CORRESPONDENCE Performance Status addresses adequately the needs of this classi- In Reply: Cranial Chordoma: A New fication. Additional radiological features, such as Alberta stroke Preoperative Grading System programme early CT score, cited by the commenter, are not To the Editor: relevant for the surgery of chordomas. We appreciate the interest of Balasubramanian et al. The Finally, our article specifically addresses 2 of the main concerns comments are directed toward our recent article in Neuro- of the commentator: first, we wrote that future developments of surgery titled “Cranial Chordoma: A New Preoperative Grading the genetic knowledge of chordomas would result in reappraisal System”. of the classification; and second, we have specifically mentioned The proposed classification incorporates anatomical, radio- the limitation of our single-institution study and the necessity of logical, and clinical features; it was designed by the senior author a validation in a larger independent group of patients. of the article to predict the difficulty of a case, to help the surgeon in advance regarding areas of anatomical difficulty, and to help Disclosure decision making of further therapy. We agree Balasubramanian The authors have no personal, financial, or institutional interest in any of the et al that classifications evolve with the time and new knowledge drugs, materials, or devices described in this article. can enhance or make a classification obsolete. The anatomical criteria used for our classification were selected based on its Harley Brito da Silva, MD relevance for the surgical treatment of clivus chordomas. The Laligam Sekhar, MD commentator suggests that we should add anatomical subcom- Department of Neurological Surgery partments into our classification; we strongly disagree, adding Harborview Medical Center anatomical subcompartments that are described often in normal University of Washington cadaveric anatomical studies is mostly irrelevant for the treatment Seattle, Washington of an actual clinical case of a clivus chordoma that causes extensive alterations to the normal anatomy. REFERENCES Regarding intraoperative monitoring; we expect that all skull base cases in this age receive it, thus similar to the surgical micro- 1. Balasubramanian C, Ganesan RV, Thamburaj V. Letter: cranial chordoma: a new preoperative grading system. Neurosurgery. 2018;82(6):E177-E179. scope; it is a tool that it is already incorporated in the surgical 2. Brito da Silva H, Straus D, Barber JK, Rostomily RC, Ferreira M, Jr., Sekhar outcomes. LN. Cranial chordoma: a new preoperative grading system. Neurosurgery. 2017. Balasubramanian et al would like to add other factors in published ahead of print November 3, 2017 (doi: 10.1093/neuros/nyx423). the classification such as American Society of Anesthesiolo- gists (ASA) grade, neuropathology, molecular markers, and other 10.1093/neuros/nyy068 radiological parameters. ASA grade is important but Karnofsky E180 | VOLUME 82 | NUMBER 6 | JUNE 2018 www.neurosurgery-online.com Downloaded from https://academic.oup.com/neurosurgery/article-abstract/82/6/E180/4939255 by Ed 'DeepDyve' Gillespie user on 16 June 2018
Neurosurgery – Oxford University Press
Published: May 8, 2018
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