[Three cases of intracranial chordoma. Typical chordoma and chondroid chordoma]

Three cases of intracranial chordoma: 2 cases of typical chordoma and a case of chondroid chordoma, were reported and the clinico-pathological difference between these two types of chordoma was discussed. It is well known that typical chordoma is composed of physaliferous cells containing various quantities of intracytoplasmic mucin histologically, whereas chondroid chordoma as Heffelfinger reported in 1973 is composed of cellular area with scanty myxoid matrix and Chondroid matrix. Clinical course of the typical chordoma shows recurrence of the tumor within 2 years after surgical removal and radiation therapy in the majority of the cases, and the average survival range is said to be about 4.1 years, while chondroid chordoma takes benign course with average survival of 24.1 years after surgery and radiation therapy. One of our two patients with typical chordoma died from the recurrence two years after surgery and radiation therapy. However, the patients with chondroid chordoma showed no sign of recurrence over 2 years after subtotal removal and radiation. Surgical approach for the removal of the tumor was discussed as well. When the tumor is rather small and located at the upper clival region, transsphenoidal approach may be preferable, otherwise other approach should be chosen. When tumor has forward extension over the clivus, subtemporal approach will be most favorable with wider operative field. Identification of vessels and nerves around the tumor will be readily obtained by this approach.