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Surgical Management of Chordomas and Chondrosarcomas of the Lumbar Spine

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Chordomas and chondrosarcomas are both primary malignant (locally aggressive) bone tumors. Chordomas are considered the most common primary malignant bone tumor of the spine and sacrum, with an incidence of 0.08 per 100,000 persons. These lesions arise from notochordal remnants and…

Surgical Management of the Chordomas and Chondrosarcomas of the Thoracic Spine

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Chordomas and chondrosarcomas of the spine are malignant primary bone tumors that share several key features. Unlike other malignant primary bone tumors such as Ewing sarcoma or osteosarcoma, their behavior is more indolent. Additionally, aggressive surgical resection can facilitate long intervals…

Surgical Management of Chordomas and Chondrosarcomas of the Cervical Spine

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Chordomas are rare primary bony tumors that arise from embryonic remnants of the notochord. They are low-grade malignant tumors that make up 1%–4% of all primary malignant bone tumors and can occur throughout the spinal column from the clivus to coccyx,…

Chordomas and Chondrosarcomas of the Spine: Preoperative Planning, Surgical Strategies, and Complications Avoidance

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Primary bone tumors of the spine are rare with an estimated incidence of 2.5–8.5 cases per 100,000 people per year. Primary vertebral tumors account for fewer than 5% of spinal tumors. The clinical behavior of these lesions depends mainly on the…

Stabilization of the Craniocervical Junction Following Resection of Chordomas and Chondrosarcomas of the Skull Base and Spine

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Tumors involving the skull base demonstrate diverse histology and distinct clinical implications, including chordomas and chondrosarcomas. Advances in operative techniques enable resection of these tumors. The underlying pathology and tumor growth, as well as the extent of bony resection during surgery,…

Skull Base Reconstruction Following Resection of Skull Base Chordomas and Chondrosarcomas

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Over the past decades, the indications for endoscopic endonasal surgery expanded to include benign and malignant skull base lesions. Many surgical approaches have been described to resect petroclival chordomas and chondrosarcomas; however, expanded endoscopic endonasal approaches (EEA) are the least invasive,…

Cerebral Revascularization for Skull Base Tumors

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Chordomas and chondrosarcomas are malignant tumors whose gross total resection significantly increases the overall survival. They are locally invasive; as they breach normal anatomic planes, chordomas and chondrosarcomas may encroach upon or encase major cerebral blood vessels. Cerebral revascularization becomes necessary when…

Staged Approaches for Large Skull Base Chordomas and Chondrosarcomas

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Chordomas and chondrosarcomas are rare skull base tumors, with an incidence of less than 0.03 per 100,000 persons. Although they have similar sites of origin, histologies (definitely distinguished only by immunohistochemical stain ), clinical presentations, and radiological features, they differ in…

The Extreme Lateral Approach for Chordomas and Chondrosarcomas of the Craniovertebral Junction

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction The craniovertebral junction, a complex anatomical region, is the site of a variety of tumors that require surgical resection. These tumors range from benign to malignant and may be intradural, extradural, or both. George et al. found 28 chordomas and 19 other…

Chordomas and Chondrosarcomas of the Skull Base: Retrosigmoid Approaches

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction The retrosigmoid approach (RSA) provides a wide exposure of the cerebellopontine angle (CPA) cistern. Meckel’s cave, parasellar region, and upper clivus can be exposed via its superior extension, also called retrosigmoid intradural suprameatal approach (RISA). In addition, by dividing the tentorium,…

Chordomas and Chondrosarcomas of the Skull Base: Transpetrosal Approaches

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Indications and Preoperative Planning Chordomas and chondrosarcomas, while distinct entities, are both slowly growing and locally aggressive bony neoplasms that can develop in similar regions including the skull base. Treatment for both tumor types can involve surgical resection with postoperative adjuvant radiation.…

Subtemporal–Preauricular Approach to the Infratemporal Fossa

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Chordomas and chondrosarcomas of the skull base are pathologically and genetically distinct neoplasms that are often grouped together because of their similar radiologic, anatomical, and surgical features. Although rare tumors, compromising only about 0.15% of all intracranial tumors, they are, nonetheless, important…

Lateral Approaches

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Lateral approaches to the central skull base traverse the floor of the middle cranial fossa en route to tumors of the anteromedial half of the petrous bone, petroclival region, superior half of the clivus, and upper medial aspect of the cerebellopontine angle.…

Chordomas and Chondrosarcomas of the Skull Base: Anterolateral Approaches

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Skull base chordomas and chondrosarcomas are rare primary bone tumors of the petroclival region that have similar clinical and radiological findings but differ in their treatment response rates and overall outcomes. Skull base chordomas are thought to arise from malignant transformation…

The Endoscopic Endonasal Approach to Chordomas and Chondrosarcomas

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Skull base neoplasms are known to be difficult to access and often impossible to cure; their removal often requires extensive and/or complex approaches through a myriad of neurovascular structures. Chordomas and chondrosarcomas epitomize this challenge, as they arise in the heart…

Midline Subfrontal Approaches: The Transbasal Approach and Extended Modifications to Access the Clivus

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction After Frazier’s description of bifrontal craniotomy in 1913, Tessier and Derome developed the transbasal approach to the anterior skull base. Numerous modifications of the transbasal approach add varying degrees of bone removal from the supraorbital bar, orbital roof and wall, lateral…

Skull Base Tumors: Surgical Considerations

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction Control of local disease is the critical determinant of the ultimate treatment outcome in most cases of chordomas and chondrosarcomas. Surgical resection, with the aim of complete tumor removal, is considered the mainstay treatment modality. Surgery can provide definitive pathologic diagnosis,…

Surgical Anatomy of the Skull Base

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Introduction This chapter will review the anatomy of the base of the skull as it pertains to approaches used for the treatment of chordomas and chondrosarcomas of this region. Since chordomas and chondrosarcomas usually arise within the clivus and the petroclival synchondrosis,…

Imaging Chordoma and Chondrosarcoma of the Vertebrae and Sacrum

© 2018 Elsevier Inc. All rights reserved. Please note that the copyright for the original figures submitted by the contributors is owned by Contributors. Chordomas and chondrosarcomas are uncommon primary bone tumors that may arise in the spine. Computed tomography (CT) and magnetic resonance (MR) are the preferred noninvasive tools used to diagnose these lesions and to distinguish them from other spinal masses. Imaging defines the…