Endoscopic Endonasal Approach for Resection of Clival Chordomas: A Systematic Review and Meta-Analysis.

Meta-analysisOperative neurosurgery (Hagerstown, Md.)· Jul 2026

Endoscopic Endonasal Approach for Resection of Clival Chordomas: A Systematic Review and Meta-Analysis.

Rudolfh Batista Arend, Natan Lucca Lima, Pedro Henrique Ieggli … Guilherme Gago

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Skull BaseMeta-analysisTreatmentQ2IF 1.0

About half of clival chordoma patients achieve gross total resection endoscopically.

Endoscopic Endonasal Approach for Resection of Clival Chordomas: A Systematic Review and Meta-Analysis.

Rudolfh Batista Arend … Guilherme Gago

Operative neurosurgery (Hagerstown, Md.) · Jul 2026 · Q2 in Surgery

Background

Clival chordoma is a rare, locally invasive tumor originating from notochord remnants.

Purpose

The aim of this study was to synthesize oncologic and safety outcomes of endoscopic endonasal approach for clival chordomas, focusing on extent of resection, recurrence, and complications.

Methods

We included observational studies of clival chordoma treated through endoscopic endonasal approach reporting extent of resection and outcomes.

n = 1197 patients

Results

gross total removal happens in under half of patients

48.3%

Gross total resection

29.2%

Near-total resection

27.2%

Subtotal resection

9%

Partial resection

More results

We included 18 observational studies comprising 1197 patients.

Near-total, subtotal, and partial resection rates were 29.2%, 27.2%, and 9%, respectively.

Pooled cerebrospinal fluid leak rate was 12.4% (95% CI: 6.8%-16.6%; I 2 = 64%).

More results

Complications included cranial nerve palsy 7.5% (95% CI: 4.4%-12.4%; I 2 = 68%), paresis 4.1% (95% CI: 2.3%-7.1%; I 2 = 40%), diplopia 3.7% (95% CI: 0.0%-13.4%; I 2 = 51%), brain infarction 1.2% (95% CI: 0.02.8%; I 2 = 14%), major hemorrhage 0.3% (95% CI: 0.0%-1.3%; I 2 = 6%), and hematoma 0.2% (95% CI: 0.0%-1.2%; I 2 = 0%).

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Conclusion · 1 of 2

In contemporary endoscopic endonasal approach for clival chordomas, about half of the patients achieve gross total resection. Recurrence approaches ∼32% at reported follow-up.

Conclusion · 2 of 2

Morbidity is driven chiefly by cranial nerve deficits (∼8%), whereas major vascular and bleeding events are uncommon.

Endoscopic Endonasal Approach for Resection of Clival Chordomas: A Systematic Review and Meta-Analysis.

Endoscopic Endonasal Approach for Resection of Clival Chordomas: A Systematic Review and Meta-Analysis.

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