Predicting the Need for Occipitocervical Fusion for Patients with Lower Clival Chordoma: A Single-Center Retrospective Study.

Autor: Hong S; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA., Shinya Y; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA., Lakomkin N; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA., Mahajan A; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA., Laack NN; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA., O'Brien E; Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA., Stokken JK; Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA., Janus JR; Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA., Pinheiro Neto C; Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA., Choby GW; Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Peris Celda M; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA., Link MJ; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA., Elder BD; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA., Van Gompel JJ; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: vangompel.jamie@mayo.edu.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Jul; Vol. 187, pp. e321-e330. Date of Electronic Publication: 2024 Apr 20.
DOI: 10.1016/j.wneu.2024.04.081
Abstrakt: Objective: To assess the impact of tumor extension into the occipital condyle (OC) in lower clival chordoma management and the need for occipito-cervical fusion (OCF).
Methods: A retrospective analysis was conducted on 35 patients with lower clival chordoma. The preoperative area of the intact OCs, Hounsfield units, and the integrity of the apical ligament and the tectorial membrane were assessed using preoperative imaging.
Results: Seven (20%) patients were in the OCF group. The OCF group exhibited a higher prevalence of preoperative pain in the neck or head (P = 0.006), ligament absence (P = 0.022), and increased propensity for postoperative wound issues (P = 0.022) than the non-OCF group. The OCF group had less intact OCs (P < 0.001) and higher spinal instability neoplastic score (P = 0.002) than the non-OCF group. All patients with intact OCs < 60% underwent OCF, and those with OCs ≥ 70% were treated without OCF. Those with OCs between 60% and 69% underwent OCF if the ligaments were eroded, and did not undergo OCF if the ligaments were intact. Treatment strategies varied, with endoscopic endonasal approach alone being common. Radiation therapy was administered to 89% of patients. All 3 patients treated with OCF after tumor resection had wound issues; none treated with OCF before resection had wound issues. None developed atlanto-occipital instability. Survival rates did not significantly differ between groups.
Conclusions: In the absence of mobility-related neck pain, patients with lower clival chordoma and intact OC ≥ 60%, intact apical ligament, and intact tectorial membrane, may not require OCF.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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