Intradural spinal seeding metastasis of clival chordoma: a case report

Clival chordoma is a locally aggressive tumor originating from remnants of the embryologic notochord. Although clival chordomas account for only 0.2% of all central nervous system tumors, they are characterized by local invasion and destruction, dural invasion, bone erosion, and cranial nerve palsy, and even metastasis.

We report a case of a 49-year-old female with an intradural spinal seeding metastasis 16 months after the initial endoscopic endonasal surgery (EES) for a clival chordoma. Gross total resection of tumor in upper clival region was achieved after initial EES and pathology revealed a classic chordoma. After 10 months, follow-up magnetic resonance (MR) showed a recurrence in situ and gamma knife was applied. After 16 months, the patient complained of neck pain and MR showed a new lesion in the spinal canal at C1 to C2 level. After craniotomy, the lesion in the spinal canal was totally removed, and pathology confirmed a chordoma with increased proliferative potential. The spinal chordoma might have occurred as a result of intradural spinal seeding metastasis through cerebral spinal fluid the during the initial operation.

Chordomas are not only locally aggressive but also unpredictable and may metastasize through cerebral spinal fluid. Intensive follow-up is of great importance in the long term postoperatively time for clival chordoma patients.