Recently, more and more patients have approached me for consultation and consultation of chordoma, so I would like to give you some summary knowledge and hope that more people will have a clearer and better understanding of this disease and normal choices. Trivia: Chordoma originates from the embryonic remnants of the notochordal tissue. During the embryonic period, the upper end of the notochord is distributed in the pterygoid and occipital bones at the base of the skull, partially reaching the intracranial surface and articulating with the dura above the pterygoid saddle, and in the occipital bone partially reaching the underside of this bone (i.e., the linguopharyngeal surface), and partially located between the skull base bone and the pharyngeal wall. The lower end of the spinal cord is located in the central and paracentral parts of the sacrococcygeal region. Therefore, chordomas are most common in these areas, especially in the pterygo-occipital and sacrococcygeal regions of the skull base, and to a lesser extent in the spinal region. Chordoma of the skull base or slope belongs to the category of brain neurosurgery diseases. It is histologically benign but has the following malignant features: deep location, easy to invade the skull and important neurovascular; infiltrative growth, mostly without obvious envelope; occasional metastasis; not easy to remove completely and easy to recur after surgery. Some typical questions and answers: 1. Should I actively treat chordoma when it is found? The median survival of chordoma without treatment is 6-28 months. This means that if a chordoma is found and left untreated, half of the patients will have a life-threatening condition in 6-28 months, indicating that chordoma is very dangerous. Once discovered, they should be treated aggressively, and some early, limited chordomas may be curable through surgery. 2. How are slope chordomas treated? Chordoma is histologically benign, which determines that it is not sensitive to radiotherapy (including gamma knife, radio wave knife, etc.) or chemotherapy. Surgery is currently recommended internationally and in recent years, endoscopic surgery has become the best option for minimally invasive treatment of chordoma. 3.What is the prognosis of chordoma? Benign or malignant? The survival rate of chordoma at the base of the skull was generally low, with a 5-year survival rate of 30% to 40%. In recent years, there has been a gradual increase in reports from home and abroad, and the postoperative survival rate for skull base chordoma has improved significantly, maintaining a 5-year survival rate of 60% to 70%. It is generally believed that the more complete the resection of the tumor, the better the patient’s prognosis. It is now generally accepted that older patients with chordoma have a poorer prognosis. Slope chordoma is histologically benign, but its deep location, invasive growth, and tendency to cause neurological dysfunction often present as malignant behavior in the clinical setting. 4. What are the advantages of endoscopic transnasal surgery? The common site of chordoma in the brain is the slope, which can be clinically divided into upper slope, upper-middle slope, middle-lower slope and full slope types. The disadvantages of the transoral approach are that anesthesia requires tracheotomy, interferes with postoperative feeding, and is prone to local infection and slow recovery. The endoscopic transnasopharyngeal approach to the lower slope of chordoma can completely avoid the disadvantages of the transoral approach. The endoscopic transnasopharyngeal approach requires more surgical instruments, surgical team and experience, but it can provide a more minimally invasive and effective treatment for patients. 5. What should I expect after chordoma surgery? Chordoma is histologically benign, but its clinical behavior is malignant, so regular postoperative review (usually every 6 months) is necessary. Some recurrent tumors that grow significantly faster during the observation period often require aggressive surgery again, and recovery of neurological function is often poor if surgery is performed after causing neurological dysfunction. Most studies have shown that the prognosis of chordoma is closely related to patient compliance with medical care, regular review, and aggressive retreatment.