• Hussam Metwali, Amir Samii, Venelin Gerganov, Mario Giordano, Rudolf Fahlbusch, and Madjid Samii.
• Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany; Leibniz-Institut für Neurobiologie (LIN), Magdeburg, Germany. Electronic address: drhussamm@yahoo.com.
• World Neurosurg. 2019 Aug 1; 128: e185-e194.

BackgroundSkull base chordoma can be a challenging surgical entity because of its invasive nature.ObjectiveIn this study, the role of intraoperative magnetic resonance imaging (iMRI) to optimize the resection of skull base chordomas is evaluated.MethodsWe performed a retrospective analysis of operated patients with skull base chordomas in the setting of iMRI. The clinical records, operative notes, radiologic images, tumor volumetry, location of the residual tumor, and surgical outcome were evaluated.ResultsFifteen patients were operated on for resection of skull base chordomas between 2010 and 2017 in our institution. Gross total resection was planned and achieved in 8 patients and partial resection in 7 patients. In 8 patients (53.3%), the preoperatively planned volume of resection was achieved and confirmed in the first iMRI control. In 7 patients, repeated iMRI controls were required to achieve the surgical target. In 3 patients, the tumor residual requiring further resection was located in the clivus and in 4 patients in the intradural space. The improvement of the preoperative deficits showed a significant statistical association with the resection of the intradural component and decompression of the brainstem.ConclusionsThis study shows that iMRI is a safe method for intraoperative assessment of the degree of resection and the volume and location of residual tumor when resecting skull base chordomas. When gross total resection of the tumor is not feasible, iMRI can be a useful tool for targeted tumor resection.Copyright © 2019 Elsevier Inc. All rights reserved.

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