ĐẶC ĐIỂM LÂM SÀNG, HÌNH ẢNH HỌC VÀ KẾT QUẢ PHẪU THUẬT NỘI SOI QUA MŨI U DÂY SỐNG VÙNG XƯƠNG BẢN VUÔNG

Abstract

Objective: To evaluate the surgical results of an endoscopic endonasal approach for clival chordomas. Methods: Retrospective and case series, of 31 patients were performed via the endoscopic transnasal approach for treating clival chordomas at the Neurosurgery Department of Cho Ray Hospital from 06/2018 to 06/2024.  Results: The mean age of the 14 male and 17 female patients was 42.8 years (ranging from 23 to 69 years). Clinical features consisted of headache (83.9%), cranial nerve VI palsy (29%), visual acuity decrease (80.6%), bitemporal hemianopsia (38.7%), and cranial nerve III palsy (9.7%). 100% of patients obtained brain MRI, indicating tumors located at the upper-middle clivus (61.3%), upper-third (6.5%), middle-third (3.2%), and completely invaded clivus (22.6%). The mean maximum diameter of tumors was 43.2 mm (17.6 to 67 mm). 38.7% of tumors invade cavernous sinus and 58.1% spread to subdural space. All of the cases were performed via endoscopic transnasal approaches. Gross total removal was achieved in 58% of cases, subtotal removal (29%), and partial removal (12.9%). No mortality occurred, 1 patient (3.2%) had postoperative meningitis, CSF leak occurred in 2 patient (6.4%), and a vision deficit was recorded (3.2%). The mean follow-up period was 19.45 months (ranged 1 to 69 months). The recent postoperative mean KPS score was 88.7 (ranged 80 to 90). The long-term results: 51.6% of patients were cured, 35.5% were under control, and the recurrence rate was 12.9%. Conclusions: The endoscopic transnasal approach is safe and efficient for treating clival chordomas.