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2004, Number 3

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Gac Med Mex 2004; 140 (3)

Giantclivus chordomas. Are extensive surgeries really justified?

Guinto G, Cohn F, Aréchiga N, Félix I, Kageyama M, Castellanos A, Martín J

Language: Spanish
References: 33
Page: 273-280
PDF size: 736.00 Kb.


ABSTRACT

Because of their location and biological behavior, clivus chordomas are tumors that still represent a great challenge, mainly when they have reached huge dimensions. In this paper we have selected the patients with the biggest clivus chordomas to analyze if they really can be helped with the current surgical procedures with the morbidity that it implies. Eleven patients with giant clivus chordomas were included. All of them were operated on following the recent criteria of Cranial Base Surgery. It was mainly analyzed, if the degree of the resection had any relation to the postoperative functional outcome and the disease-free survival time; it was also evaluated if there existed a correlation between the pathologic findings and the clinical course. It was possible to get a total resection in 8 patients and partial in 3. In all cases there was an evident improvement in their postoperative functional outcome, specially in those with complete resections. The disease-free survival time was also greater in the patients with more ample resections. There was not any correlation among the histologic variety of tumors (typical or chondroid) and the clinical prognosis.


REFERENCES

  1. Bouropoulou V, Bosse A, Roessner A, Vollmer E, Edel G, Wuisman P, Härle A. Immunohistochemical investigation of chordomas: histogenetic and differential diagnostic aspects. Curr Top Pathol 1989;80:183-203.

  2. Heffelfinger MJ, Dahlin DC, MacCarty CS, Beabout JW. Chordomas and cartilaginous tumors at the skull base. Cancer 1973;32:410-420.

  3. Keisch ME, García DM, Shibuya RB. Retrospective long-term follow-up analysis in 21 patients with chordomas of various sites treated at a single institution. J Neurosurg 1991;75:374-377.

  4. Snow RB, Patterson RR. Surgical treatment of tumors of the clivus and basioccipital region. En: Operative Neurosurgical Techniques. Schmidek HH, Sweet WH (Eds.) Grune & Stratton Inc.4a. Edición Orlando, 1988, pp 635-646.

  5. Eriksson B, Gunterberg B, Kindblom LG. Chordoma: a clinicopathologic and prognostic study of a Swedish national series. Acta Orthop Scand 1981;52:49-58.

  6. Rich TA, Schiller A, Suit HD, Mankin HJ. Clinical and pathologic review of 48 cases of chordoma. Cancer 1985;56:182-187.

  7. Sen CN, Sekhar LN, Schramm VL, Janecka IP. Chordoma and chondrosarcoma of the cranial base: An 8-year experience. Neurosurgery 1989;25:931-941.

  8. Magrini SM, Papi MG, Marletta F, Tomaselli S, Cellai E, Mungai V, Biti G. Chordoma natural history, treatment and prognosis. The Florence Radiotherapy Department experience (1956-90) and a critical review of the literature. Acta Oncol 1992;31:847-51.

  9. Raffel C, Wright DC, Gutin PH, Wilson CB. Cranial chordomas: Clinical presentation and results of operative and radiation therapy in twenty-six patients. Neurosurgery 1985;17:703-710.

  10. Dahlin DC, MacCarty CS. Chordoma. A study of fifty-nine cases. Cancer 1952;5:1170-1178.

  11. Gay E, Sekhar LN, Rubinstein E, Wright DC, Sen C, Janecka IP, Snyderman CH. Chordomas and chondrosarcomas of the cranial base: Results and follow-up of 60 patients. Neurosurgery 1995;36:887-897.

  12. Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma with particular reference to bronchogenic carcinoma. Cancer 1948;1:634-656.

  13. Guinto G, Abello J, Felix I, Gonzalez J, Oviedo A. Lesions confined to the sphenoid ridge. Differential diagnosis and surgical treatment. Skull Base Surg 1997;7:115-121.

  14. Hakuba A, Liu S, Nishimura S. The orbitozygomatic infratemporal approach: A new surgical technique. Surg Neurol 1986;26:271-276.

  15. Sekhar LN, Schramm VL, Jones NF. Subtemporal-preauricular infratemporal fossa approach to large lateral and posterior skull base neoplasms. J Neurosurg 1987;67:488-499.

