Clival chordomas: The endoscopic transnasal transsphenoidal approach

Abstract

Cranial base chordomas are rare, locally aggressive tumours. They represent a surgical challenge due to their proximity to vital neurovascular structures and hight potential to recur. The authors describe the case report of a 45 year-old woman, with history of headache, anisocoria and diplopia for five months. Complementary exams revealed an extensive lesion occupying the superior 2/3 of the clivus, with extension to the sphenoid sinus, to both cavernous sinus and destruction of the sellar region. After diagnostic biopsy compatible with chordoma, the patient underwent surgical removal by endoscopic transnasal transsphenoidal (ETT) approach, with image guidance. At 3 months of follow-up the patient has no complaints and the magnetic resonance imaging reveals an eventual residual tumor in the right cavernous sinus. The ETT approach is a valid minimally invasive alternative for the treatment of cranial base tumours, providing the potential, in selected cases, for, at least, similar resections compared with traditional techniques, with limited morbidity.