The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Login
EN
+7 (495) 482-4118
+7 (495) 482-4329
+8 800 250-18-12
  • (toll-free number for subscriptions)
    Mon-Fri from 10 a.m. to 6 p.m.

  • © 1998-2025
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Chernov I.V.

Burdenko Neurosurgical Center

Shkarubo A.N.

Burdenko Neurosurgical Center

Konyashin D.A.

Burdenko Voronezh State Medical University

Andreev D.N.

Burdenko Neurosurgical Center

Transoral approach in surgery for chordomas extending into craniovertebral junction: a systematic review of the literature

Authors:

Chernov I.V., Shkarubo A.N., Konyashin D.A., Andreev D.N.

More about the authors

Journal: Burdenko's Journal of Neurosurgery. 2024;88(3): 111‑119

DOI: 10.17116/neiro202488031111

Read: 1470 times

Download PDF (RU)
Download PDF
Contact the author
Table of contents

TRANSORAL APPROACH IN SURGERY FOR CHORDOMAS EXTENDING INTO CRANIOVERTEBRAL JUNCTION: A SYSTEMATIC REVIEW OF THE LITERATURE
TRANSORAL APPROACH IN SURGERY FOR CHORDOMAS EXTENDING INTO CRANIOVERTEBRAL JUNCTION: A SYSTEMATIC REVIEW OF THE LITERATURE

To cite this article:

Chernov IV, Shkarubo AN, Konyashin DA, Andreev DN. Transoral approach in surgery for chordomas extending into craniovertebral junction: a systematic review of the literature. Burdenko's Journal of Neurosurgery. 2024;88(3):111‑119. (In Russ., In Engl.)
https://doi.org/10.17116/neiro202488031111

Подписка 2025 Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко (Burdenko's Journal of Neurosurgery)
МСФ на ЯМ
Использование инфографики авторами научных работ
Close metadata
Recommended articles:
Combination of posterior median and transoral approaches in surgical treatment of giant chordoma of the craniovertebral junction. Burdenko's Journal of Neurosurgery. 2025;(6):70-75
Proton therapy of skull base chordoma. P.A. Herzen Journal of Onco­logy. 2025;(5):64-67
Abstract:

To date, treatment of chordomas involves maximal tumor resection followed by proton therapy. Various approaches are used depending on location of tumor (transcranial and through natural anatomical openings (nose, mouth), as well as their combinations). Although transoral approach has been introduced into neurosurgical practice for a long time, it is routinely used in patients with chordoma only in certain hospitals in the world.

OBJECTIVE

To analyze postoperative outcomes in patients with chordomas of skull base and craniovertebral joint after transoral surgery.

MATERIAL AND METHODS

We analyzed literature data devoted to patients with chordomas of skull base and craniovertebral joint after transoral surgery or another approach combined with transoral access. Among 111 primary articles, we selected 38 manuscripts including description of 109 patients with skull base chordoma who underwent transoral surgery or combination of approaches including transoral one.

RESULTS

Gross total resection was achieved in 45.9% (n=50) of cases including 1 patient after en bloc resection. Subtotal resection was carried out in 28.4% of cases, partial — in 24.8%, biopsy — in 0.9% of cases. The complication rate in this group was 30%. The most common events were swelling of the tongue (10%) and diastasis of posterior pharyngeal wall sutures (8.2%) that required redo surgery. CSF leakage and meningitis were rare (1.8% and 3.6%, respectively).

CONCLUSION

Transoral access allows for gross total resection of midline tumors with low incidence of severe complications. Combination of transoral and transcranial approaches is advisable to increase extent of resection.

Keywords:

chordoma
transoral approach

Authors:

Chernov I.V.

Burdenko Neurosurgical Center

Shkarubo A.N.

Burdenko Neurosurgical Center

Konyashin D.A.

Burdenko Voronezh State Medical University

Andreev D.N.

Burdenko Neurosurgical Center

Received:

14.12.2023

Accepted:

22.03.2024

Close metadata

References:

