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Clival Chordoma: Endoscopic Bilateral Transmaxillary Approach
A Samy Youssef1, Alexander Yang2, Anne E Getz3
1Department of Neurosurgery and Otolaryngology, University of Colorado, Aurora, Colorado, United States.
Journal of Neurological Surgery. Part B, Skull Base
|November 22, 2019
Summary
This case study details the successful endoscopic removal of a large clival chordoma using an expanded endonasal approach. The minimally invasive technique achieved gross-macroscopic resection, offering a viable treatment option for complex skull base tumors.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Clival chordomas are rare bone tumors originating in the skull base.
- Large tumors can cause significant symptoms and pose surgical challenges.
- Endoscopic endonasal approaches offer minimally invasive access to the skull base.
Purpose of the Study:
- To present a case of a large clival chordoma treated with an expanded endoscopic endonasal approach.
- To demonstrate the feasibility and outcomes of this surgical technique for complex skull base tumors.
- To highlight the use of stereotactic navigation and combined transmaxillary-transclival corridors.
Main Methods:
- Expanded endoscopic endonasal approach with stereotactic navigation.
- Bilateral transmaxillary approach with ethmoidectomy and transclival corridor creation.
- Dissection from cavernous sinuses, gross-macroscopic resection, and skull base reconstruction.
Main Results:
- Successful gross-macroscopic resection of a large clival chordoma.
- Unremarkable postoperative course with no complications.
- Achieved tumor-free status at 6-month follow-up after adjuvant radiotherapy.
Conclusions:
- The expanded endoscopic endonasal approach is a safe and effective method for resecting large clival chordomas.
- Minimally invasive techniques can achieve complete tumor removal while preserving critical neurovascular structures.
- Adjuvant radiotherapy plays a role in managing residual or recurrent chordoma.
