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Clival chordoma with an atypical presentation: a case report
Jaber Alshammari1, Philippe Monnier, Roy T Daniel
1Department of Otorhinolaryngology, University Hospital - CHUV, Lausanne, Switzerland. kishore.sandu@hopitalvs.ch.
Journal of Medical Case Reports
|December 1, 2012
Summary
Cerebrospinal fluid rhinorrhoea can be a rare sign of clival chordoma, an erosive skull base lesion. Early diagnosis and surgical intervention are crucial for effective treatment of this challenging condition.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Clival chordomas are rare tumors that can cause symptoms like headaches and cranial nerve palsies.
- Occasionally, these tumors lead to cerebrospinal fluid (CSF) leaks (rhinorrhoea) due to skull base erosion.
Purpose of the Study:
- To highlight a rare presentation of clival chordoma causing meningitis via CSF rhinorrhoea.
- To emphasize the diagnostic challenges and importance of surgical exploration for suspected erosive lesions.
Main Methods:
- Case report of a 60-year-old woman with meningitis secondary to CSF rhinorrhoea.
- Initial imaging was inconclusive; diagnosis was confirmed via intraoperative findings and histological analysis of a clival chordoma.
Main Results:
- The chordoma had eroded the clivus and extended through the dura.
- Initial radiological assessment failed to identify the underlying tumor.
Conclusions:
- Meningitis with CSF rhinorrhoea may indicate an underlying, potentially missed, erosive lesion.
- Histological diagnosis after surgical exploration is vital for guiding treatment.
- Revision endoscopic excision of clival chordomas presents significant surgical challenges.
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