High-speed k-linear swept laser using acousto-optic deflectors with Doppler shift compensation for optical coherence tomography.

Swept laser based on the acousto-optic deflector (AOD) is a promising swept source in optical coherence tomography (OCT) applications for its high wavenumber linear sweep without mechanical motion. However, the poor coherence length and the elongated cavity of the laser imposed limitations on the acquisition of high-quality images with adequate imaging depth and high imaging speed. In this Letter, we demonstrate a compact high-speed wavenumber linear swept laser based on AOD using Doppler shift compensation, achieving a high linearity of Pearson's R of 0.999991, a duty cycle of ∼100%, an extended coherence length of 5.7 mm, an output power of 18 mW, and excellent phase stability at a sweep speed of 500 kHz. OCT structural images with a system sensitivity of 103.2 dB and OCT angiography (OCTA) of human palm in vivo have been successfully performed, serving as a compelling demonstration of the excellent performance of this swept laser. We believe that the proposed laser will be of high potential in various clinical and industrial applications in the future.

The Influence of Etiology and Stimulation Target on the Outcome of Deep Brain Stimulation for Chronic Neuropathic Pain: A Systematic Review and Meta-Analysis.

OBJECTIVES: Deep brain stimulation (DBS) to treat chronic neuropathic pain has shown variable outcomes. Variations in pain etiologies and DBS targets are considered the main contributing factors, which are, however, underexplored owing to a paucity of patient data in individual studies. An updated meta-analysis to quantitatively assess the influence of these factors on the outcome of DBS for chronic neuropathic pain is warranted, especially considering that the anterior cingulate cortex (ACC) has emerged recently as a new DBS target. MATERIALS AND METHODS: A comprehensive literature review was performed in PubMed, Embase, and Cochrane data bases to identify studies reporting quantitative outcomes of DBS for chronic neuropathic pain. Pain and quality of life (QoL) outcomes, grouped by etiology and DBS target, were extracted and analyzed (α = 0.05). RESULTS: Twenty-five studies were included for analysis. Patients with peripheral neuropathic pain (PNP) had a significantly greater initial stimulation success rate than did patients with central neuropathic pain (CNP). Both patients with CNP and patients with PNP with definitive implant, regardless of targets, gained significant follow-up pain reduction. Patients with PNP had greater long-term pain relief than did patients with CNP. Patients with CNP with ACC DBS gained less long-term pain relief than did those with conventional targets. Significant short-term QoL improvement was reported in selected patients with CNP after ACC DBS. However, selective reporting bias was expected, and the improvement decreased in the long term. CONCLUSIONS: Although DBS to treat chronic neuropathic pain is generally effective, patients with PNP are the preferred population over patients with CNP. Current data suggest that ACC DBS deserves further investigation as a potential way to treat the affective component of chronic neuropathic pain.

Multimodal-based machine learning strategy for accurate and non-invasive prediction of intramedullary glioma grade and mutation status of molecular markers: a retrospective study.

BACKGROUND: Determining the grade and molecular marker status of intramedullary gliomas is important for assessing treatment outcomes and prognosis. Invasive biopsy for pathology usually carries a high risk of tissue damage, especially to the spinal cord, and there are currently no non-invasive strategies to identify the pathological type of intramedullary gliomas. Therefore, this study aimed to develop a non-invasive machine learning model to assist doctors in identifying the intramedullary glioma grade and mutation status of molecular markers. METHODS: A total of 461 patients from two institutions were included, and their sagittal (SAG) and transverse (TRA) T2-weighted magnetic resonance imaging scans and clinical data were acquired preoperatively. We employed a transformer-based deep learning model to automatically segment lesions in the SAG and TRA phases and extract their radiomics features. Different feature representations were fed into the proposed neural networks and compared with those of other mainstream models. RESULTS: The dice similarity coefficients of the Swin transformer in the SAG and TRA phases were 0.8697 and 0.8738, respectively. The results demonstrated that the best performance was obtained in our proposed neural networks based on multimodal fusion (SAG-TRA-clinical) features. In the external validation cohort, the areas under the receiver operating characteristic curve for graded (WHO I-II or WHO III-IV), alpha thalassemia/mental retardation syndrome X-linked (ATRX) status, and tumor protein p53 (P53) status prediction tasks were 0.8431, 0.7622, and 0.7954, respectively. CONCLUSIONS: This study reports a novel machine learning strategy that, for the first time, is based on multimodal features to predict the ATRX and P53 mutation status and grades of intramedullary gliomas. The generalized application of these models could non-invasively provide more tumor-specific pathological information for determining the treatment and prognosis of intramedullary gliomas.

