• Baig MirzaAsfandADepartment of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom. Electronic address: asfand.mirza@nhs.net., James Bartram, Mohamed Okasha, Qusai Al Banna, Amisha Vastani, Eleni Maratos, Richard Gullan, and Nick Thomas.
• Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom. Electronic address: asfand.mirza@nhs.net.
• World Neurosurg. 2021 Dec 1; 156: e111-e129.

ObjectiveChordoma is a rare neoplasm of the neuraxis derived from remnants of the primitive notochord. The importance of wide margins and use of adjuvant therapy in spinal chordomas are still contentious points in the management of spinal chordomas. We conducted a systematic review of the surgical management of spinal chordomas alongside our 10-year institutional experience.MethodsA systematic search of the literature was performed in November 2020 using Embase and MEDLINE for articles regarding the surgical management of chordomas arising from the mobile spine and sacrum. We also searched for all adult patients who were surgically managed for spinal chordomas at our institute between 2010 and 2020. In both the systematic review and our institutional case series, data on adequacy of resection, use of adjuvant therapy, complications, recurrence (local or metastatic), and survival outcomes were collected.ResultsWe identified and analyzed 42 articles, yielding 1531 patients, from which the overall gross total or wide resection rate was 54.9%. Among the 8 cases in our institutional experience (4 sacral, 3 cervical, and 1 lumbar), we achieved gross total resection in 50% of initial operations. The recurrence rate was 25% in our gross total resection group and 50% where initial resection was subtotal. Of patients, 75% had no evidence of recurrence at most recent follow-up.ConclusionsAlbeit difficult at times because of the proximity to neurovascular tissue, achieving a wide resection followed by adjuvant therapy for spinal chordomas is of great importance. Multidisciplinary discussion is valuable to ensure the best outcome for the patient.Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.

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