Kocaeli University, Neurosurgery Department, Pituitary Research Center, Kocaeli, Turkey.
Kocaeli State Hospital, Neurosurgery Department, Kocaeli, Turkey.
Clin Neurol Neurosurg. 2021 Sep;208:106875. doi: 10.1016/j.clineuro.2021.106875. Epub 2021 Aug 5.
Gross total resection (GTR) is the mainstay therapy for chordomas and chondrosarcomas to have the best prognosis. The aims of this study were to specify the limits of EEA, emphasize the need for additional combined approaches for tumors beyond these limitations for high resection rates, discuss the prognostic factors and operative nuances that affect GTR, and present the causes and characteristics of early and late recurrences.
We retrospectively analyzed the endoscopic endonasal surgeries in the Pituitary Research Center and Neurosurgery Department of the Kocaeli University Faculty of Medicine, Turkey between January 2004 and December 2019. We retrospectively reviewed the medical data, radiological images, and surgical videos of patients, and 72 patients with chordoma and chondrosarcoma were included in the study.
Based on pathology reports, 72 patients (seven pediatric) were identified, to whom 91 endoscopic operations were performed. We determined the surgical limitations for each clival segment as superior, middle, and inferior. Then, we divided these into three subgroups according to whether the tumor shows dural invasion (extradural chordoma, large extradural - minimal intradural component, and minimal extradural - large intradural component). The tumors of 19 (26.4%), 25 (26.4%), and nine (12.5%) patients originated from the superior, middle, and inferior clivus, respectively. Nineteen (26.4%) patients had panclival involvement. GTR was performed in 47 (65.3%) the patients. The GTR rate in patients with panclival tumors was 47.3% (9/19). The experience, lateralization, dural involvement, and origin of the clivus affecting GTR were analyzed. Extradural - intradural extensions were verified as negative predictor factors for GTR, whereas tumors located in the superior (OR: 16.710, p=0.030) and middle (OR: 11.154, p=0.023) segments were positive predictive factors for GTR.
An increasing experience in endoscopic surgery significantly increases the GTR rates by widening the surgical limitations. Due to dense bone infiltration and adhesion to critical neurovascular structures, recurrence rates are high despite performing GTR. Although surgery and adjuvant treatments improve the 5-year survival of patients, the mortality rates remain high. Therefore, surgery of these tumors should be performed by experienced centers. In addition to surgical and adjuvant therapies, targeted molecular and translational biological therapies are also needed for chordomas and chondrosarcomas in the future.
广泛切除（GTR）是脊索瘤和软骨肉瘤的主要治疗方法，可获得最佳预后。本研究的目的是明确 EEA 的局限性，强调对于超出这些限制的肿瘤需要额外的联合治疗方法以获得更高的切除率，讨论影响 GTR 的预后因素和手术细节，并阐述早期和晚期复发的原因和特征。
我们回顾性分析了土耳其科贾埃利大学医学院垂体研究中心和神经外科 2004 年 1 月至 2019 年 12 月期间的内镜经鼻手术。我们回顾性地查阅了患者的医疗数据、影像学图像和手术视频，纳入了 72 例脊索瘤和软骨肉瘤患者。
根据病理报告，确定了 72 例患者（7 例为儿童），对其中 91 例患者进行了内镜手术。我们确定了每个斜坡段的手术局限性，分别为上、中、下。然后，我们根据肿瘤是否有硬脑膜侵犯（硬膜外脊索瘤、大硬膜外-小硬膜内成分和小硬膜外-大硬膜内成分）将其分为三组。19 例（26.4%）、25 例（26.4%）和 9 例（12.5%）患者的肿瘤分别起源于上、中、下斜坡。19 例（26.4%）患者有全斜坡受累。47 例（65.3%）患者行 GTR。全斜坡肿瘤患者的 GTR 率为 47.3%（9/19）。分析了经验、侧化、硬脑膜受累和斜坡起源对 GTR 的影响。硬膜内外延伸被证实为 GTR 的负预测因素，而位于上斜坡（OR：16.710，p=0.030）和中斜坡（OR：11.154，p=0.023）的肿瘤则是 GTR 的正预测因素。
内镜手术经验的增加通过扩大手术局限性显著提高了 GTR 率。尽管进行了 GTR，但由于致密骨浸润和与关键的神经血管结构的粘连，复发率仍然很高。尽管手术和辅助治疗改善了患者的 5 年生存率，但死亡率仍然很高。因此，这些肿瘤的手术应由有经验的中心进行。除了手术和辅助治疗外，未来还需要针对脊索瘤和软骨肉瘤的靶向分子和转化生物学治疗。
