Surgical Management of Skull Base Chordomas: Single-Center Results in the Last 10 Years
Bibliographic record
Abstract
Introduction: Skull base chordomas are aggressive tumors arising from the clivus that pose a significant surgical challenge due to their location, invasiveness, and relationship with surrounding neurovascular structures. Endoscopic endonasal approaches (EEA) have been successfully applied as a strategy to manage those tumors in the last decade. In the current abstract, we report the results of our center in the surgical management of clivus chordomas in the past 10 years. Methods: The authors conducted a retrospective analysis of all skull base chordomas operated on our institution from January 2007 to December 2017. Clinical and radiological characteristics of patients and tumors were extracted. The primary outcome was defined as recurrence-free survival. Secondary outcome included extent of resection, adjuvant therapy, and complications and impact of the Sekhar’s Grading System for Cranial Chordomas on the outcome of patients. Patients with less than 12 months of follow-up (FU) were excluded from the analysis. Results: A total of 37 patients matched the inclusion criteria. Mean age of patients was 52.03 (± 15.1); range: 19–79 years old. 10 patients (27%) had had previous surgery and radiotherapy. Tumors were located at upper clivus: 23 (62.1%), middle clivus: 22 (59.4%), and lower clivus in 14 (37.8%) cases. Tumor extension into the cavernous sinus, vascular encasement, and dura invasion were observed in 40.5, 43.2, and 43.2%, respectively. The mean Sekhar Grading System score was 8.1 ± 4.3. Most cases underwent EEA for tumor resection ( n = 33, 89.2%). Gross total and partial resection were achieved in 8 cases (21.6%) and 29 cases (78.4%), followed by adjuvant IMRT in 32 cases (86.4%). Most common complications were postoperative CSF leak and meningitis (5.4 and 8.1%). Recurrences were observed in 18 cases (48.6%), mean follow-up of 46.5 ± 36.4 months. Progression-free survival was 66 months (95% CI: 21.7–110.2) in the entire cohort. Improved PFS was associated with lower Sekhar scores ( p = 0.01), first-time surgery (no prior treatment) ( p = 0.006), adjuvant radiation ( p = 0.01), and gross total resection ( p = 0.04). Conclusion: Our results demonstrate the important role of EEA for the management of chordomas. The invasiveness of chordoma, however, impacts its extent of resection. A low rate of complications has been achieved in our series, but gross total resection was observed in only one out of five patients. Factors such as Shekhar’s grading score, adjuvant radiation, and extent of resection impacted PFS of skull base chordoma.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".