Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
World Neurosurg. 2020 Oct;142:391. doi: 10.1016/j.wneu.2020.05.200. Epub 2020 May 29.
Chordomas are slow-growing, low-grade, locally invasive, and locally aggressive tumors. They peak at 40-60 years of age, with a male preponderance (2:1). Belonging to the sarcoma family and thought to develop from the notochord remnant, they are most commonly found in the midline, with half located at the sacrum and about one third at the skull base. Their treatment mainly consists of surgical excision, followed by radiation therapy. The endoscopic endonasal approach provides direct access to the clival chordomas with no need for brain retraction or manipulation of neurovascular structures. Herein we present a step-by-step resection technique of a clival chordoma invading the subarachnoid space and touching the brainstem and vertebrobasilar vessels in a 46-year-old man with headaches, with a prior failed attempt of resection at an outside institution, resulting in a biopsy only in the palate. An endoscopic endonasal transclival approach was performed and gross total removal was achieved (Video 1). The patient had an uneventful recovery with no deficits, and he was then sent to proton beam therapy.
脊索瘤是一种生长缓慢、低度恶性、局部侵袭性和局部侵袭性的肿瘤。它们在 40-60 岁时达到高峰，男性居多（2:1）。属于肉瘤家族，被认为是由脊索残余发展而来，它们最常见于中线，一半位于骶骨，约三分之一位于颅底。它们的治疗主要包括手术切除，然后是放射治疗。内镜经鼻入路可直接进入斜坡脊索瘤，无需脑牵拉或操作神经血管结构。本文介绍了一例 46 岁男性患者的手术切除技术，该患者头痛，斜坡脊索瘤侵犯蛛网膜下腔，触及脑干和椎基底动脉。该患者曾在外院行手术切除失败，仅在腭部行活检。采用内镜经鼻颅底入路，实现了大体全切除（视频 1）。患者术后恢复顺利，无神经功能缺损，随后转至质子束治疗。
