Diagnosis And Treatment Of The Intracranial Chordomas

Purpose:We reviewed and evaluated the diagnosis and treatment of intracranial chordomas. The purpose of this study was to standardize treatment and improve outcomes.Methods:We conducted a retrospective study of 112 patients with intracranial chordomas seen at Huashan Hospital from 2003 to 2009.We analyzed and compared operative methods and long-term outcomes.Results:(1) A total of 132 operations were performed on 112 patients.Surgical results included 29 gross total resections,52 subtotal resections,51 partial resections. (2)Surgical approach:via transsphenoidal in 51 cases, subtemporal in 39, anterior transbasal in 15, retromastoid in 8, far-lateral in 10, oropharyngeal in 2, transethmoidal in 1,combined approach in 5,other in 1.(3) Patient satisfaction rates were higher in cases with neuronavigation as opposed to cases without neuronavigation(p value<0.05)Conclusions:(1) neuronavigation raises the extent of resection. (2) The transsphenoidal approach is suitable for tumors mainly involving the superior middle clivus with extension into the sphenoid sinus, posterior ethmoid sinus and nasal cavity. The anterior transbasal approach can used to resect tumors involving the sphenoid sinus, posterior ethmoid sinus, and inferior middle clivus. The far lateral approach is appropriate for tumors involving the inferior middle clivus, the ventral medulla and cervical cord. (3) Radiation can be used as adjuvent therapy for chordomas, but has possible carcinogenic potential.