Long-Term Outcome after Aggressive Surgical Resection of Clival Chordomas and Gamma Knife Radiosurgery for Recurrences

• Main Authors: Saito, Kiyoshi, Nagatani, Tetsuya, Aimi, Yuri, Ichikawa, Masahiro, Yoshida, Jun
• Format: Conference Proceeding
• Language: English
• ISSN: 1531-5010; 1532-0065
• DOI: 10.1055/s-2007-983997

Purpose: Treatment of patients with clival chordomas is still a challenge for neurosurgeons. We present our long-term results after aggressive surgical resection and gamma knife radiosurgery for recurrence. Methods: During 13 years, we operated on 18 patients (7 to 75 years old, 10 males and 8 females) with clival chordomas. One patient was referred to us with recurrent tumor. All tumors with surrounding bone were aggressively removed using various approaches according to their extensions: trans-sphenoidal approach for 5 localized tumors, anterior craniofacial approach for 7 tumors with mainly anterior extension, petrosal approach for 2 tumors with mainly posterior extension, orbitozygomatic approach for 2 tumors with mainly lateral extension, and 3-staged (right and left transcondylar and transfacial) approaches for 2 tumors with inferior extension. Three patients in our early series underwent conventional radiotherapy after surgical resection. Postoperative follow-up ranged from 12 to 137 months (mean, 71 mos). Result: During follow-up periods, 11 patients showed recurrence (twice in 1, three times in 2, and four times in 1). All recurrent tumors were localized. Four tumors were totally resected and 15 tumors were treated with gamma knife radiosurgery. All tumors were controlled during follow-up (1 to 97 mos; mean, 37 mos) after gamma knife radiosurgery. All patients led active lives with scores on the Karnofsky scale of 70 to 100. Conclusion: Even after aggressive resection of clival chordomas, it is difficult to prevent recurrence. Recurrent tumors, however, were small and localized after aggressive resection. Our results suggest that small and localized tumors could be controlled by gamma knife radiosurgery with enough marginal doses (usually 20 Gy). No death during mean follow-up of 71 months is better than reported results in the literature. Initial aggressive resection with gamma knife radiosurgery for recurrence is an effective treatment for clival chordomas.