Article

A multidisciplinary team approach to skull base chordomas.

Department of Surgical Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Journal of Neurosurgery (impact factor: 2.96). 09/2001; 95(2):175-83. DOI:10.3171/jns.2001.95.2.0175 pp.175-83
Source: PubMed

ABSTRACT A multidisciplinary team devised a protocol for long-term care of patients with skull base chordomas. In this study they describe their approach.
Forty-two patients presented between 1986 and 1998 and were treated by maximum surgical cytoreduction and photon radiation therapy. Tumor volume-doubling time determined on the basis of magnetic resonance imaging, immunostaining, and cell proliferation (Ki67 labeling index [LI]) studies indicated growth rates of individual chordomas. The best outlook was associated with the greatest extent of tumor removal achieved during the first operation. There were no deaths associated with patients who underwent first-time surgery, but there was a 7.1% mortality rate associated with those who underwent subsequent operations. Cerebrospinal fluid leaks, additional cranial nerve palsies, and pharyngeal wound problems were the most difficult management problems encountered after second and subsequent surgeries. The time interval between operations was usually between 2 years and 3 years after the first surgery; very few patients required a second surgery, with a quiescent period in excess of 5 years. Life-table 5- and 10-year survival rates were 77% and 69%, respectively.
The authors believe that this series of skull base chordomas provides new insights into the management of these lesions, particularly with regard to techniques that increase survival times and studies that aid in formulating prognoses.

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Keywords

10-year survival rates
 
7.1% mortality rate
 
cell proliferation
 
Cerebrospinal fluid leaks
 
difficult management problems
 
first surgery
 
first-time surgery
 
greatest extent
 
growth rates
 
increase survival times
 
Ki67 labeling index [LI]
 
Life-table 5-
 
magnetic resonance imaging
 
pharyngeal wound problems
 
photon radiation therapy
 
second surgery
 
skull base chordomas
 
subsequent operations
 
subsequent surgeries
 
time interval