Microscopic and Endoscopic Transoral Approaches for the Management of Craniocervical Chordomas

Background: Craniocervical chordoma representing a challenge for surgeons. The endoscopic transoral approach is used for treatment. Additional exposure is required. However, its benefits are not sufficiently addressed.    Aim: To evaluate the use of endoscopy in the transoral approach and the benefits of additional exposure in cases of craniocervical chordomas. Patients and Methods: in this study, 12 patients had a confirmed diagnosis of chordoma after histopathological examination due to the presence of craniocervical destructive lesions. The author performed all surgical cases using a microscopic transoral approach in 6 patients, an endoscopic-assisted microscopic transoral approach in 3 patients, and a purely endoscopic transoral approach in 3 patients. Eight patients required posterior cervical fusion according to the extent of instability. Preoperative and postoperative data were collected, including radiological examination and clinical status data. Results: in this study, 12 patients were evaluated clinically and radiologically. It was found that the use of endoscopic assistance in the microscopic transoral approach, or the use of the purely endoscopic transoral approach,added greater angles of exposure of the tumors that could not be reached when using a microscope alone. This led to greater tumor removal and excision with the same precautions and safety for the patient using these approaches compared with the use of the microscopic approach alone. The use of endoscopy alone minimized the incision of the posterior pharyngeal wall and led to good healing, which is an important goal in this field and additional angles of view. Conclusion: The use of endoscopy either for assistance in the microscopic transoral approach or alone led to the safe implementation and greater extent of tumor removal and excision. We recommend the use of endoscopy in such cases.