2025 Poster Presentations
P070: ENDOSCOPIC ENDONASAL SURGERY FOR CLIVAL CHORDOMAS. CASE SERIES.
Bakhtiyar Pashaev, MD1; Arseniy Pichugin, PhD2; Gulnar Vagapova, PhD3; Dilyara Miftakhova, MD1; 1Interregional Clinical Diagnostic Cwnter; 2Kazan State Medical University; 3Kazan State Medical Academy
Background: Skull base chordomas are rare tumors, with a prevalence in males and an annual incidence of 0.04-0.08 per 100,000 individuals. The standard treatment involves surgical removal and radiosurgery. Complete surgical resection of the tumor is the most important factor for achieving a 5-year progression-free survival, with a success rate of 78% based on published studies.
Objective: The authors present a series of patients with clival chordoma treated at a single institution.
Material and methods: Vital patients’ data, along with postoperative radiation history and follow-up information, were systematically collected.
Results: In the Department of Neurosurgery at the Interregional Clinical Diagnostic Center, a total of 16 patients with clival chordoma underwent surgery between 2011 and 2024. Of these patients, 7 were male and 9 were female, with ages ranging from 23 to 74 years and a median age of 51.9 years. Primary surgery was performed in 11 (68.7%) patients, while 3 (18,7%) patients underwent surgery due to tumor recurrence between 34 and 58 months after the initial surgery. In one case, surgery was divided into two stages with a 4-month interval. One patient underwent two partial removals in other hospitals, and tumor progression was identified 3 years after the last surgery. The tumor volume ranged from 2.12 cm3 to 144.9 cm3. All surgeries were purely endoscopic with neuronavigation and intraoperative neurophysiological monitoring assistance. Gross total removal was achieved in 5 (31.2%) patients, while 8 (50%) patients underwent subtotal tumor resection. In 2 (12,5%) patients a partial removal, and in 1 (6,2%) patient only biopsy was performed. Among the 14 patients operated on after 2016, a Ki-67 with a range between 0 and 40% was identified. Postoperative complications included massive intraoperative blood loss in 1 (6,2%) patient, basilar artery injury with subsequent aneurysm formation in 1 (6,2%) case, swallowing impairment in 1 (6,2%) patient, CSF-leak in 2 (12,5%) patients followed by meningitis in one patient, and deep vein thrombosis (DVT) in 1 (6,2%) patient.
Six (37,5%) patients underwent conventional stereotactic radiotherapy, while 3 (18,7%) patients received proton-beam therapy. One (6,2%) patient is currently under observation without post-surgical irradiation. At present, 9 (56,2%) patients are alive and free from disease progression. Unfortunately, 1 (6,2%) patient passed away on the fourth day after the surgery due to bleeding in the residual portion of the tumor located at the brain stem site. Additionally, 3 (18,7%) patients succumbed to tumor progression during the follow-up period, occurring between 12 to 18 months after recurrence was detected. Tragically, 1 (6,2%) patient passed away during the COVID-19 pandemic. The median progression-free survival in our cohort was 31 months, with a maximum of 72 months.
Conclusions: Endoscopic endonasal surgery is considered the preferred method, particularly for tumors located along the midline. Achieving gross total resection is a key factor in predicting progression-free survival. The learning curve for this technique remains steep, and achieving long-term treatment outcomes necessitates ongoing follow-up and the development of advanced skills and experience.