Unusual Huge Clival Chordoma with Compression to Brain Stem Treated with Endoscopic Transnasal Trans-Sphenoidal Approach

Abstract

Background: Surgical approach for clival tumor is an invasive treatment that associated with significant rate of morbidity and mortality. We describe transnasal endoscopic approach for treatment of clival chordoma.

Case presentation: the patient is a 37 years old man that suffered from headache, diplopia, dysphagia and dysphonia. MRI revealed huge clival mass lesion (isointense in T1 and T2) that compress brainstem. On contrast-enhanced MRI enhancement was shown. A neuronavigational image-guided endoscopic transnasal-sphenoidal approach was performed to total resection of the tumor. After surgery pathological diagnosis was made as chordoma. After one week the patient discharge with good condition and no more neurological deficit was observed.

Conclusion: endoscopic transnasal trans-sphenoidal approach is an excellent choice for resection of clival mass particular which are located medially. With advancement of instrument this approach will be treatment of choice for many of these tumors.