Polarization-isolated stretched-pulse mode-locked swept laser for 10.3-MHz A-line rate optical coherence tomography.

Stretched-pulse mode-locked (SPML) lasing based on a chirped fiber Bragg grating (CFBG) has proven to be a powerful method to generate wavelength-swept lasers at speeds of tens of megahertz. However, light transmitted through the CFBG may lead to undesirable laser oscillation that disrupts the mechanism of the laser active mode locking in the theta ring cavity. In this Letter, we demonstrate a simple and low-cost approach to suppress the transmitted light and achieve an effective duty cycle of ∼100% with only one CFBG and no need for intra-cavity semiconductor optical amplifier (SOA) modulation, extra-cavity optical buffering, and post amplification. By utilizing polarization isolation of the bi-directional CFBG, a swept laser centered at 1305 nm, with repetition rate of 10.3 MHz, optical power of 84 mW, and 3 dB bandwidth of 109 nm, is demonstrated. Ultrahigh speed 3D optical coherence tomography (OCT) structural imaging of a human palm in vivo using this swept laser is also demonstrated. We believe that this ultrahigh speed swept laser will greatly promote the OCT technique for industrial and biomedical applications.

LINC01158 works as an oncogene in glioma via sponging miR-6734-3p to boost CENPK expression.

BACKGROUND: Long non-coding RNAs (lncRNAs) have been certified to play vital biological functions in glioma and have received considerable attention in the recent literature. Nonetheless, the role of LINC01158 in glioma remains to be elucidated. METHODS: qRT-PCR, western blot and GEPIA database were applied for reporting the expression of CENPK and LINC01158 in glioma and the correlation between LINC01158 and CENPK expression. EdU, colony formation, CCK-8, caspase-3 activity and TUNEL assays probed the impacts of LINC01158 on glioma cell growth. Subcellular fractionation and FISH assays revealed the cellular distribution of LINC01158. Luciferase reporter and RIP assays examined ceRNA network of LINC01158, CENPK and miR-6734-3p. RESULTS: LINC01158 and CENPK were both overexpressed in glioma and a positive regulation of LINC01158 on CENPK was corroborated. LINC01158 served a pro-proliferative and anti-apoptotic part in glioma by sponging miR-6734-3p to augment CENPK. CONCLUSION: LINC01158 enhances CENPK by serving as sponge for miR-6734-3p to facilitate glioma development, proposing LINC01158 as a new player in glioma.

A rare case of atypical spinal neurocytoma with EGFR mutation in a 12-year-old boy.

Spinal neurocytoma (SN), although frequently reportedly as tumors of the central nervous system (CNS), are a distinct class of tumors, which can achieve a better prognosis following subtotal or gross total tumor resection. Nonetheless, even with the premise of successful treatment after tumor resection, poor prognosis after treatment due to the SN high proliferation index (typically known as atypical SN) have been reported. Over the past two decades, atypical SN was only reported in four pediatric cases, amidst the lingering controversy surrounding its postoperative adjuvant therapy. Thus, herein, we report a unique case of atypical SN with epidermal growth factor receptor (EGFR) amplification mutation in a 12-year-old boy. We, however, also highlighted the significance of radiotherapy and target therapy for patients with SN.

Directional axonal regrowth induced by an aligned fibrin nanofiber hydrogel contributes to improved motor function recovery in canine L2 spinal cord injury.

Spinal cord injuries (SCI) normally disrupt the long axonal tracts of the spinal cord and cause permanent neurological deficits, for which there is currently a lack of effective therapeutic methods. Biomaterial-based regenerative medicine is a pivotal strategy to induce axonal regeneration through delivery of biophysical and/or biochemical regulatory cues by biomaterials. We previously fabricated a hierarchically aligned fibrin hydrogel (AFG) that could promote neurogenic differentiation of stem cells in vitro and has been successfully applied for peripheral nerve and spinal cord regeneration in rats. In this study, AFG was used to repair a canine lumbar segment 2 hemisection spinal cord injury, and the consistency of histological, imageological and behavioral results was compared. AFG was used to construct an aligned fiber bridge that supported cell adhesion in vitro and rapidly facilitated tissue invasion along the long axis of fibers in vivo, Moreover, in vivo results demonstrated regrowth of axons in an oriented pattern connecting the rostral and caudal stumps. Consistent results were confirmed by diffusion tensor imaging, which allowed successful tracing of reconnected nerve fibers across the defect. As a result, directional axonal regrowth contributed to significantly improved recovery of motor functional behavior of SCI canines with AFG implantation. Our results suggest that AFG has great promise for rapidly directing axonal regrowth for nerve regeneration.

