parameters for surgical management of these pediatric tumors are not well characterized. OBSERVATIONS In this case, a 3-year-old male was found to have a clival chordoma on imaging with extension to the craniocervical junction resulting in spinal cord compression. Endoscopic-assisted transoral transclival approach for clival tumor resection was performed first. As a second stage, the patient underwent a left-sided far lateral craniotomy and cervical laminectomy for resection of the skull base chordoma and instrumented fusion of the occiput to C3. He made excellent improvements in strength and dexterity during rehab and was discharged after 3 weeks. LESSONS In pediatric patients with chordoma with extension to the craniocervical junction and spinal cord compression, decompression with additional occipito-cervical fusion appears to offer a good clinical outcome. Fusion performed as a separate surgery before or at the same time as the initial tumor resection surgery may lead to better outcomes.
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Affiliation(s)
- Matthew A. Liu
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Julian L. Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland
| | - Joshua J. Loya
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Nolan J. Brown
- Department of Neurosurgery, University of California Irvine, Orange, California; and
| | - Amber Keith
- Department of Neurosurgery, University of California Irvine, Orange, California; and
| | - Ronald Sahyouni
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Mickey E. Abraham
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - David Gonda
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
- Rady Children’s Hospital San Diego, California
| | - Michael L. Levy
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
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