eMedicine Specialties > Radiology > Brain/Spine

Chordoma: Follow-up

Author: Paule Peretti, MD, Neuroradiologist, Radiological Department, Sainte Marguerite Hospital, France
Coauthor(s): Hervé Brunel, MD, Consulting Staff, Department of Neuroradiology, Montpellier of Pr Bonafé, France; Frédéric P Borrione, MD, Assistant Professor of Orthopedic Surgery, University of Marseilles; President, Center for Evaluation of Osteoarthritis Diseases, Marseilles, France; Guillaume Gorincour, MD, Staff Physician, Department of Neuroradiology, University Hospital of Marseilles, France
Contributor Information and Disclosures

Updated: Dec 23, 2008

Intervention

Clival chordomas: Chordomas are radioresistant tumors in which surgical management is difficult. However, the proximity of essential neurovascular structures does not exclude surgery, since these tumors may be dissected relatively safely in several cases. The prognosis is better when tumor removal is more complete.

  • The best tool for demonstrating tumoral site and extension and for selecting the surgical approach is 3-dimensional MRI.
  • Microsurgery is performed through subfrontal, subtemporal, and transsphenoidal approaches. Involvement of a cavernous sinus does not exclude surgery.
  • Advances in hyperfocal radiosurgical techniques, such as a gamma knife, linear accelerator, or proton therapy, provide better control of the residual tumor, with high-dose radiation therapy sparing the adjacent tissues. This therapeutic procedure is particularly useful in clival chordomas because of the difficult surgical approach in this area and the close relationship between this tumor and essential neurovascular structures.

Lumbosacral chordomas: The patient's only chance for cure with this entity is an en bloc resection with a margin of healthy tissue. Chordomas below the S1 vertebra should be resected en bloc to provide a chance for cure.

  • In other locations, a surgical strategy ensuring preservation of function should be chosen with adjunctive high-dose radiotherapy.
  • Postsurgical bladder and rectal functions are major complications and related directly to the number of preserved nerve roots.
  • Effective management of sacrococcygeal chordomas consists of early diagnosis, definitive and adequate surgical resection with proven tumor-free cut margins, and close follow-up care, including MRI and CT scanning.

Medical therapy: Research indicates that imatinib mesylate exhibits antitumor activity in patients with chordoma.8

 


More on Chordoma

Overview: Chordoma
Imaging: Chordoma
Follow-up: Chordoma
Multimedia: Chordoma
References
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References

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Further Reading

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Keywords

chordoma, notochord tumor, primitive notochord tumor, notochord mass, intracranial tumor, intracranial mass

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Contributor Information and Disclosures

Author

Paule Peretti, MD, Neuroradiologist, Radiological Department, Sainte Marguerite Hospital, France
Paule Peretti, MD is a member of the following medical societies: French Society of Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Hervé Brunel, MD, Consulting Staff, Department of Neuroradiology, Montpellier of Pr Bonafé, France
Disclosure: Nothing to disclose.

Frédéric P Borrione, MD, Assistant Professor of Orthopedic Surgery, University of Marseilles; President, Center for Evaluation of Osteoarthritis Diseases, Marseilles, France
Disclosure: Nothing to disclose.

Guillaume Gorincour, MD, Staff Physician, Department of Neuroradiology, University Hospital of Marseilles, France
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey L Creasy, MD, Associate Professor, Associate Section Head, Division of Neuroradiology, Director, Neuroradiology Fellowship, Department of Radiology, Vanderbilt University
Jeffrey L Creasy, MD is a member of the following medical societies: American College of Radiology, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

C Douglas Phillips, MD, Professor, Departments of Radiology, Neurosurgery, and Otolaryngology, University of Virginia Health Sciences Center
C Douglas Phillips, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Society of Head and Neck Radiology, American Society of Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Amirsys Royalty Consulting

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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