Endoscopic endonasal approach for resection of pediatric chordoma with brainstem invasion

Area of Science:

• Neurosurgery
• Endoscopic Skull Base Surgery
• Pediatric Oncology

Background:

• Chordomas are rare bone tumors that can occur along the skull base.
• Recurrence necessitates advanced surgical techniques for complete resection.
• Minimally invasive approaches are increasingly favored for complex skull base tumors.

Purpose of the Study:

• To describe the surgical technique and outcomes of an endoscopic endonasal approach for a recurrent pontine chordoma.
• To evaluate the feasibility and safety of this approach in a pediatric patient.

Main Methods:

• Orbitozygomatic craniotomy followed by endoscopic endonasal approach for tumor resection.
• Extensive clival and posterior clinoid exposure with internal carotid artery skeletonization.
• Resection of tumor from dural layers and brainstem, preserving neurovascular structures.

Main Results:

• Complete resection of the chordoma was achieved.
• The patient remained neurologically intact postoperatively.
• The endoscopic endonasal approach facilitated safe tumor removal from critical anatomical locations.

Conclusions:

• The endoscopic endonasal approach is a viable and effective option for managing recurrent pontine chordomas.
• This minimally invasive technique allows for maximal tumor resection with minimal morbidity.
• Preservation of the abducens nerve and pontine perforators is achievable with meticulous surgical technique.