  1. Smoll NR, Gautschi OP, Radovanovic I, Schaller K, Weber DC. Incidence and relative survival of chordomas. Cancer. 2013;119:2029-2037. https://doi.org/10.1002/cncr.28032
  2. Choi D, Crockard HA. Evolution of transoral surgery: three decades of change in patients, pathologies, and indications. Neurosurgery. 2013;73:296-303; discussion 303-304.  https://doi.org/10.1227/01.neu.0000430324.24623.10
  3. Choi D, Melcher R, Harms J, Crockard A. Outcome of 132 Operations in 97 Patients With Chordomas of the Craniocervical Junction and Upper Cervical Spine. Neurosurgery. 2010;66:59-65.  https://doi.org/10.1227/01.NEU.0000362000.35742.3D
  4. Alonso W, Black P, Connor Gh, Uematsu S. Transoral transpalatal approach for resection of clival chordoma. Laryngoscope. 1971;81(10):1626-1631. https://doi.org/10.1288/00005537-197110000-00007
  5. Windle-Taylor PC. Cervical chordoma: Report of a case and the technique of transoral removal. British Journal of Surgery. 2005;64:438-441.  https://doi.org/10.1002/bjs.1800640618
  6. Nagib MG, Wisiol ES, Simonton SC, Levinson RM. Transoral labiomandibular approach to basiocciput chordomas in childhood. Child’s Nervous System. 1990;6:126-130.  https://doi.org/10.1007/BF00308487
  7. Delgado TE, Garrido E, Harwick RD. Labiomandibular, Transoral Approach to Chordomas in the Clivus and Upper Cervical Spine. Neurosurgery. 1981;8:675-679.  https://doi.org/10.1227/00006123-198106000-00007
  8. Arbit E, Patterson RH. Combined transoral and median labiomandibular glossotomy approach to the upper cervical spine. Neurosurgery. 1981;8:672-674.  https://doi.org/10.1227/00006123-198106000-00006
  9. Pásztor E, Vajda J, Piffkó P, Horváth M, Gádor I. Transoral surgery for craniocervical space-occupying processes. Journal of Neurosurgery. 1984;60:276-281.  https://doi.org/10.3171/jns.1984.60.2.0276
  10. Handa J, Suzuki F, Nioka H, Koyama T. Clivus chordoma in childhood. Surgical Neurology. 1987;28:58-62.  https://doi.org/10.1016/0090-3019(87)90207-2
  11. Fink F-M, Ausserer B, Schröcksnadel W, Pallua AK, Frommhold H, Mikuz G. Clivus Chordoma in A 9-Year-Old Child: Case Report and Review of the Literature. Pediatric Hematology and Oncology. 1987;4:91-100.  https://doi.org/10.3109/08880018709141254
  12. Seifert V, Laszig R. Transoral transpalatal removal of a giant premesencephalic clivus chordoma. Acta Neurochirurgica. 1991;112:141-146.  https://doi.org/10.1007/BF01405143
  13. Erbengi A, Tekkok IH, Acikgoz B. Posterior fossa chordomas — with special reference to transoral surgery. Neurosurgical Review. 1991;14:23-28.  https://doi.org/10.1007/BF00338188
  14. Makhmudov UB, Tcherekayev VA, Tanyashin SV. Transoral Approach to Tumors of the Clivus. Journal of Craniofacial Surgery. 1992;3:35-38.  https://doi.org/10.1097/00001665-199207000-00013
  15. Kawai K, Sasaki T, Yanai A, Teraoka A. <I>High Cervical Chordoma</I>. Neurologia Medico-Chirurgica. 1995;35:165-167.  https://doi.org/10.2176/nmc.35.165
  16. Yang S, Gao Y. Clinical results of the transoral operation for lesions of the craniovertebral junction and its abnormalities. Surgical Neurology. 1999;51:16-20.  https://doi.org/10.1016/S0090-3019(97)00501-6
  17. Vougioukas VI, Hubbe U, Schipper J, Spetzger U. Navigated Transoral Approach to the Cranial Base and the Craniocervical Junction: Technical Note. Neurosurgery. 2003;52:247-251.  https://doi.org/10.1097/00006123-200301000-00034
  18. van Lierop AC, Fagan JJ, Taylor KL. Recurrent chordoma of the palate occurring in the surgical pathway: A case report. Auris Nasus Larynx. 2008;35:447-450.  https://doi.org/10.1016/j.anl.2007.09.006
  19. Doorenbosch X, Santoreneos S, Molloy CJ, David DJ, Anderson PJ. Modified transoral approach for resection of skull base chordomas in children. Child’s Nervous System. 2009;25:1481-1483. https://doi.org/10.1007/s00381-009-0955-y
  20. Matsumoto M, Watanabe K, Ishii K, Tsuji T, Takaishi H, Nakamura M, Toyama Y, Chiba K, Imanishi Y, Kishi K, Kawana H. Complicated Surgical Resection of Malignant Tumors in the Upper Cervical Spine After Failed Ion-Beam Radiation Therapy. Spine. 2010;35:E505-509.  https://doi.org/10.1097/BRS.0b013e3181caa86c
