Endoscopic Functional Debulking of a Destructive Clival-Sphenoid Benign Notochordal Cell Tumor

Extensive clival and sphenoid lesions may extend into the posterior sinonasal tract and produce progressive nasal obstruction. In selected patients, endoscopic sinus surgery may provide both diagnostic tissue acquisition and symptomatic functional improvement.

A 30-year-old man initially underwent evaluation for headache, and computed tomography and magnetic resonance imaging demonstrated a large destructive clival-sphenoid lesion. Because no progressive neurological deficits or cranial neuropathies were identified, the lesion was initially managed conservatively with observation. Several months later, worsening nasal obstruction developed because of extension of the mass into the posterior nasal cavity and nasopharynx. Endoscopic surgery was subsequently performed with a limited objective of functional palliative debulking to restore nasal airflow and obtain tissue for histopathologic evaluation. The procedure included bilateral endoscopic sinus surgery, posterior septectomy, and navigation-guided partial resection of the obstructing intranasal component. Histopathologic findings favored a benign notochordal-spectrum lesion. Postoperatively, the patient experienced improvement in nasal breathing, sleep-related discomfort, and voice-related symptoms, without clinically significant recurrent obstruction during short-term follow-up.

Endoscopic functional debulking may represent a reasonable management strategy for symptom relief and tissue diagnosis when definitive skull base resection is not feasible or would entail excessive morbidity.