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Surgical Management of Skull Base and Spine Chordomas

  • Sarcoma (SH Okuno, Section Editor)
  • Published:
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Opinion Statement

Management of chordoma along the cranial-spinal axis is a major challenge for both skull base and spinal surgeons. Although chordoma remains a rare tumor, occurring in approximately 1 per 1 million individuals, its treatment poses several challenges. These tumors are generally poorly responsive to radiation and chemotherapy, leading to surgical resection as the mainstay of treatment. Due to anatomic constraints and unique challenges associated with each primary site of disease, gross total resection is often not feasible and is associated with high rates of morbidity. Additionally, chordoma is associated with high rates of recurrence due to the tumor’s aggressive biologic features, and postoperative radiation is increasingly incorporated as a treatment option for these patients. Despite these challenges, modern-day surgical techniques in both skull base and spinal surgery have facilitated improved patient outcomes. For example, endoscopic endonasal techniques have become the mainstay in resection of skull base chordomas, improving the ability to achieve gross total resection, while reducing associated morbidity of open transfacial techniques. Resection of spinal chordomas has been facilitated by emerging techniques in preoperative imaging, intraoperative navigation, spinal reconstruction, and radiotherapy. Taken collectively, the treatment of chordoma affecting the skull base and spinal requires a multidisciplinary team of surgeons, radiation oncologists, and medical oncologists who specialize in the treatment of this challenging disease.

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  1. The authors Joel Z. Passer, MD, and Christopher Alvarez-Breckenridge, MD, PhD, contributed equally.

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  1. Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 442, Houston, TX, 77030-4009, USA

    Joel Z. Passer MD, Christopher Alvarez-Breckenridge MD, PhD, Laurence Rhines MD, Franco DeMonte MD, Claudio Tatsui MD & Shaan M. Raza MD

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Correspondence to Shaan M. Raza MD.

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Joel Z. Passer declares that there is no conflict of interest. Christopher Alvarez-Breckenridge declares that there is no conflict of interest. Laurence Rhines declares that there is no conflict of interest. Franco DeMonte declares that there is no conflict of interest. Claudio Tatsui declares that there is no conflict of interest. Shaan M. Raza declares that there is no conflict of interest.

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Passer, J.Z., Alvarez-Breckenridge, C., Rhines, L. et al. Surgical Management of Skull Base and Spine Chordomas. Curr. Treat. Options in Oncol. 22, 40 (2021). https://doi.org/10.1007/s11864-021-00838-z

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