{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T15:35:57Z","timestamp":1791041757225,"version":"4.1.0"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Iatrogenic tumor seeding after open surgery for chordoma has been well described in the literature. The incidence and particularities related to endoscopic endonasal surgery (EES) have not been defined.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors retrospectively reviewed their experience with EES for clival chordoma, focusing on cases with iatrogenic seeding. The clinical, radiographic, pathological, and molecular characterization data were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Among 173 EESs performed for clival chordomas at the authors\u2019 institution between April 2003 and May 2016, 2 cases complicated by iatrogenic seeding (incidence 1.15%) were identified. The first case was a 10-year-old boy, who presented 21 months after an EES for a multiply recurrent clival chordoma with a recurrence along the left inferior turbinate, distinct from a right petrous apex recurrence. Both appeared as a T2-hypertintense, T1-isointense, and heterogeneously enhancing lesion on MRI. Resection of the inferior turbinate recurrence and debulking of the petrous recurrence were both performed via a purely endoscopic endonasal approach. Unfortunately, the child died 2 years later due progression of disease at the primary site, but with no sign of progression at the seeded site. The second patient was a 79-year-old man with an MRI-incompatible pacemaker who presented 19 months after EES for his clival chordoma with a mass involving the floor of the left nasal cavity that was causing an oro-antral fistula. On CT imaging, this appeared as a homogeneously contrast-enhancing mass eroding the hard palate inferiorly, the nasal septum superiorly, and the nasal process of the maxilla, with extension into the subcutaneous tissue. This was also treated endoscopically (combined transnasal-transoral approach) with resection of the mass, and repair of the fistula by using a palatal and left lateral wall rotational flap. Adjuvant hypofractionated stereotactic CyberKnife radiotherapy was administered using 35 Gy in 5 fractions. No recurrence was appreciated endoscopically or on imaging at the patient\u2019s last follow-up, 12 months after this last procedure. In both cases, pathological investigation of the original tumors revealed a fairly aggressive biology with 1p36 deletions, and high Ki-67 levels (10%\u201315%, and &gt; 20%, respectively). The procedures were performed by a team of right-handed surgeons (otolaryngology and neurosurgery), using a 4-handed technique (in which the endoscope and suction are typically passed through the right nostril, and other instruments are passed through the left nostril without visualization).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Although uncommon, iatrogenic seeding occurs during EES for clival chordomas, probably because of decreased visualization during tumor removal combined with mucosal trauma and exposure of subepithelial elements (either inadvertently or because of mucosal flaps). In addition, tumors with more aggressive biology (1p36 deletions, elevated Ki-67, or both) are probably at a higher risk and require increased vigilance on surveillance imaging and endoscopy. Further prospective studies are warranted to evaluate the authors\u2019 proposed strategies for decreasing the incidence of iatrogenic seeding after EES for chordomas.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.6.jns17111","type":"journal-article","created":{"date-parts":[[2017,12,22]],"date-time":"2017-12-22T15:01:37Z","timestamp":1513954897000},"page":"947-953","source":"Crossref","is-referenced-by-count":22,"title":["Iatrogenic seeding of skull base chordoma following endoscopic endonasal surgery"],"prefix":"10.3171","volume":"129","author":[{"given":"David T.","family":"Fernandes Cabral","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios A.","family":"Zenonos","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C.","family":"Fernandez-Miranda","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric W.","family":"Wang","sequence":"additional","affiliation":[{"name":"Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Gardner","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Cellular