• World Neurosurg · Aug 2020

    Review Meta Analysis

    Surgical Outcomes with Midline Vs. Lateral Approaches for Cranial Base Chordomas: A Systematic Review and Meta-Analysis.

    • Devi P Patra, Ryan A Hess, Evelyn L Turcotte, Matthew E Welz, Rudy J Rahme, Tanmoy K Maiti, Karl R Abi-Aad, Ahmad K AlMekkawi, Sameer Keole, Devyani Lal, Michael Marino, Maciej Mrugala, Alyx Porter, Sujoy Vora, and Bernard R Bendok.
    • Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Laboratory, Mayo Clinic, Phoenix, Arizona, USA.
    • World Neurosurg. 2020 Aug 1; 140: 378-388.e2.

    BackgroundCranial base chordomas are complex lesions centered on the clivus that surgically can be approached from either a midline or a lateral corridor.ObjectiveTo compare the surgical outcomes from midline versus lateral approaches by conducting a meta-analysis of the literature.MethodsStudies were identified between 2000 and 2018. The primary outcome was gross total resection (GTR) rate. The secondary outcomes were recurrence rate and rates of cerebrospinal fluid (CSF) leak and new cranial nerve palsy. Odds ratios were calculated with a random-effect model using studies describing both approaches. An indirect (proportion) meta-analysis was performed pooling studies describing either of the approaches. Individual patient data were analyzed for differences in GTR or recurrence rate with different tumor extensions.ResultsThirty-three studies were found suitable for indirect meta-analysis and 10 studies for direct meta-analysis. The overall odds of GTR with a midline approach compared with a lateral approach was 0.83 (95% confidence interval [CI], -0.43 to 1.62). The odds ratios for recurrence, CSF leak, and new cranial nerve palsy were 0.82 (95% CI, 0.26-2.56), 1.49 (95% CI, 0.14-15.5), and 0.14 (95% CI, 0.04-0.56), respectively. With individual patient data analysis, no statistically significant difference was observed in GTR or recurrence rates between the 2 approaches with different tumor extensions.ConclusionsThe meta-analysis did not show any significant difference in GTR or recurrence rates between the midline versus lateral approaches. Tumor extension to different compartments did not affect the GTR or recurrence rates with either approach. In terms of complications, CSF leak rate was higher in midline approaches and cranial nerve palsy was higher in lateral approaches.Copyright © 2020 Elsevier Inc. All rights reserved.

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