[Transcervical and transoral approach to clival and upper cervical chordoma: a case report]

The patient, a 48-year-old man, was first admitted in 1981 for the chief complaints of retropharyngeal tumor and anosmia. Computerized tomography scan disclosed destruction of the lower half of the clivus and retropharyngeal tumor predominantly located in the third prevertebral region. The tumor was removed partially via the transcervical approach and was histologically a typical chordoma. Two years later the tumor recurred and was operated on by the same approach. However, only partial removal of the tumor was realized due to difficulties in dissecting the fibrous adhesion. In 1986 (7 years after onset of the symptoms), the patient was readmitted due to severe dysphagia. The sagittal MRI scan demonstrated a huge oval retropharyngeal tumor with precise delineation between the tumor and clivus, clivus upper cervical spine and brain stem. The tumor was extirpated subtotally on the midline via the transoral approach. Dysphagia completely improved postoperatively and the patient regained normal smell sensation. The advantages and disadvantages of the transcervical and transoral approach to clival lesion are discussed and the advantage of the MRI imaging is stressed for preoperative information for the transoral approach.