Quantitative protein profiling and pathway analysis of spinal arteriovenous malformations.

Spinal arteriovenous malformations (sAVM) are rare and heterogeneous group of blood vessel disorders that affect spinal cord function directly or indirectly; however, the pathogenesis of sAVM is still unclear. In this study, we compared four sAVM specimens obtained during surgery and donated control samples in a Tandem Mass Tag (TMT)-labeled proteomic analysis. We identified 3101 proteins, 654 of which were differentially expressed in sAVM samples compared with the controls. Of these, 96 proteins were upregulated and 358 proteins were downregulated. Gene ontology (GO) analysis revealed that extracellular matrix organization in the biological process category and integrin-binding proteins in the molecular function category were the most enriched items. Two significant differentially expressed proteins (MYLK and MMP9) were verified by Western blot analysis. The pathway analysis indicated that the differentially expressed proteins in the pathways of angiogenesis, focal adhesion and cytoplasmic ribosome contributed to sAVM. The changes in protein profiles identified in this proteomic study provide an improved understanding of the pathogenesis of sAVM. The proteomics data are available via ProteomeXchange with identifier PXD007982.

Rosai-Dorfman disease involving the central nervous system: seven cases from one institute.

BACKGROUND: Rosai-Dorfman disease (RDD) is a rare, idiopathic, non-neoplastic histioproliferative disease. Central nervous system (CNS) manifestations are extremely rare. Its low incidence and unknown etiology restrict early diagnosis and optimal therapy. METHODS: In the 1995-2013 period, seven CNS-RDD patients with intracranial and/or spinal lesions were retrospectively analyzed, including the clinical data, laboratory and imaging results, treatment applied and outcome. All seven case samples were screened for the SLC29A3 gene mutation, and the literature was reviewed. RESULTS: Seven RDD patients (6 male/1 female, aged between 7 and 68) with CNS manifestations are reported. Five of the seven patients (71.4 %) had intracranial lesions (1 with skull erosion and 1 with multiple lesions mimicking meningiomas), and two (28.6 %) had spinal subdural lesions. The patients' symptoms included headaches, seizures, visual loss, epileptoid convulsions in the lower legs, fever, spastic paraparesis and paraplegia. An elevated erythrocyte sedimentation rate (ESR) was detected in five of the seven cases. The diagnosis was confirmed by immunohistochemical staining revealing that the characteristic histiocytes were positive for the S100 protein and CD68 and negative for CD1a. All patients were operated on: three recovered completely, two were partially rehabilitated, and two died. No SLC29A3 gene mutations were found in any of the seven samples. CONCLUSION: This short series suggests the following: (1) RDD should be included in the differential diagnosis of lesions mimicking intracranial/spinal meningiomas or inflammatory lesions, especially in children; (2) the definitive diagnosis is based on histopathology and immunocytochemistry; (3) surgical resection seems to be the most effective therapy; (4) the exact etiology and adjuvant therapy for relapsing/incompletely resected lesions remain to be established.

[Diagnosis and treatment of primary intraspinal melanocytoma].

OBJECTIVE: To investigate the clinical features, diagnostic and therapeutic strategy of primary intraspinal melanocytoma. METHOD: The clinical data of primary intraspinal melanocytoma patients who underwent surgical operations from June 2011 to December 2014 in Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University were retrospectively reviewed. RESULTS: Six cases of intraspinal melanocytoma, identified with pathology were collected, including 5 male and 1 female patients with the average age of 39.8 years (range 23-50 years). Limbs anesthesia and weakness were present in 2 cases. Neck and back pain were present in 4 cases. All patients performed MRI examination before operation, and only 1 case was diagnosed as primary melanocytoma, and the others were confirmed by postoperative pathology. All cases were confirmed by the pathological examination. Total resection was achieved in 2 cases, subtotal resection was achieved in 2 cases, 2 disseminated cases only achieved partial resection. The average period of postoperative follow-up process was 25.7 months(range 9-52 months). One case recurred in 9 months after surgery and died in 16 months, one case recurred in 1 year after surgery, and the other 4 cases had no recurrence. The recurrenced 2 patients had been not treated with radiotherapy, 2 patients of the 4 that not recurrenced had received radiotherapy. All patients didn't receive chemotherapy. The other patients were in good condition after surgery. CONCLUSIONS: The intraspinal primary melanocytoma is less likely to recurrence and metastasis if total resection is achieved. Diagnosis relies on pathology. Surgery is the first choice and early total resection is strongly recommend. Appropriate radiotherapy for partial resection cases can delay tumor recurrence.

