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Stuebe CM, Rindler RS, Laack N, Carr CM, Choby G, Inwards CY, Van Gompel JJ. Evaluation of Long-Term Follow-Up in Ecchordosis Physaliphora versus Chordoma. World Neurosurg 2023; 174:157-168. [PMID: 36898627 DOI: 10.1016/j.wneu.2023.03.016] [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: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Ecchordosis physaliphora (EP) is a non-neoplastic notochord remnant with limited literature. We present a review on surgically resected clival EP to evaluate if available follow-up is adequate to distinguish EP from chordomas. METHODS A systematic literature review was completed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Case reports or series of adults with histopathologic and radiographic findings of surgically resected EP were included. Articles including pediatric patients, systematic reviews, chordomas, and without microscopic or radiographic confirmation, or the surgical approach, were excluded. Corresponding authors were contacted twice to further evaluate outcomes. RESULTS Eighteen articles were included (n = 25 patients; mean age 47.5 years ± 12.6 [standard deviation] months). All patients had symptomatic, surgically resected EP, with cerebrospinal fluid leak or rhinorrhea the most common symptom (48%). All but 3 had gross total resection, with endoscopic endonasal transsphenoidal transclival the most common approach (80%). All but 3 reported immunohistochemistry findings, with physaliphorous cells the most common. All but 5 patients had definitive follow-up (80%), with average of 19.5 ± 17.2 months. One corresponding author reported longer-term follow-up for 1 patient (57 months). No recurrence or malignant transformation was reported. Mean time to clival chordoma recurrence (53.9 ± 26.8 months) was also evaluated in a review of 8 studies. CONCLUSIONS Mean follow-up for resected EP was almost 3 times shorter than mean time to recurrence of chordomas. Available literature is likely inadequate to confirm the suspected benign nature of EP especially in reference to chordoma, precluding treatment and follow-up recommendations.
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Affiliation(s)
- Caren M Stuebe
- Department of Neurosurgery, Texas A&M School of Medicine, Bryan, Texas, USA
| | - Rima S Rindler
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nadia Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Carrie M Carr
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Garret Choby
- Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Carrie Y Inwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Kwon JE, Ji SY, Hwang K, Lee KS, Choe G, Kim CY, Han JH. Management challenges associated with a pineal region chordoma: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE21110. [PMID: 35855099 PMCID: PMC9245841 DOI: 10.3171/case21110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/26/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Chordomas, which are rare malignant neoplasms arising from notochordal remnants, often cause gradually progressive clinical symptoms. Intradural cranial chordomas (ICCs) are extremely rare and generally have a favorable prognosis. However, the authors reported the case of a primary ICC originating in the pineal gland presenting with recurrent thalamic hemorrhage and displaying an aggressive postoperative clinical course.
OBSERVATIONS
A 41-year-old man arrived at the emergency department with morning headaches and recurrent syncope that had lasted several months. Computed tomography and magnetic resonance imaging (MRI) revealed a pineal gland mass causing obstructive hydrocephalus and a subacute hematoma in the right thalamus. Three weeks after an endoscopic third ventriculostomy was performed, recurrent hemorrhage was observed in the right thalamus. The tumor was promptly removed surgically. The yellowish-white tumor did not exhibit abundant bleeding. No evidence of intratumoral hemorrhage around the hematoma pocket was found. Histopathological examination revealed the characteristics of a chordoma with minimal vascularity. MRI performed 10 weeks postoperatively for worsening headaches revealed abnormal enhancement of multiple cranial nerves, suggesting leptomeningeal seeding (LMS) of the tumor.
LESSONS
Despite radiotherapy and intrathecal chemotherapy, the patient’s neurological status worsened; he died 2 years postoperatively. A pineal ICC may cause recurrent thalamic hemorrhage and potentially fatal LMS, even in the early postoperative period.