  21. Zener R, Jacquet Y, Wong JW, Enepekides D, Higgins KM. A rare case of surgical pathway implantation of clival chordoma presenting as a neck mass. Journal of Surgical Case Reports. 2011;2011:3.  https://doi.org/10.1093/jscr/2011.1.3
  22. Carrau RL, Prevedello DM, de Lara D, Durmus K, Ozer E. Combined transoral robotic surgery and endoscopic endonasal approach for the resection of extensive malignancies of the skull base. Head & Neck. 2013;35:E351-358.  https://doi.org/10.1002/hed.23238
  23. Alberto O-PL, Ernesto C-AE, Nicasio A-M, Luis G-AJ, Martín G-G, Juan B-C. Operative Technique for En Bloc Resection of Upper Cervical Chordomas: Extended Transoral Transmandibular Approach and Multilevel Reconstruction. Asian Spine Journal. 2014;8:820.  https://doi.org/10.4184/asj.2014.8.6.820
  24. Shidoh S, Toda M, Kawase T, Nakajima H, Tomita T, Ogawa K, Yoshida K. Transoral vs. Endoscopic Endonasal Approach for Clival/Upper Cervical Chordoma. Neurologia Medico-Chirurgica. 2014;54:991-998.  https://doi.org/10.2176/nmc.st.2014-0135
  25. Taran S, Yusof AH, Yusof MI. Endoscopic Transoral Resection of an Axial Chordoma: A Case Report. Malays Orthop J. 2015 Nov;9(3):75-77. PMID: 28611918; PMCID: PMC5393143. https://doi.org/10.5704/MOJ.1511.015
  26. Weil A, Shehadeh M, Ayad T, Abboud O, Shedid D. En bloc resection of a C2-C3 upper cervical chordoma: Technical note. Surgical Neurology International. 2015;6:615.  https://doi.org/10.4103/2152-7806.170450
  27. Shkarubo AN, Andreev DN, Konovalov NA, Lubnin AY, Zelenkov PV., Turkin AM, Kadashev BA, Sidorkin DV, Voronina IA, Koval’ KV, Karnaukhov VV. The algorithm for surgical treatment of skull base tumors invading the craniovertebral junction. Burdenko’s Journal of Neurosurgery. 2016;80(2):21-34. (In Russ.). https://doi.org/10.17116/neiro201680221-34
  28. Rutkowski MJ, Birk HS, Wood MD, Perry A, Nicolaides T, Ames CP, Gupta N. Metastatic clival chordoma: a case report of multiple extraneural metastases following resection and proton beam radiotherapy in a 5-year old boy. Journal of Neurosurgery: Pediatrics. 2017;19:531-537.  https://doi.org/10.3171/2017.1.PEDS16549
  29. Abdul Jalil MF, Story RD, Rogers M. Extended maxillotomy for skull base access in contemporary management of chordomas: Rationale and technical aspect. Journal of Clinical Neuroscience. 2017;39:212-215.  https://doi.org/10.1016/j.jocn.2017.01.031
  30. Hara T, Akutsu H, Yamamoto T, Tanaka S, Yasuda M, Takano S, Kino H, Miyamoto H, Matsumura A. Combined Endoscopic Endonasal and Transoral Surgery for a Chordoma in the Whole Clivus With Marked Caudal Extension. Operative Neurosurgery. 2018;14:463-464.  https://doi.org/10.1093/ons/opx168
  31. McCann AC, Berger C, Mahmoud AF, Kuan EC, Malhotra NR, O’Malley BW. Novel approach using transoral robotic surgery for resection of cervical spine chordoma. Laryngoscope. 2019;129:1395-1399. https://doi.org/10.1002/lary.27489
  32. Sayyahmelli S, Dogan I, Wieland AM, Pyle M, Başkaya MK. Aggressive, Multidisciplinary Staged Microsurgical Resection of a Giant Cervicomedullary Junction Chordoma. Journal of Neurological Surgery Part B: Skull Base. 2019;80:S378-379.  https://doi.org/10.1055/s-0039-1695062
  33. Henry LE, Haugen TW, Rassekh CH, Adappa ND, Weinstein GS, O’Malley BW. A novel transpalatal‐transoral robotic surgery approach to clival chordomas extending into the nasopharynx. Head & Neck. 2019; 41(8):133-140.  https://doi.org/10.1002/hed.25747
  34. Moy JD, Gardner PA, Sridharan S, Wang EW. Radial Forearm Free Tissue Transfer to Clival Defect. Journal of Neurological Surgery Part B: Skull Base. 2019;80:S380-381.  https://doi.org/10.1055/s-0039-1700890
  35. Petrov D, Spadola M, Berger C, Glauser G, Mahmoud AF, O’Malley B, Malhotra NR. Novel approach using ultrasonic bone curettage and transoral robotic surgery for en bloc resection of cervical spine chordoma: case report. Journal of Neurosurgery: Spine. 2019;30:788-793.  https://doi.org/10.3171/2018.11.SPINE181162