Lentiviral vectors enveloped with rabies virus glycoprotein can be used as a novel retrograde tracer to assess nerve recovery in rat sciatic nerve injury models.

Retrograde labeling has become the new "gold standard" technique to evaluate the recovery of injured peripheral nerves. In this study, lentiviral vectors with rabies virus glycoprotein envelop (RABV-G-LV) and RFP genes are injected into gastrocnemius muscle to determine the location of RFP in sciatic nerves. We then examine RFP expression in the L4-S1 spinal cord and sensory dorsal root ganglia and in the rat sciatic nerve, isolated Schwann cells, viral dose to expression relationship and the use of RABV-G-LV as a retrograde tracer for regeneration in the injured rat sciatic nerve. VSV-G-LV was used as control for viral envelope specificity. Results showed that RFP were positive in the myelin sheath and lumbar spinal motorneurons of the RABV-G-LV group. RFP gene could be detected both in myelinated Schwann cells and lumbar spinal motor neurons in the RABV-G-LV group. Schwann cells isolated from the RABV-G-LV injected postnatal Sprague Dawley rats were also RFP-gene positive. All the results obtained in the VSV-G-LV group were negative. Distribution of RFP was unaltered and the level of RFP expression increasing with time progressing. RABV-G-LV could assess the amount of functional regenerating nerve fibers two months post-operation in the four models. This method offers an easy-operated and consistent standardized approach for retrograde labeling regenerating peripheral nerves, which may be a significant supplement for the previous RABV-G-LV-related retrograde labeling study.

Surgical outcomes in spinal cord subependymomas: an institutional experience.

Spinal cord subependymomas are very rare. Most studies on spinal cord subependymomas have been case reports with literature reviews. This study presented a surgical series of 13 patients with histologically proven spinal cord subependymomas. Their clinical data, radiological findings, operative records, and follow-up outcomes were reviewed. There were 5 male and 8 female patients with a mean age of 39.5 years. The mean follow-up period was 67.8 months. Four tumors were located in the cervical spine, 5 in the cervicothoracic spine, and 4 in the thoracic spine. Gross total resection (GTR) of the tumor with a well-demarcated dissection plane was achieved in 9 cases, and subtotal resection was achieved in 4 cases. The symptoms present before the surgery were improved in 11 cases at last follow-up and the current status of 2 patients had no change compared to the preoperative presentation at last follow-up. The postoperative follow-up magnetic resonance imaging showed no recurrence in the 9 GTR cases during the mean follow-up period of 70.3 months. No recurrence/regrowth of the residual tumors was observed in the 4 STR cases during the mean follow-up period of 62.0 months. Spinal cord subependymomas are amenable to surgical resection. It is possible to achieve GTR of intramedullary subependymomas that have a well-demarcated dissection plane. When GTR cannot be achieved, STR of the lesion for decompression is advised, and follow-up imaging is needed. A good clinical outcome after GTR or STR can be expected.

Clinical characteristics and surgical outcomes of spinal intramedullary ependymal cysts.

OBJECT: Intramedullary ependymal cysts are exceedingly rare lesions, and have been previously reported in the literature as case reports. The aim of this study was to discuss the clinical presentation and the outcomes of microsurgery for these benign lesions. METHODS: The authors retrospectively reviewed the records of ten patients who underwent microsurgery for intramedullary ependymal cysts. All patients had preoperative and postoperative magnetic resonance imaging. The surgical treatment included gross total resection and biopsy plus a cyst-subarachnoid shunt. The diagnosis of intramedullary ependymal cysts was based on radiological and pathological criteria. All patients were followed up, with a mean duration of 47.6 months. RESULTS: Intramedullary ependymal cysts were hypointense on T1-weighted images and hyperintense on T2-weighted images. Contrast-enhanced T1-weighted images showed no enhancement. Gross total resection was achieved in one case. Biopsy of the cyst wall plus cyst-subarachnoid shunt placement was achieved in nine cases. Long-term neurological function was improved in eight patients. No recurrence was observed on magnetic resonance imaging. CONCLUSIONS: Ependymal cysts should be considered in the differential diagnosis of intramedullary cysts. For symptomatic patients, early surgery should be performed before neurological deficits deteriorate. Complete decompression and cyst-subarachnoid shunt placement is the optimal treatment and the outcome may be favorable.

