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Updated: May 3, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Clival chordoma of the nasal septum secondary to surgical pathway seeding
J Peyton Hines1, Mary G Ashmead2, Scott P Stringer2
1Department of Otolaryngology, Mayo School of Graduate Medical Education, Phoenix, AZ, USA.
Educational Objective:
At the conclusion of this presentation, the participants should be able to recognize seeding as a form of treatment failure in transseptal resection of clival chordomas.
Objectives:
The purpose is to present a case of implanted metastases in the nasal septum after a transseptal approach for resection of clival chordoma and to compare it with other reported cases in the literature.
Study Design:
Case report and literature review.
Methods:
The clinical history, radiologic imaging, and pathology of a single patient are reviewed.
Results:
A 35-year-old female presented with a left intranasal mass that completely occluded the left nasal passage. The patient had a history of clival chordoma treated at an outside institution with multiple partial resections via a transseptal approach and postoperative Gamma Knife radiotherapy. A 2.5 cm mass in the left nasal cavity as well as a 4 cm sellar mass was identified on MRI. Biopsy of the left nasal mass confirmed the diagnosis of chordoma, which was presumed to be secondary to seeding from a previous resection attempt. The patient received no further treatment due to multiple comorbidities.
Conclusions:
Recurrence of clival chordoma due to seeding along the surgical pathway is an infrequent mechanism of treatment failure, with only rare cases documented in the literature. When deciding on the appropriate surgical approach, the surgeon must consider the risk of septal seeding during a transseptal approach. The emergence of transnasal endoscopic skull base approaches may reduce the likelihood of surgical pathway tumor seeding.
Insights
Tumor seeding in the nasal septum is a rare complication of transseptal surgery for clival chordoma. This case highlights the importance of considering this treatment failure pathway.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Clival chordomas are rare bone tumors originating in the skull base.
- Transseptal approaches are utilized for surgical resection but carry potential risks.
Observation:
- A patient with a history of clival chordoma treated with transseptal resection developed an intranasal mass.
- Imaging revealed a nasal septum mass, confirmed as chordoma on biopsy.
- This was presumed to be secondary to tumor seeding during prior surgical attempts.
Findings:
- Tumor seeding along the surgical pathway is an infrequent cause of treatment failure in clival chordoma resection.
- This case presents a rare instance of implanted metastases in the nasal septum.
Implications:
- Surgeons must weigh the risk of septal seeding when choosing transseptal approaches for clival chordoma.
- Transnasal endoscopic skull base surgery may offer a reduced risk of tumor seeding compared to traditional transseptal methods.
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