  36. Zhang Y, Ai F, Fu S, Li K, Xia H, Wu Z, Ma X. An application of posterior cervical and transoral approaches to treating primary malignant osseous tumors in craniovertebral junction. Chinese journal of reparative and reconstructive surgery. 2020;34:1149-1157. https://doi.org/10.7507/1002-1892.202001014
  37. Liu MA, Gendreau JL, Loya JJ, Brown NJ, Keith A, Sahyouni R, Abraham ME, Gonda D, Levy ML. Management of pediatric clival chordoma with extension to the craniocervical junction and occipito-cervical fusion: illustrative case. Journal of Neurosurgery: Case Lessons. 2021; 2(21):CASE21434. https://doi.org/10.3171/CASE21434
  38. D’Ortenzio RM, Tolhurst S, Harvey M, Ghag R, Heran MKS. The CT guided transoral approach: A biopsy technique for a poorly differentiated chordoma in a 5 year old. Journal of Radiology Case Reports. 2021;15:1-8.  https://doi.org/10.3941/jrcr.v15i3.4208
  39. Korwutthikulrangsri E, Ongard S, Pisutbenya J, Ruangchainikom M, Sutipornpalangkul W. Midterm outcome after en bloc resection of C2 chordoma with transoral mandibular split and mesh cage reconstruction: a case report. Journal of Medical Case Reports. 2023;17:229.  https://doi.org/10.1186/s13256-023-03958-2
  40. Morinaga Y, Tsunemi Y, Kurokawa R, Akutsu H. Endoscopic transoral resection for an upper cervical chordoma in a pediatric patient. Acta Neurochirurgica. 2023;165(12):4293-4296. https://doi.org/10.1007/s00701-023-05548-z
  41. Passeri T, Champagne P-O, Giammattei L, Abbritti R, Cartailler J, Calugaru V, Feuvret L, Guichard J-P, Polivka M, Adle-Biassette H, Mammar H, Bresson D, Herman P, Mandonnet E, George B, Froelich S. Management strategies in clival and craniovertebral junction chordomas: a 29-year experience. Journal of Neurosurgery. 2022;138(6):1640-1652. https://doi.org/10.3171/2022.8.JNS221621
  42. Sen C, Shrivastava R, Anwar S, Triana A. Lateral Transcondylar Approach for Tumors at the Anterior Aspect of the Craniovertebral Junction. Neurosurgery. 2010;66:A104-112.  https://doi.org/10.1227/01.NEU.0000365930.95389.60
  43. Almefty K, Pravdenkova S, Colli BO, Al‐Mefty O, Gokden M. Chordoma and chondrosarcoma: Similar, but quite different, skull base tumors. Cancer. 2007;110:2467-2477. https://doi.org/10.1002/cncr.23073
  44. Colli BO, Al-Mefty O. Chordomas of the skull base: follow-up review and prognostic factors. Neurosurgical Focus. 2001;10:1-11.  https://doi.org/10.3171/foc.2001.10.3.2
  45. Champagne P-O, Zenonos GA, Wang EW, Snyderman CH, Gardner PA. The rhinopharyngeal flap for reconstruction of lower clival and craniovertebral junction defects. Journal of Neurosurgery. 2021;135(5):1319-1327. https://doi.org/10.3171/2020.8.JNS202193
  46. Choi D, Melcher R, Harms J, Crockard A. Outcome of 132 Operations in 97 Patients With Chordomas of the Craniocervical Junction and Upper Cervical Spine. Neurosurgery. 2010;66:59-65.  https://doi.org/10.1227/01.NEU.0000362000.35742.3D
  47. McLoughlin GS, Sciubba DM, Suk I, Bydon A, Witham T, Wolinsky J-P, Gokaslan ZL. Resection of a Retropharyngeal Craniovertebral Junction Chordoma Through a Posterior Cervical Approach. Journal of Spinal Disorders and Techniques. 2010;23:359-365.  https://doi.org/10.1097/BSD.0b013e3181aaca99
  48. Menezes AH, VanGilder JC. Transoral-transpharyngeal approach to the anterior craniocervical junction. Journal of Neurosurgery. 1988;69:895-903.  https://doi.org/10.3171/jns.1988.69.6.0895
Contact the author
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Contact us
If you have any questions, complaints or suggestions, please use this feedback form.
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.
Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
Registration
E-mail
Password
Forgot Password?

Log in to the site using your account in one of the services

Password recovery
E-mail
Login
Register

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.