Spinal angiolipoma: experience of twelve patients and literature.

PURPOSE: To summarize our experience in treating patients with spinal angiolipomas. MATERIALS AND METHODS: We conducted a retrospective review of the case records of patients with spinal angiolipoma who underwent surgery between March 1992 and March 2013. RESULTS: Of the 12 patients seen during the study period, 10 patients had total removal of the lesion and 2 patients had sub-total removal. The postoperative course was uneventful, and the outcomes were good in patients who underwent total excision of the lesion. No patient received adjuvant radiation even in the patients with sub-total excision. CONCLUSION: In patients with spinal angiolipoma, total excision should be achieved and is associated with good outcomes.

[Clinical classification and surgical management of cervicothoracic intraspinal lipomas].

OBJECTIVE: To explore the clinical classification and surgical management of cervicothoracic intraspinal lipomas. METHODS: A total of 22 patients with cervicothoracic intraspinal lipomas were analyzed retrospectively with regards to clinical manifestations, radiographic features, intraoperative findings, surgical techniques and follow-ups. RESULTS: Total (n = 4), subtotal (n = 7) and partial (n = 11) resection was performed. Long-term neurological outcomes were evaluated by modified McCormick classification scheme. Their symptoms improved (n = 15), unchanged (n = 3) and deteriorated (n = 4). And cervicothoracic intraspinal lipomas could be classified into extradural, transitional, chaotic and secondary intramedullary groups. CONCLUSION: Different groups of cervicothoracic intraspinal lipomas vary in the degree of resection and surgical efficacy. Total resection may be performed on most extradural lipomas. The surgical objective of transitional lipomas is decompression. Chaotic and secondary intramedullary lipomas should target effective resection to avoid neurological function injury. Intraoperative use of laser facilitates tumor resection. Intraoperative electrophysiological monitoring protects spinal cord.

[Clinical features and microsurgical treatment of spinal intramedullary cavernoma].

OBJECTIVE: To explore the clinical features and microsurgical treatment of spinal intramedullary cavernomas (SICs). METHODS: A total of 21 patients with pathologically confirmed SIC undergoing microsurgical resection of cavernomas at Beijing Tiantan Hospital and Taian Central Hospital from June 2005 to December 2012 were reviewed retrospectively. RESULTS: The postoperative neurological status improved (n = 13) and remained unchanged (n = 6) and aggravated (n = 2). CONCLUSION: The clinical features of SICs are related with their different pathological processes. Magnetic resonance imaging (MRI) is specific for the diagnosis of SICs. Appropriate strategies and refined microsurgical techniques are essential for improving the clinical efficacies of SICs.

[Outcome of microsurgical decompression combined with cervical artificial disc replacement].

OBJECTIVE: To study the microsurgical decompression combined with cervical artificial disc replacement clinical efficacy for the treatment of cervical spondylosis. METHODS: From January 2006 to November 2011, 21 cases of cervical spondylosis, totally 23 intervertebral spaces, were under the microscope disc decompression and cervical artificial disc replacement. There were 11 male and 10 female patients; aged from 28 to 60 years, with an average of 46.3 years. The diagnosis included 5 cases of nerve root type cervical spondylosis and 16 cases of cervical spondylotic myelopathy. Application of Bryan prosthesis treatment of 9 patients, a total of 10 intervertebral spaces; ProDisc-C prosthesis to treat 12 patients, a total of 13 intervertebral space. Following-up Japanese Orthopedic Association (JOA), neck disability index (NDI) and visual analogue scale (VAS) scores were recorded and compared with pre-operative scores by the paired t-test. RESULTS: The patients were followed up for 6 to 74 months, with an average of 27.7 months. Although a patient with spinal bony stenosis symptom improved, but not satisfied, and after the posterior decompression, who had a better prognosis. The remaining patients during follow-up symptoms were obvious improved, and the replacement segments were stable. There was no prosthesis subsidence and significantly offset. In 1 month post-operation and last follow-up compared with pre-operative scores, JOA (t = 9.195 and 17.070), NDI (t = 7.193 and 14.062) and VAS (t = 14.851 and 16.133) scores were significantly different (P < 0.05); and 1 month post-operation compared with last follow-up, JOA (t = 5.916), NDI (t = 7.722) and VAS (t = 4.564) scores were significantly different (P < 0.05). CONCLUSIONS: Cervical artificial disc replacement combined with microscopic decompression surgery can completely remove the oppression of nerve tissue caused by pressure, and the efficacy is more secure.