  16. Sekhar LN, Wright DC, Sen CN. Extended frontal approach to tumors and aneurysms of the cranial base. En: Neurosurgery. Wilkins RH, Rengachary SS (Eds.) McGraw Hill Co. Inc. 2ª Edición New York, 1996, pp 1611-1621.

  17. Al-Mefty O, Fox JL, Smith PR. Petrosal approach for petroclival meningiomas. Neurosurgery 1988;22:510-517.

  18. Sen CN, Sekhar LN. An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum. Neurosurgery 1990;27:197-204.

  19. Jackson IT. Craniofacial osteotomies to facilitate the resection of tumors of the skull base. En: Neurosurgery. Wilkins RH, Rengachary SS (Eds.) McGraw Hill Co. Inc. 2ª Edición New York,1996, pp 1585-1621.

  20. Richtsmeier WJ, Scher RL. Transfacial-transmaxillary approach to the anterior skull base. En: Neurosurgery. Wilkins RH, Rengachary SS (Eds.) McGraw Hill Co. Inc. 2ª Edición New York, 1996, pp 1623-1628.

  21. Menezes AH. Transoral approaches to the clivus and upper cervical spine. En: Neurosurgery. Wilkins RH, Rengachary SS (Eds.) McGraw Hill Co. Inc. 2ª Edición New York, 1996, pp 1629-1639.

  22. McDonnell DE, Harrison SJ. Anterolateral cervical approach to the craniovertebral junction. En: Neurosurgery. Wilkins RH, Rengachary SS (Eds.) McGraw Hill Co. Inc. 2ª Edición New York, 1996, pp 1641-1653.

  23. Hirsch BE, Sekhar LN, Kamerer DB. Transtemporal and infratemporal approach for benign tumors of the jugular foramen and temporal bone. En: Surgery of Cranial Base Tumors. Sekhar LN, Janecka IP (Eds.) Raven Press. New York, 1993, pp 267-289.

  24. Guinto G, Abello J, Molina A, Gallegos F, Oviedo A, Nettel B, Lopez R. Zygomatic-transmandibular approach for giant tumors of the infratemporal fossa and parapharyngeal space. Neurosurgery 1999;45:1385-1398.

  25. O’Connell JX, Renard LG, Liebsch NJ, Efird JT, Munzenrider JE, Rosenberg AE. Base of skull chordoma. A correlative study of histologic and clinical features of 62 cases. Cancer 1994;74:2261-2267.

  26. Forsyth PA, Cascino TL, Sahw EG, Scheithauer BW, O’Fallon JR, Dozier JC, Piepgras DG. Intracranial chordomas: A clinicopathological and prognostic study of 51 cases. J Neurosurg 1993;78:741-747.

  27. Rupa V, Rajshekhar V, Bhanu TS, Chandi SM. Primary chondroid chordoma of the base of the petrous temporal bone. J Laryngol Otol 1989;103:771-773.

  28. O’Neill P, Bell BA, Miller JD, Jacobson I, Guthrie Wn Fifty years of experience with chordomas in southeast Scotland. Neurosurgery 1985;16:166-170.

  29. Perzin KH, Pushparaj N. Nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. Cancer 1986;57:784-796.

  30. Weber AL, Liebsch NJ, Sanchez R, Sweriduk ST. Chordomas of the skull base. Radiologic and clinical evaluation. Neuroimag Clin North Am 1994;4:515-527.

  31. Sze G, Uichanco LS, Brant-Zawadzki MN, Davis RL, Gutin PH, Wilson CB, Norman D, Newton TH. Chordomas: MR imaging. Radiology 1988;166:187-191.

  32. Mitchell A, Scheithauer BW, Unni KK, Forsyth PJ, Wold LE, McGivney DJ. Chordomas and chondroid tumors of the spenoocciput: An immunohistochemical study of 41 cases with prognostic and nosologic implications. Cancer 1993;72:2943-2949.

  33. Ishida T, Dorfman HD. Chondroid chordoma versus low-grade chondrosarcoma of the base of the skull: Can immunohistochemistry resolve the controversy? J Neurooncol 1994;18:199-206.




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