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Affiliation(s)
- Ji-Eyon Kwon
- Departments of Neurosurgery and
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - So Young Ji
- Departments of Neurosurgery and
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kihwan Hwang
- Departments of Neurosurgery and
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyu Sang Lee
- Pathology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea; and
| | - Gheeyoung Choe
- Pathology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea; and
| | - Chae-Yong Kim
- Departments of Neurosurgery and
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Ho Han
- Departments of Neurosurgery and
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
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Rinaldo L, Priemer DS, Vortmeyer AO, Cohen-Gadol AA, Brat DJ, Mahajan A, Giannini C, Burns TC. Chordoma of the corpus callosum: case report. J Neurosurg 2019; 131:1380-1386. [PMID: 30497142 DOI: 10.3171/2018.6.jns181028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/11/2018] [Indexed: 11/06/2022]
Abstract
Chordomas are neoplasms that typically arise from midline skeletal structures and rarely originate within the intradural compartment of the CNS. A chordoma arising from the corpus callosum has not been previously described. The authors report the surgical management of a chordoma originating within the splenium of the corpus callosum. To determine the incidence and distribution of intracranial intradural chordoma, a literature search for additional cases was performed. MEDLINE was searched using the MeSH keyword "chordoma," yielding 2010 articles. These articles were screened for cases of primary intradural chordoma rostral to the craniocervical junction, which led to the identification of 46 relevant articles. The authors report the case of a 69-year-old man who initially presented with nonspecific neurological symptoms including spatial disorientation and cognitive decline. These symptoms eventually prompted intracranial imaging, including MRI, which revealed a ring-enhancing, heterogeneous, cystic mass localized within the splenium of the corpus callosum and extending into the bilateral ventricles. The lesion was believed to represent a high-grade glioma and the patient underwent a left interhemispheric approach and subtotal resection. After pathologic evaluation confirmed a diagnosis of an anaplastic chordoma, the patient underwent further resection. A gross-total resection (GTR) was achieved with a transfalcine approach to the contralateral portion of the tumor. Postoperatively, the patient had a partial left homonymous quadrantanopsia, but was otherwise at his neurological baseline. Proton beam radiotherapy was performed to the resection cavity but diffuse intraventricular disease ensued. The results of a literature search suggest that a chordoma arising in the corpus callosum has not been previously described. The present case demonstrates that chordomas can occur in the corpus callosum, and illustrates the utility of a transfalcine approach for GTR of lesions in this location, as well as the need for improved strategies to prevent intraventricular dissemination.
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Affiliation(s)
| | - David S Priemer
- 2Department of Anatomic Pathology and Neuropathology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alexander O Vortmeyer
- 2Department of Anatomic Pathology and Neuropathology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aaron A Cohen-Gadol
- 3Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana; and
| | - Daniel J Brat
- 4Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Caterina Giannini
- Departments of1Neurosurgery
- 6Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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A Diagnostic Pitfall: Atypical Teratoid Rhabdoid Tumor Versus Dedifferentiated/Poorly Differentiated Chordoma: Analysis of a Mono-institutional Series. Appl Immunohistochem Mol Morphol 2019; 27:147-154. [DOI: 10.1097/pai.0000000000000554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Choudhri O, Feroze A, Hwang P, Vogel H, Ajlan A, Harsh G. Endoscopic Resection of a Giant Intradural Retroclival Ecchordosis Physaliphora: Surgical Technique and Literature Review. World Neurosurg 2014; 82:912.e21-6. [DOI: 10.1016/j.wneu.2014.06.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/18/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
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Kim KH. Intradural clival chordoma: a case report. Brain Tumor Res Treat 2014; 2:76-80. [PMID: 25408929 PMCID: PMC4231615 DOI: 10.14791/btrt.2014.2.2.76] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/02/2014] [Accepted: 07/24/2014] [Indexed: 11/20/2022] Open
Abstract
Clival chordoma is a rare intracranial neoplasm located in the clivus with bony extension and destruction. It is difficult to resect completely and generally has a poor prognosis. However, intradural clival chordomas have been reported with good surgical outcomes. We present a rare case of intradural chordoma and a review of the literature.
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Affiliation(s)
- Ki Hong Kim
- Department of Neurosurgery, Catholic University of Daegu College of Medicine, Daegu, Korea
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HASHIM H, ROSMAN AK, ABDUL AZIZ A, ROQIAH AK, BAKAR NS. Atypical Clival Chordoma in an Adolescent without Imaging Evidence of Bone Involvement. Malays J Med Sci 2014; 21:78-82. [PMID: 25977639 PMCID: PMC4418131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 06/08/2014] [Indexed: 06/04/2023] Open
Abstract
Clival chordoma is a rare primary bone tumour that arises from the remnant of the notochord and typically occurs in older adults. Upon imaging, the tumour can be seen arising from the clivus and causes clival destruction. This usually provides insight for a diagnosis. Here we present a case of a non-enhancing, pre-pontine mass that was hypointense on T1W and hyperintense on T2W in an adolescent. No clival bone erosion was observed. Based on the age group, imaging findings, and lack of clival erosion, a provisional diagnosis of epidermoid cyst was made and the tumour was resected. This patient was eventually diagnosed with a clival chordoma based on histopathological examination.