Real-Time Navigation with Guide Template for Pedicle Screw Placement Using an Augmented Reality Head-Mounted Device: A Proof-of-Concept Study.

Objective: This study aims to explore the real-time navigation with guide template using an augmented reality head-mounted device (ARHMD) for pedicle screw placement. Methods: The spatial coordinate relationships between augmented reality images and real objects were established through the custom-made guide template, and the registration and tracking were completed using an ARHMD. The feasibility and accuracy of this method were verified by pedicle screw placement in 2 lumbar models. According to the Gertzbein-Robbins grading scale, the accuracy of pedicle screw placement was assessed. The navigation errors were estimated by measuring the deviation values of entry point and trajectory angle. Results: A total of 20 pedicle K-wires were placed into L1-L5 in 2 lumbar models, which were successfully completed, with an average time of 11.5 min per model and 69 s per screw. The overall K-wires placement accuracy was 100% (20 screws). The navigation error was 2.77 ± 0.82 mm for the deviation value of entry point, and 3.03° ± 0.94° for the deviation value of trajectory angle. Conclusions: The application of an ARHMD combined with guide template for pedicle screw placement is a promising navigation approach.

Intratumor Injection of Thermosensitive Polypeptide with Resveratrol Inhibits Glioblastoma Growth.

Local tumor treatment is a feasible measure for patients with glioblastoma (GBM) who are unsuitable for surgical resection. Interferon-elastin-like polypeptide [IFN-ELP(V)] is a slow-release, biodegradable, thermosensitive fusion protein with antitumor immunity, and resveratrol (Res) is a polyphenolic compound with an antitumor effect. In this study, we found that intratumor injection of IFN-ELP(V) combined with intraperitoneal injection of Res is more effective in delaying GBM growth in mice. Specifically, in an orthotopic GBM model, we found a significant improvement in the median survival with this strategy. Our results suggested that the combined use of IFN-ELP(V) and Res has a dramatic synergistic effect on GBM, thus providing a novel and effective therapeutic strategy for tumors. Impact statement We report a novel and effective strategy in which the combined use of interferon-elastin-like polypeptide [IFN-ELP(V)] and Res effectively inhibits glioblastoma growth. IFN-ELP(V) can create a reservoir in the tumor and continuously release IFN to produce a powerful in situ antitumor immune response; furthermore, the combination of IFN-ELP(V) and Res is more effective in inhibiting tumor growth.

Emotional Problems, Quality of Life and Symptom Burden in Patients with Chordoma.

Chordomas are very rare malignant bone tumors. Following surgery, their effects on neurological, physical, psychological, social, and emotional functioning are substantial and can have a major impact on a patients' quality of life (QOL). In this survey, we aimed to characterize the postoperation health-related QOL and emotional problem in patients with chordoma using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30 (EORTC QLQ-C30) and Hamilton Depression Rating Scale (HAMD). The cohort included 100 patients who underwent resection surgery between 2014 and 2020. Being single or divorced, living in a rural area, receiving a diagnosis of sacrococcygeal chordoma, Karnofsky performance status (KPS) ≤ 70, and weight loss were associated with increased likelihood of depression (p < 0.05). Patients who were single or divorced, with KPS ≤ 70, and experiencing weight loss had a higher likelihood of a worse QOL (p < 0.05). The uni- and multivariate logistic regression analyses indicated that the KPS level (p = 0.000) and postoperative radiation therapy (p = 0.009) were related to depression; marital status (p = 0.029), KPS level (p = 0.006), and tumor location (p = 0.033) were related to worse QOL. Certain characteristics placed patients with chordoma at increased risk of emotional problems, which are associated with a lowered QOL and a higher symptom burden. Further knowledge regarding emotional problems is key to improving the QOL for patients with chordoma.