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Endoscopic Endonasal Surgery Approach Surgery for Chordomas

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On Topic Video Transcript

Paul A. Gardner, MD

Co-Director, Center for Cranial Base Surgery

A chordoma is a tumor that’s thought to arise from a precursor of the disc spaces in your body. Remnants perhaps get left behind and these can turn into a tumor. The tumor is somewhere between a cancer and a benign tumor. Some of them can be very aggressive and even spread like a cancer, and some of them can be very slow growing. Chordomas occur both at the base of the skull and the base of the spine. At UPMC we treat both; our skull base center has extensive experience with treating skull base chordomas.

Chordoma Treatment

The primary treatment for chordoma is removal of the tumor. If a chordoma can be completely removed, that can be curative of the tumor. Often this can be difficult at the base of the skull because the tumor can be wrapped around critical arteries or nerves. Sometimes if the tumor cannot be completely removed, or even if there are microscopic tumor cells left behind, radiation is required as a secondary treatment. But surgery remains the primary treatment for chordoma.

Advantage: Endoscopic Endonasal Approach

The endoscopic endonasal approach really has been a revolution for treating skull base chordomas. In the past, large open surgeries were required to access these tumors, which sit at the center of the base of the skull. By working purely through the nostrils using an endoscope, we are able to land directly onto the tumor and remove the tumor without touching the delicate arteries and nerves that can often be on the outside, or even involved with the tumor. This allows us to get complete removal in many cases with very low risk to the patient.

Decade of Experience

The advantage of coming to UPMC for treatment of chordoma has a lot to do with our experience, as well as our relationships with the chordoma community in general. We have a long experience with the endoscopic endonasal approach, having been performed at UPMC for over a decade. We have operated on close to 100 chordomas endonasally, which is possibly one of the largest series like this in the world. This extensive experience has allowed us to provide lower risk with greater resections of these tumors.

In addition, we have very close ties with the chordoma community. This is a very rare tumor and we take chordoma patient care very seriously and very personally. We have close relationships we’ve followed for a long period of time with many of our patients, and both pediatric and adult patients have been treated with great success at UPMC. We like to think we are part of the larger chordoma community and we think this is really critical as a part of treating chordoma.

For more information, contact us at (412) 647-3685, or visit the Cranial Base Center at the University of Pittsburgh.