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Affiliation(s)
- Hilwati HASHIM
- Imaging Unit, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia
| | - Azmin Kass ROSMAN
- Department of Neurosurgery, Sungai Buloh Hospital, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia
| | - Aida ABDUL AZIZ
- Department of Radiology, Sungai Buloh Hospital, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia
| | - Abdul Kadir ROQIAH
- Imaging Unit, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia
| | - Nor Salmah BAKAR
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia
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AlOtaibi F, Guiot MC, Muanza T, Di Maio S. Giant petroclival primary intradural chordoma: case report and systematic review of the literature. J Neurol Surg Rep 2014; 75:e160-9. [PMID: 25083378 PMCID: PMC4110134 DOI: 10.1055/s-0034-1378157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/09/2014] [Indexed: 11/24/2022] Open
Abstract
Background Chordomas are rare, locally aggressive neoplasms thought to arise from notochordal remnants in the axial skeleton. Primary intradural chordomas are considered to be extremely rare. In this article a giant intradural petroclival chordoma is presented, and a synthesis of the available literature is performed to measure overall survival (OS) and recurrence-free survival (RFS) and to identify prognostic factors. Methods A systematic Medline review yielded 47 patients with purely intradural tumors from 38 publications including 39 chordomas, 8 cases of ecchordosis physaliphora, and 1 case with features of both. The 5-year OS and RFS were calculated based on the Kaplan-Meier method. Risk factors for progression or mortality were analyzed using binomial logistic regression. Results Maximal tumor diameter varied from 1.5 to 6.0 cm (mean: 3.2 cm). Tumors were located predominantly in the prepontine area (66.7%). Combined 5-year Kaplan-Meier OS and RFS were 77% ± 11% and 74% ± 11%, respectively. Incomplete surgical resection, larger tumor diameter, and an elevated Ki-67 index were statistically more frequent in cases of recurrence and mortality. Conclusions Based on a systematic literature review, the behavior of primary intradural chordomas may be closer to typical chordomas than was previously thought.
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Affiliation(s)
- Fahad AlOtaibi
- Division of Neurosurgery, Department of Radiation Oncology, McGill University, Jewish General Hospital, Montreal, Quebec, Canada ; Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical Center, Riyadh, Saudi Arabia
| | - Marie-Christine Guiot
- Department of Neuropathology, McGill University, Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Thierry Muanza
- Department of Radiation Oncology, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
| | - Salvatore Di Maio
- Division of Neurosurgery, Department of Radiation Oncology, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
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Endoscopic endonasal approach in the management of skull base chordomas--clinical experience on a large series, technique, outcome, and pitfalls. Neurosurg Rev 2013; 37:217-24; discussion 224-5. [PMID: 24249430 DOI: 10.1007/s10143-013-0503-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 06/28/2013] [Accepted: 07/27/2013] [Indexed: 10/26/2022]
Abstract
Skull base chordomas represent very interesting neoplasms, due to their rarity, biological behavior, and resistance to treatment. Their management is very challenging. Recently, the use of a natural corridor, through the nose and the sphenoid sinus, improved morbidity and mortality allowing also for excellent removal rates. Prospective analysis of 54 patients harboring a skull base chordoma that were managed by extended endonasal endoscopic approach (EEA). Among the 54 patients treated (during a 72 months period), 21 were women and 33 men, undergoing 58 procedures. Twenty-two cases (40%) were recurrent and 32 (60%) newly diagnosed chordomas. Among the 32 newly diagnosed chordomas, a gross total resection was achieved in 28 cases (88%), a near total (>95% of tumor) in 2 cases (6%), a partial (>50% of tumor) in 2 cases (6%). Among the 22 recurrent chordomas, resection was complete in 7 cases (30%), near total in 7 (30%), and partial in 8 (40%). The global gross total resection rate was 65% (35/54 cases). Four patients (11%) recurred and 4 (11%) progressed within a mean follow-up of 34 months (range 12-84 months). Four patients (11%) were re-operated; one patient (1.8%) died due to disease progression, one patient (1.8%) died 2 weeks after surgery due to a massive bleeding from an ICA pseudo aneurysm. CSF leakage occurred in four patients (8%), and meningitis in eight cases (14%). No new permanent neurological deficit occurred. The EEA management of skull base chordomas requires a long and gradual learning curve that once acquired offers the possibility of either similar or better resection rates as compared to traditional approaches while morbidity is improved.
