Chordomas are the most common malignant tumors arising from the spine. Their origin is believed to be from remnants of the notochord, which is the origin of nucleus pulposus of intervertebral discs. They can be found anywhere within the spinal column, but the most common locations are in the base of the skull and in the sacrum. These tumors are slow growing and can be quite large by the time of diagnosis. Although chordomas are slow growing tumors, they are invasive and can metastasize to other body parts. Without treatment, patients will succumb to this disease and life expectancy is generally less than 2-3 years.

Symptoms:

Patients with chordoma can present with palpable mass, pain, or neurological problems. Chordomas in the skull base and upper cervical spine can cause symptoms of cranial nerve compression or brain stem compression. The symptoms can include double vision, sensory loss in the face, facial weakness, hearing loss, difficulty with swallowing, hoarseness, or loss of gag reflex. Patients with sacral chordomas often presents with pain and trouble with urination or defecation.

Diagnostic test:

MRI of the brain or spine is essential for evaluation of chordomas. MRI allows physicians to determine the extent of tumor involvement and the proximity of spinal cord, nerves, and other organs in relationship to the tumor. In addition to MRI, a biopsy of the mass is essential. Surgery for chordoma is quite different and more complex than surgery for other tumors. A histological diagnosis is needed prior to committing patients to complex surgical procedures.

Treatment:

The most optimal treatment of chordomas is wide excision of these tumors in whole (aka. en bloc tumor excision or en bloc sacrectomy) without entering into the tumor. This approach avoids contamination of surrounding tissues with tumor cells and improves the chance of long-term survival and possible cure. En bloc tumor excisions can be achieved for most sacral chordomas or chordomas in other areas of the spine. However, it is nearly impossible for treatment of skull base chordomas. En bloc tumor excision is a highly complex and technically demanding procedure that is performed only in selected center nationwide. Successful surgery outcome and treatment for chordoma is best achieved with an experienced multi-disciplinary team of physicians. At USC Neurosurgery Spine Center, our neurosurgeons and spine surgeons are fellowship trained in oncology, and we are experienced in the en bloc resection of spinal chordomas and endoscopic resection of skull base chordomas. We have an experienced team of specialists, including oncologists, radiation oncologists, physicists, head and neck surgeons, vascular surgeons, colorectal surgeons, and plastic surgeons. Our passion is to provide the finest and most compassionate medical treatments for chordoma patients.

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