Surgical resection of upper-middle clivus chordomas via a modified anterior transpetrous approach

- The modified APTA approach could be choosed for the upper-middle clivus chordomas with relatively good prognosis and limited complications.
- The merits and demerits of the modified ATPA approach were discussed.
- Clivus chordomas was of challenge and the radical surgery combined with radiotherapy might improve the prognosis, long term following up was needed.

BackgroundSkull base chordomas are challenging and have a high rate of recurrence.MethodsA modified anterior transpetrous approach (ATPA) was performed in 17 upper clivus chordomas, and clinical data were retrospectively studied.ResultsAll 17 cases were radically treated via the modified ATPA, and the total removal and subtotal removal rates were 23.5% and 76.5%, respectively. The primary complaints were headaches and visual disturbances. The short-term postoperative complications were diplopia (12 cases, 70.6%) and facial numbness (7 cases, 41.2%). With a mean follow up of 44.5 months, 5 cases (29.4%) presented with tumor recurrence, and most cases had relatively good outcomes except for 2 patients who died because of rapid recurrence. The long-term complications were facial numbness (35.3%).ConclusionsThe upper skull base chordomas could be radically removed via the modified ATPA under selected conditions, with limited complications and improved outcomes. The radical surgery treatment strategy was recommended for skull base chordomas. However, the present series included limited cases; therefore, post-operative follow-up, long-term outcomes and a larger number of cases of clivus chordomas should be observed to evaluate the effectiveness of the modified ATPA approach.