Cordoma de Clivus: vivir en tierra de nadie. Vivencias de una enfermera y cuidadora familiar / Chordoma of Clivus: live in no man's land. Experiences of a nurse and family caregiver

Los cordomas de Clivus son tumores raros, típicamente de lento crecimiento, localmente agresivos y que se originan de remanentes de la notocorda. Son neoplasias benignas con alta tasa de recurrencia y mortalidad. Para los equipos médicos representan un gran desafío, no solo por el tratamiento de la enfermedad en sí, sino también por el número de especialidades que deben coordinarse para la atención del paciente. Entre ellos, deberían estar presentes los expertos en cuidados paliativos. Hay que ayudar al paciente y a la familia a sentirse mejor, a prevenir, a tratar los síntomas y los efectos secundarios de la enfermedad y de los tratamientos. Hay que abordar también los problemas emocionales, sociales, prácticos y espirituales que la enfermedad plantea. En definitiva, hay que tratar de mejorar su calidad de vida. Pero la realidad viene siendo otra, ya que, a veces, los pacientes son derivados tarde a cuidados paliativos. Con este relato biográfico se pretenden conocer las vivencias de una cuidadora, enfermera de profesión, que atiende a su madre afectada por este tipo de tumor, las trabas con las que se encuentra para acceder a unos cuidados paliativos de calidad y el desgaste psíquico y emocional que supuso su cuidado

Chordomas of Clivus are rare, typically slow-growing, locally aggressive tumors that originate from remnants of the notochord. They are benign neoplasms with a high rate of recurrence and mortality. For medical teams represent a great challenge, not only for the treatment of the disease itself, but also for the number of specialties that must be coordinated for patient care. Among them, experts in palliative care should be present. We must help the patient and the family to feel better, to prevent, to treat the symptoms and side effects of the disease and treatments. We must also address the emotional, social, practical and spiritual problems that the disease poses. In short, we must try to improve their quality of life. But reality has been different, since patients aresometimesreferred to palliative care late. With this biographical report, it is intended to know the experiences of a nurse-caregiver of his mother affected by this type of tumor, the obstacles with which he is to access quality palliative care and the psychological and emotional wearthat his care entailed

Upper cervical spine chordoma: a case study.

Cervical chordomas are rare, slow-growing, but locally aggressive tumors. Predominantly found in people 50-69 years old, a chordoma arises from remnants of the primitive notochord. It is most often found in the sacrococcygeal or skull base areas. However, it can be found throughout the spine. Because chordomas are slow growing, they may reach considerable size before the patient becomes symptomatic. Surgical resection with a wide margin is the only curative procedure. Usually, because of tumor location and infiltration, this is not possible. Although this type of tumor is generally considered radioresistant, radiation therapy is often prescribed after surgical resection. The following case study illustrates the clinical presentation, surgical interventions, and neuroscience nursing considerations for a patient undergoing a posterior stabilization as well as a midline mandibulotomy-glossotomy approach for an upper cervical spine chordoma resection.

A case report: maxillotomy for removal of a clival chordoma.

Although clival chordomas account for only a small percentage (0.2%) of all intracranial tumors, they represent a considerable challenge for the neurosurgical team. The problems of surgical accessibility to the clivus, management of postoperative complications and tendency of the chordoma to recur are well recognized. This infiltrative tumor located at the skull base has the potential to metastasize and recur, thus meeting the characteristics of a malignant tumor. The maxillotomy, as well as a number of other surgical approaches to the clivus, has been developed and refined for removal of this formidable tumor. It is important to have an understanding of the anatomy of the clivus, the pathology of a chordoma and the surgical technique of a maxillotomy. A case report demonstrates these concepts and nursing considerations for the patient undergoing a maxillotomy for resection of a clival chordoma.