Extreme Lateral Transodontoid Approach for Resection of Clival Chordoma: 2-Dimensional Operative Video.

Area of Science:

• Neurosurgery
• Oncology
• Radiology

Background:

• Chordomas are rare, slow-growing bone tumors arising from notochordal remnants.
• Craniovertebral junction (CVJ) chordomas present diagnostic and surgical challenges due to proximity to critical neurovascular structures.
• Early diagnosis and complete resection are crucial for favorable outcomes in CVJ chordomas.

Observation:

• A 15-year-old female presented with nasal obstruction, dysphagia, weight loss, and hoarse voice.
• Imaging revealed an erosive clival and occipital condyle lesion with significant brainstem compression at the CVJ.
• Biopsy confirmed chordoma; the tumor extended into the retropharyngeal space.

Findings:

• Complete tumor resection was achieved using the left extreme lateral transodontoid (ELTO) approach.
• This approach provided bilateral exposure of the ventral CVJ and retropharyngeal space for single-stage resection.
• Postoperative MRI confirmed gross-total resection and brainstem decompression; proton beam therapy is planned.

Implications:

• The ELTO approach is a viable option for complex CVJ chordomas, enabling complete resection.
• Multidisciplinary management, including surgery and adjuvant radiotherapy, is essential for chordoma treatment.
• Further research into optimizing surgical techniques and adjuvant therapies for CVJ chordomas is warranted.