# A refined treatment strategy for skull base chordoma: A protocol and management algorithm

## TL;DR

This paper proposes a new treatment strategy for skull base chordomas, combining surgery, radiation, and emerging therapies to improve patient outcomes.

## Contribution

A cohesive treatment paradigm for skull base chordomas based on 197 patients and 307 surgical resections is proposed.

## Key findings

- The endoscopic endonasal approach is emphasized as a key surgical method for skull base chordomas.
- Maximal safe resection and individualized treatment planning are critical for optimizing outcomes.
- Emerging therapies like immunotherapy are suggested as potential additions to treatment protocols.

## Abstract

Skull base chordomas (SBCs) are rare and challenging tumors due to their midline location and invasive behavior, requiring a multidisciplinary approach that integrates advancements in surgical techniques, radiation therapy, and emerging therapies. This paper synthesizes clinical experience with 307 surgical resections performed on 197 patients to propose a cohesive treatment paradigm for SBCs. The endoscopic endonasal approach (EEA) is highlighted as a cornerstone of surgical management, with key considerations for postoperative radiation strategies and novel therapeutic options, such as immunotherapy, discussed. By emphasizing the importance of maximal safe resection, individualized treatment planning, and ongoing innovation, this paper aims to provide a framework for optimizing outcomes in patients with SBCs while highlighting areas for future research in this complex field.