• World Neurosurg · Jul 2024

    Predicting the need for occipitocervical fusion for patients with lower clival chordoma: a single-center retrospective study.

    • Sukwoo Hong, Yuki Shinya, Nikita Lakomkin, Anita Mahajan, Nadia N Laack, Erin O'Brien, Janalee K Stokken, Jeffrey R Janus, Carlos Pinheiro Neto, Garret W Choby, Maria Peris Celda, Michael J Link, Benjamin D Elder, and Jamie J Van Gompel.
    • Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.
    • World Neurosurg. 2024 Jul 1; 187: e321e330e321-e330.

    ObjectiveTo assess the impact of tumor extension into the occipital condyle (OC) in lower clival chordoma management and the need for occipito-cervical fusion (OCF).MethodsA 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.ResultsSeven (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.ConclusionsIn 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.

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