{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:11:38Z","timestamp":1792541498894,"version":"4.5.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>In the past decade, the role of the endoscopic endonasal approach (EEA) has relevantly evolved for skull base tumors. In this study, the authors review their surgical experience with using an EEA in the treatment of clival chordomas, which are deep and infiltrative skull base lesions, and they highlight the advantages and limitations of this ventral approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>All consecutive cases of chordoma treated with an EEA between 1998 and 2015 at a single institution are included in this study. Preoperative assessment consisted of neuroimaging (MRI and CT with angiography sequences) and endocrinological, neurological, and ophthalmological evaluations, which were repeated 3 months after surgery and annually thereafter. Postoperative adjuvant therapies were considered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Sixty-five patients (male\/female ratio 1:0.9) were included in this study. The median age was 48 years (range 9\u201380 years). Gross-total resection (GTR) was achieved in 47 cases (58.7%). On univariate analysis, primary procedures (p = 0.001), location in the superior or middle third of the clivus (p = 0.043), extradural location (p = 0.035), and histology of conventional chordomas (p = 0.013) were associated with a higher rate of GTR. The complication rate was 15.1%, and there were no perioperative deaths. Most complications did not result in permanent sequelae and included 2 CSF leaks (2.5%), 5 transient cranial nerve VI palsies (6.2%), and 2 internal carotid artery injuries (2.5%), which were treated with coil occlusion of the internal carotid artery without neurological deficits. Three patients (3.8%) presented with complications resulting in permanent neurological deficits due to a postoperative hematoma (1.2%) causing a hemiparesis, and 2 permanent ophthalmoplegias (2.5%). Seventeen patients (26.2%) have died of tumor progression over the course of follow-up (median 52 months, range 7\u2013159 months). Based on Kaplan-Meier analysis, the survival rate was 77% at 5 years and 57% at 10 years. On multivariate analysis, the extent of tumor removal (p = 0.001) and the absence of previous treatments (p = 0.001) proved to be correlated with a longer survival rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The EEA was associated with a high rate of tumor removal and symptom control, with low morbidity and preservation of a good quality of life. These results allow for a satisfactory overall survival rate, particularly after GTR and for primary surgery. Considering these results, the authors believe that an EEA can be a helpful tool in chordoma surgery, achieving a good balance between as much tumor removal as possible and the preservation of an acceptable patient quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2016.11.jns162082","type":"journal-article","created":{"date-parts":[[2017,4,14]],"date-time":"2017-04-14T11:15:04Z","timestamp":1492168504000},"page":"329-338","source":"Crossref","is-referenced-by-count":86,"title":["Clival chordomas: considerations after 16 years of endoscopic endonasal surgery"],"prefix":"10.3171","volume":"128","author":[{"given":"Matteo","family":"Zoli","sequence":"first","affiliation":[{"name":"Center of Pituitary and Endoscopic Skull Base Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Milanese","sequence":"additional","affiliation":[{"name":"Center of Pituitary and Endoscopic Skull Base Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco","family":"Bonfatti","sequence":"additional","affiliation":[{"name":"Center of Pituitary and Endoscopic Skull Base Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Faustini-Fustini","sequence":"additional","affiliation":[{"name":"Center of Pituitary and Endoscopic Skull Base Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Marucci","sequence":"additional","affiliation":[{"name":"Anatomic Pathology, Bellaria Hospital, University of Bologna;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Tallini","sequence":"additional","affiliation":[{"name":"Department of Medicine (DIMES), Anatomic Pathology-Molecular Diagnostic Unit, AUSL of Bologna, University of Bologna School of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Zenesini","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics Service, IRCCS Istituto delle Scienze Neurologiche di Bologna; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo","family":"Sturiale","sequence":"additional","affiliation":[{"name":"Center of Pituitary and Endoscopic Skull Base Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Frank","sequence":"additional","affiliation":[{"name":"Center of Pituitary and Endoscopic Skull Base Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Pasquini","sequence":"additional","affiliation":[{"name":"ENT Department, Ospedale Bellaria, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Mazzatenta","sequence":"additional","affiliation":[{"name":"Center of Pituitary and Endoscopic Skull Base Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns162082","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"182","DOI":"10.3171\/jns.1997.86.2.0182","article-title":"Skull base chordomas: a management challenge","volume":"86","author":"Al-Mefty O,","year":"1997","unstructured":"Al-Mefty O, Borba LA: Skull base chordomas: a management challenge. 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