CLIVAL CHORDOMAS
"No matter what stage of the disease you are facing or where your tumor is located, the way surgery is performed is very important.”
OVERVIEW
Chordoma is a type of bone cancer that belongs to the sarcoma family. This rare cancer affects only one in a million people, which is why it is very difficult to find true expertise in its management. DrJFM is one of very few Skull Base Surgeons with true expertise and innovation in Chordoma treatment worldwide.
THE IMPORTANCE OF EXPERTISE
As recommended by The Chordoma Foundation: “It is important to go...where doctors have experience diagnosing and treating chordoma as soon as chordoma is suspected. You should avoid having a biopsy or surgery to confirm the diagnosis of chordoma outside of a referral center because, if not done properly, these procedures can cause the chordoma to spread… If you cannot travel to see a doctor who has experience with chordoma, have your imaging tests sent to a doctor with chordoma experience for a second opinion before you get treatment or a biopsy.”
TREATMENT
Chordoma treatment begins with surgery.
As stated by The Chordoma Foundation “No matter what stage of the disease you are facing [new, recurrent, advanced, metastatic] or where your tumor is located, the way surgery is performed is very important.”
The preferred surgical treatment for most chordomas of the skull base is the Endoscopic Endonasal Approach (EEA).
Dr. Fernandez-Miranda has been at the forefront of the development and refinement of EEA for skull base chordomas, describing multiple anatomical nuances and novel surgical techniques relevant for successful chordoma surgery.
When the entire tumor is successfully removed, patients statistically live longer and the tumor is less likely to grow back. In fact, cases with favorable tumor genetics AND complete resection, might not need radiation therapy
If your entire tumor was not successfully removed with the first surgery, consider getting a second opinion on removing the remaining tumor before starting radiation.
Frequently Asked Questions
What is a chordoma? Chordoma is a rare type of bone cancer belonging to the sarcoma family. It develops from remnants of the notochord — the embryological structure that forms the early spine. Chordomas most commonly occur at the skull base (clival chordoma) or the sacrum. With an incidence of approximately one in a million people, finding a surgeon with genuine expertise in chordoma treatment is critical for optimal outcomes.
Why is it important to find an expert surgeon for chordoma? As recommended by the Chordoma Foundation, it is essential to seek treatment at a center with specific chordoma expertise. Having a biopsy or surgery performed by a surgeon without chordoma experience can cause the tumor to spread. The way surgery is performed directly impacts survival and recurrence, regardless of the stage of disease.
How is clival chordoma treated surgically? The preferred surgical treatment for most skull base chordomas is the Endoscopic Endonasal Approach (EEA) — a minimally invasive technique performed through the nose. Dr. Fernandez-Miranda has been at the forefront of developing and refining EEA for skull base chordomas. When the entire tumor is successfully removed, patients live statistically longer and the tumor is less likely to recur.
Is radiation needed after chordoma surgery? Not always. Cases with favorable tumor genetics and complete surgical resection may not need radiation therapy. However, when radiation is indicated, proton beam therapy is typically recommended. The quality of the initial surgical resection is the most important factor in determining whether radiation is needed.
What if my first chordoma surgery was incomplete? If your tumor was not completely removed with the first surgery, it is recommended to get a second opinion on removing the remaining tumor before starting radiation. Revision surgery by an expert chordoma surgeon can sometimes achieve complete resection, which significantly improves long-term outcomes.
Does the Chordoma Foundation recommend specific surgeons? The Chordoma Foundation maintains a list of experienced chordoma specialists and emphasizes that patients should seek treatment at referral centers with chordoma expertise. They strongly advise against biopsy or surgery at centers without chordoma experience. Dr. Fernandez-Miranda is recognized as one of the world's leading experts in endoscopic skull base chordoma surgery.
How do I get a consultation for a chordoma? You can request a consultation or second opinion through drjfm.com or Stanford Health Care. Please provide medical records and imaging studies. Your case will be evaluated with a recommendation typically within 24–48 hours. International patients are welcome, and imaging review can be done remotely.
Chordomas
Chondrosarcoma EEA
Chordomas and Chondrosarcomas: Surgical Anatomy and Technical Nuances
Clival Chordoma
CONTACT US FOR A CONSULTATION OR SECOND OPINION
We will do our best to contact you back within 24-48 hours
Please be ready to provide medical records and imaging studies
Your case will be carefully evaluated and will provide our recommendation and eligibility for surgical intervention