and Molecular Immunology","author":"Abbas AK","year":"2014","unstructured":"Abbas AK, Lichtman AH, Pillai S: Cellular and Molecular Immunology. Philadelphia: Elsevier, 2014"},{"key":"b2","series-title":"Biol Direct","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/1745-6150-7-31","article-title":"Evasion of tumours from the control of the immune system: consequences of brief encounters","volume":"7","author":"Al-Tameemi M","year":"2012","unstructured":"Al-Tameemi M, Chaplain M, d\u2019Onofrio A: Evasion of tumours from the control of the immune system: consequences of brief encounters. Biol Direct 7:31, 201210.1186\/1745-6150-7-3123009638"},{"key":"b3","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"798","DOI":"10.3171\/jns.2001.95.5.0798","article-title":"Surgical seeding of chordomas","volume":"95","author":"Arnautovi\u0107 KI","year":"2001","unstructured":"Arnautovi\u0107 KI, Al-Mefty O: Surgical seeding of chordomas. J Neurosurg 95:798\u2013803, 20011170287010.3171\/jns.2001.95.5.0798"},{"key":"b4","series-title":"AJNR Am J Neuroradiol","first-page":"406","article-title":"Frontal lobe implantation of craniopharyngioma by repeated needle aspirations","volume":"9","author":"Barloon TJ","year":"1988","unstructured":"Barloon TJ, Yuh WT, Sato Y, Sickels WJ: Frontal lobe implantation of craniopharyngioma by repeated needle aspirations. AJNR Am J Neuroradiol 9:406\u2013407, 19883128093"},{"key":"b5","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1007\/s10143-013-0503-9","article-title":"Endoscopic endonasal approach in the management of skull base chordomas\u2014clinical experience on a large series, technique, outcome, and pitfalls","volume":"37","author":"Chibbaro S","year":"2014","unstructured":"Chibbaro S, Cornelius JF, Froelich S, Tigan L, Kehrli P, Debry C, : Endoscopic endonasal approach in the management of skull base chordomas\u2014clinical experience on a large series, technique, outcome, and pitfalls. Neurosurg Rev 37:217\u2013225, 20142424943010.1007\/s10143-013-0503-9"},{"key":"b6","series-title":"South Med J","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1097\/00007611-199504000-00023","article-title":"Iatrogenic transplantation of osteosarcoma","volume":"88","author":"Cole GW Jr","year":"1995","unstructured":"Cole GW Jr, Sindelar WF: Iatrogenic transplantation of osteosarcoma. South Med J 88:485\u2013488, 1995771660810.1097\/00007611-199504000-00023"},{"key":"b7","series-title":"Clin Otolaryngol Allied Sci","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1111\/j.1365-2273.1996.tb01742.x","article-title":"Exfoliated malignant cells in glove and instrument washings following head and neck surgery","volume":"21","author":"Curran AJ","year":"1996","unstructured":"Curran AJ, Smyth D, Kane B, Toner M, Timon CI: Exfoliated malignant cells in glove and instrument washings following head and neck surgery. Clin Otolaryngol Allied Sci 21:281\u2013283, 1996881850410.1111\/j.1365-2273.1996.tb01742.x"},{"key":"b8","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1227\/NEU.0b013e3182446783","article-title":"Current surgical outcomes for cranial base chordomas: cohort study of 95 patients","volume":"70","author":"Di Maio S","year":"2012","unstructured":"Di Maio S, Rostomily R, Sekhar LN: Current surgical outcomes for cranial base chordomas: cohort study of 95 patients. Neurosurgery 70:1355\u20131360, 20122215754510.1227\/NEU.0b013e3182446783"},{"key":"b9","series-title":"AJNR Am J Neuroradiol","first-page":"578","article-title":"Recurrence of clival chordoma along the surgical pathway","volume":"21","author":"Fischbein NJ","year":"2000","unstructured":"Fischbein NJ, Kaplan MJ, Holliday RA, Dillon WP: Recurrence of clival chordoma along the surgical pathway. AJNR Am J Neuroradiol 21:578\u2013583, 200010730655"},{"key":"b10","series-title":"Am J Otolaryngol","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1016\/j.amjoto.2013.12.018","article-title":"Clival chordoma of the nasal septum secondary to surgical pathway seeding","volume":"35","author":"Hines JP","year":"2014","unstructured":"Hines JP, Ashmead MG, Stringer SP: Clival chordoma of the nasal septum secondary