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Bag AK, Chapman PR. Neuroimaging: Intrinsic Lesions of the Central Skull Base Region. Semin Ultrasound CT MR 2013; 34:412-35. [DOI: 10.1053/j.sult.2013.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Golden LD, Small JE. Benign notochordal lesions of the posterior clivus: retrospective review of prevalence and imaging characteristics. J Neuroimaging 2013; 24:245-9. [PMID: 23464492 DOI: 10.1111/jon.12013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 01/07/2013] [Accepted: 02/03/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Distinguishing BNCT from chordoma with imaging is critical because of the profound differences in prognosis and management. Yet few reports define the variable imaging characteristics of BNCT. This study aims to evaluate the prevalence and characteristics of BNCT. METHODS A total of 916 patients with 64-section CT and 1.5T MR imaging through the posterior fossa between 2004 and 2009 were evaluated to catalogue the prevalence, clinical presentation, morphology, and imaging properties associated with BNCT. RESULTS BNCTs were identified in 7 patients (imaging prevalence of 0.76%). All were midline, T1 hypointense, and T2 hyperintense. When present, the bony stalk often associated with EP measured between 1.65 and 3.72 mm. Five cases demonstrated atypical features such as absence of bony stalk (one case), arterial enhancement (one case), clival erosion (four cases), clinical symptoms (one case), and mass effect (one case). CONCLUSION Many notochordal lesions do not fit neatly into the diagnostic criteria for either EP or chordoma. It may be useful to consider these atypical cases along a spectrum of notochord remnant lesions. Close inspection of imaging reveals BNCTs at a similar frequency to its pathologic prevalence. BNCTs such as EP vary in size and may be easily overlooked.
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Affiliation(s)
- Louis D Golden
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Massachusetts (LDG); and Department of Radiology, Lahey Clinic Medical Center, Massachusetts (JES)
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Guillonnet A, Bengolea L, Funes J, Velán O, Mónaco RG, Besada C. Cervical chordoma with moderate bone impairment in a child. Answer to October E-quid. Diagn Interv Imaging 2012; 93:903-6. [PMID: 23146827 DOI: 10.1016/j.diii.2012.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A Guillonnet
- Departamento de Neurorradiología, Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Potosí, Buenos Aires, Argentina.
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Tan NCW, Naidoo Y, Oue S, Alexander H, Robinson S, Wickremesekera A, Floreani S, Vrodos N, Santoreneos S, Ooi E, McDonald M, Wormald PJ. Endoscopic surgery of skull base chordomas. J Neurol Surg B Skull Base 2012; 73:379-86. [PMID: 24294554 DOI: 10.1055/s-0032-1321508] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/28/2012] [Indexed: 12/17/2022] Open
Abstract
Objective To assess our clinical experience in treating midline intracranial pathology using minimally invasive surgical techniques. Design Retrospective chart review of patients undergoing endoscopic endonasal resection of clival chordomas. Setting Two tertiary referral centers in Australia and New Zealand. Main Outcome Measures Patients were assessed by intraoperative findings (macroscopic resection rate, tumor size, and operative complications) and clinical outcomes (residual disease, postoperative complications, recurrence rate, and mortality). Results Fourteen patients underwent endoscopic resection of clival chordomas (seven primary, seven revision) with a mean follow-up of 41.45 months (3 to 104 months). Macroscopic resection rates were 71% and 29%, respectively. Mean operative time was 386 minutes. Overall cerebrospinal fluid (CSF) leak rate was 3/14 (21%) and, using the nasoseptal flap, it was 0/5 (0%). Two patients developed late recurrence; one died of disease and one was treated with intensity modulated radiation therapy. Overall mortality was 2/14 (14%). Conclusion Endoscopic resection of clival chordomas is a safe and viable alternative to the traditional open approach. The nasoseptal flap is an excellent method of obtaining a watertight skull base closure. Furthermore, this series highlighted the fact that the primary attempt at surgery offers the best chance to achieve a total resection.
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Affiliation(s)
- Neil C-W Tan
- Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, South Australia, Australia
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Barresi V, Caffo M, Alafaci C, Granata F, Tuccari G. Intradural chordoma of the Meckel's cave: A challenging differential diagnosis. Neuropathology 2012; 32:577-82. [DOI: 10.1111/j.1440-1789.2011.01295.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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