Individualized scheme for surgical management of malignancies involving the clivus

Abstract

Background Deep ⁃ seated clival varied malignancies represent a surgical challenge because of complex anatomy and surgical procedures posing great risks to adjacent neurovascular structures. To investigate effects of diagnosis and treatment of clival region lesions, review experience of individualized surgical procedures and comprehensive therapy. Methods and Results A total of 56 patients with clival malignancies from July 2007 to December 2018 were included. The patients mainly presented with headache and cranial nerve paresis. After multidisciplinary consultation, radical resection were performed in 45 cases different kinds of surgical approaches including endonasal (15 cases, 33.33% ), intraoral accompanied by intraoral and endonasal combined (7 cases, 15.56%), Derome (8 cases, 17.78%), maxillary swing (9 cases, 20% ), and infratemporal (6 cases, 13.33% ) approaches were chosen according to clinical and radiographic findings, and biopsies were performed in 11 patients to confirm the pathological diagnosis. The primary pathological finding was chordoma (28 cases, 50%). Total resection was achieved in 21 cases (46.67%), and 17 cases (37.78%) underwent subtotal resection. Besides, partial resection was performed in 7 cases (15.56% ). The complications developed in 28 patients, including cranial nerve deficits (13 cases, 23.21%), cerebrospinal fluid leakage (14 cases, 25%), intracranial infection (8 cases, 14.29%), pneumonitis (2 cases, 3.57% ), postoperative hematoma (2 cases, 3.57% ), and mental disorder (1 cases, 1.79% ). Adjuvant chemoradiotherapy was provided by the oncologists depending on the pathological findings. The average follow⁃up was 59.90 months, but 8 patients (14.29%) were lost. The progression⁃free survival was achieved in 16 patients (28.57%), whereas the disease progression occurred in 13 patients (23.21%). The mortality was 33.93% (19/56). Conclusions Although malignancies occupy a larger subset of clival tumors, not all are needed to be radically resected. Our preliminary results suggest that multidisciplinary consultation is indispensable to clarify the therapeutic purpose and provide individualized surgical approaches. Postoperative comprehensive therapy may reduce the surgical complications and improve the outcomes of patients.DOI：10.3969/j.issn.1672⁃6731.2020.03.008