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Total Resection of Clival Chordoma with Brainstem Invasion via Endoscopic Transnasal Approach: Technical Note
Guenther C Feigl1, Roman Bosnjak2, Daniel Staribacher3
1Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany; Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA; Department of Minimally invasive neurosurgery, Clinic Oberwart, Oberwart, Austria.
World Neurosurgery
|May 18, 2025
Summary
This study details a rare case of clival chordoma invading the brainstem. A successful endoscopic resection was performed, demonstrating that complete tumor removal is achievable for this challenging condition.
Area of Science:
- Neurosurgery
- Oncology
- Otorhinolaryngology
Background:
- Clival chordomas invading the brainstem are exceptionally rare, with only five prior reports.
- Surgical resection of these tumors presents significant intraoperative risks and challenges for neurosurgeons.
- Tumor resection quality is a critical factor for patient prognosis, even with proton therapy.
Purpose of the Study:
- To report a rare case of clival chordoma with brainstem invasion.
- To illustrate a successful surgical approach for complete tumor resection.
- To highlight the feasibility of achieving total resection in select cases.
Main Methods:
- A case report of a 39-year-old male patient presenting with diplopia and left trochlear nerve palsy.
- Diagnosis of clival chordoma with brainstem invasion confirmed.
- Surgical intervention via a unilateral left mononostril endoscopic transnasal approach.
Main Results:
- Successful gross total resection of the clival chordoma.
- Postoperative development of mild left abducens nerve paresis.
- Improvement of abducens nerve palsy during the postoperative period.
Conclusions:
- Clival chordomas with brainstem invasion represent an extremely rare clinical entity.
- Total tumor resection can be accomplished in specific circumstances.
- Endoscopic endonasal approaches offer a viable surgical option for these complex tumors.
