Combined endoscopic endonasal and posterior cervical approach to a clival chordoma

Chordomas in the clival-cervical region present challenges to the neurosurgical team due to their encroaching nature, proximity to critical neurovascular structures and often large size due to late presentation. This report illustrates the utility of a staged approach when confronted with such a pervasive tumour. We describe the adaptive combination of two approaches, the endoscopic endonasal transsphenoidal plus posterior cervical approaches, in the surgical management of a clival chordoma extending inferiorly to C3 in an 18-year-old male.