to surgical pathway seeding. Am J Otolaryngol 35:431\u2013434, 20142448051210.1016\/j.amjoto.2013.12.018"},{"key":"b11","series-title":"J Neurol Surg Rep","doi-asserted-by":"publisher","first-page":"e246","DOI":"10.1055\/s-0034-1387184","article-title":"Surgical pathway seeding of clivo-cervical chordomas","volume":"75","author":"Iloreta AM","year":"2014","unstructured":"Iloreta AM, Nyquist GG, Friedel M, Farrell C, Rosen MR, Evans JJ: Surgical pathway seeding of clivo-cervical chordomas. J Neurol Surg Rep 75:e246\u2013e250, 201410.1055\/s-0034-138718425485223"},{"key":"b12","series-title":"Kuby Immunology","author":"Kindt TJ","year":"2007","unstructured":"Kindt TJ, Goldsby RA, Osborne BA: Kuby Immunology. New York: W. H. Freeman, 2007"},{"key":"b13","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1227\/NEU.0b013e31825ea3e0","article-title":"Endoscopic endonasal approach for resection of cranial base chordomas: outcomes and learning curve","volume":"71","author":"Koutourousiou M","year":"2012","unstructured":"Koutourousiou M, Gardner PA, Tormenti MJ, Henry SL, Stefko ST, Kassam AB, : Endoscopic endonasal approach for resection of cranial base chordomas: outcomes and learning curve. Neurosurgery 71:614\u2013625, 20122259232810.1227\/NEU.0b013e31825ea3e0"},{"key":"b14","series-title":"World J Surg","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1007\/s002689900613","article-title":"Tumor seeding following laparoscopy: international survey","volume":"23","author":"Paolucci V","year":"1999","unstructured":"Paolucci V, Schaeff B, Schneider M, Gutt C: Tumor seeding following laparoscopy: international survey. World J Surg 23:989\u2013997, 199910.1007\/s00268990061310512937"},{"key":"b15","series-title":"Ann Pathol","first-page":"479","article-title":"[Embryology and pathology of the human notochord.]","volume":"21","author":"Salisbury JR","year":"2001","unstructured":"Salisbury JR: [Embryology and pathology of the human notochord.] Ann Pathol 21:479\u2013488, 2001 (Fr)11910935"},{"key":"b16","series-title":"J Pathol","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1002\/path.1711710404","article-title":"The pathology of the human notochord","volume":"171","author":"Salisbury JR","year":"1993","unstructured":"Salisbury JR: The pathology of the human notochord. J Pathol 171:253\u2013255, 199310.1002\/path.17117104048158454"},{"key":"b17","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.3171\/2009.9.JNS08596","article-title":"Clival chordomas: clinical management, results, and complications in 71 patients","volume":"113","author":"Sen C","year":"2010","unstructured":"Sen C, Triana AI, Berglind N, Godbold J, Shrivastava RK: Clival chordomas: clinical management, results, and complications in 71 patients. J Neurosurg 113:1059\u20131071, 20101992919810.3171\/2009.9.JNS08596"},{"key":"b18","series-title":"J Biomed Biotechnol","first-page":"2011","article-title":"Tumor evasion from T cell surveillance","volume":"918471","author":"T\u00f6pfer K","year":"2011","unstructured":"T\u00f6pfer K, Kempe S, M\u00fcller N, Schmitz M, Bachmann M, Cartellieri M, : Tumor evasion from T cell surveillance. J Biomed Biotechnol 2011:918471, 2011"},{"key":"b19","series-title":"Lancet Oncol","doi-asserted-by":"publisher","first-page":"e69","DOI":"10.1016\/S1470-2045(11)70337-0","article-title":"Chordoma: current concepts, management, and future directions","volume":"13","author":"Walcott BP","year":"2012","unstructured":"Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ: Chordoma: current concepts, management, and future directions. Lancet Oncol 13:e69\u2013e76, 201210.1016\/S1470-2045(11)70337-022300861"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/129\/4\/article-p947.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/129\/4\/article-p947.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/129\/4\/article-p947.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T03:14:13Z","timestamp":1743390853000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/129\/4\/article-p947.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10]]},"references-count":19,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2017.6.jns17111","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10]]}}}