Surgery Management Of Clival Tumors

Objective As is known that it is difficult to treat clival tumors by surgery, becauseof their deep position, surrounding neurovascular structure and heterogenous pathologywhich may hardly diagnose before the operation. Certain tumors which are sensitive toradiotherapy or chemotherapy, such as lymphoma and nasopharyngeal carcinoma, justneed a biopsy by surgery. Unreasonable operation may cause massive wound with highrisk and poor prognosis. In this study,35cases of clivus tumors are retrospectivelyanalyzed, to investigate the ideal treatment and surgery process.Methods There are male in19cases and female in16cases been retrospectivelyreviewed. All cases were identified to be clivus lesions by Computed Tomography(CT)or Magnetic Resonance Imaging(MRI), including clivus original and clivus invasivetumors. Staff from department of neurosurgery, head and neck surgery, radiology,oncology and radiation therapy composed a multidisciplinary team. The teamevaluated every preoperative clinical data, identified each surgical indication, anddetermined individual surgical project and treatment plan. Neurosurgeon, alone orcombined with head and neck surgeon, preformed operation according to differentapproach. Oncologist provided adjuvant radiation therapy or chemotherapy dependingon the histology result.Results Seven cases underwent biopsy surgery by trans-sphenoidal approach.Theother cases underwent radical resection in7different individual approach,among there28cases,21cases achieved total resection,6were subtotal resection, and1was partialresection.The pathology result showed there were11cases of chordoma,7meningioma,3myofibroblastoma,3squamous cell carcinoma,2lymphoma, and oneeach case of chondrosarcoma, pituitary adenoma, angiofibroma, teratoma,plasmacytoma, simple cyst, fibrous dysplasia, pleomorphic adenoma, metastatic tumor (squamous cell carcinomas) had been proved in this study. The complicationsincluded cranial nerve deficit, cerebrospinal fluid leakage, intracranial infection,mental status defection and surgical area hematoma. Nine cases (3chordoma,3myofibroblastoma,1chondrosarcoma,1squamous cell carcinoma and1plasmacytoma) received intensity modulated radiation therapy(IMRT), one chordomacase and one meningioma case received stereotactic radiotherapy(SRT),2lymphomacases and a metastasis case received concurrent chemoradiotherapy. In a3to55months follow-up, three cases died of recurrence, one died of other causes, one was in avegetative state,12cases with tumor residual, and18disease-free cases lived in goodperformance status,KPS80in average.Conclusions Total removal surgery is not necessary for all the clivus tumors, preoperativemultidisciplinary comprehensive evaluation according to the radiology findings is helpful toclarify the treatment options, which may enhance the security, rationality and the efficacy ofthe surgical treatment.