Typically, the goal of chordoma surgery is to remove the whole tumor, or as much of it as possible. Thanks to major advances in surgical techniques and equipment, skull base chordomas may be removed through the nostrils (endoscopic-endonasal or transsphenoidal surgery), using those natural corridors to reach areas that are difficult to access. This minimally invasive technique doesn’t require an incision and has a lower risk of complications. Spinal chordomas may be removed using open surgery or, when possible, advanced minimally invasive spine surgery.
Ideally the whole tumor should be removed, but sometimes that is too dangerous because of its involvement with other structures. The removal of a chordoma in the skull base and cervical spine (neck), for example, may impact nerves that affect the eyes, face, and swallowing. Therefore complete removal may not be recommended, as it could cause damage to those nerves. Even if all of the visible chordoma is removed, microscopic cells may remain. Because of these factors, additional treatment involving radiation is commonly prescribed to destroy remaining cells.
To reduce the risk of serious nerve injury, neurophysiological monitoring is often recommended during surgery.
The gold standard for treatment of chordomas in other parts of the spine is also removal of the tumor. And as with chordomas in the skull base, follow-up management with radiation may be recommended to destroy any remaining cells and prevent them from spreading. Radiation may begin soon after surgical removal of the chordoma. (See Diagnosing and Treating a Chordoma)
Reviewed by: Theodore Schwartz, MD
Last reviewed: September 2023