[Surgical treatment of clival chordomas]

Clival chordomas are benign neoplastic tumors displaying high morbidity and mortality rates. The difficulties involved in obtaining a total resection and its infiltrative nature explain this aggressiveness.

We present a retrospective clinical series of 8 surgically treated cases of clival chordomas at our department from 1993 to 2006.

All 8 patients underwent a total of 14 surgical procedures, 6 of which were anterior approaches (5 transmandibular), 2 subtemporal-preauricular, 2 from the transcondylar lateral edge and 2 transcochlear. In 7 patients the surgery was performed with curative intent. In 2 cases it was necessary to perform the surgery sequentially, in two steps. Total resection was achieved in 58% of patients. Average follow up was 40 months. Two patients died due to local recurrence, one patient died in the postoperative period and another died due to causes which were not related with the tumor.

The low incidence of clival chordomas makes it difficult to carry out random clinical studies of its management. The treatment of choice is surgery, supplemented by radiotherapy in selected cases. We prefer to use the transmandibular approach, combined with transcondylar lateral edge approach when the occipital condyle is infiltrated. For lateral extensions, we use the subtemporal-preauricular or transpetrosal approaches. New radiotherapy modalities provide an effective treatment of tumoural residues.

Extradural approaches imply anatomical regions which are familiar for otolaryngologists. Specific knowledge about the limitations of each approach is essential in order to avoid unnecessary morbidity and incomplete resections.