Endoscopic Resection of Clival Chordomas: A Single-Institution Case Series

Introduction: Clival chordomas are rare and aggressive tumors with little published data. Endoscopic chordoma resection is a recent innovation that has been controversial in the literature. We report surgical technique and outcomes for a series of six endoscopic chordoma resections at our institution.

Methods: All patients were treated between 2012 and 2020. All surgeries utilized an endoscopic transsphenoidal approach. Two patients had tumors with extension into the cavernous sinus, and one of these required a combined open and endoscopic approach for resection.

Results: Patients ages ranged from 10 to 82; four were male and two female. Two patients required a staged-endoscopic approach with two surgeries. Two intraoperative CSF leaks were noted. Gross total resection was achieved for all patients. All defects were closed with nasoseptal flaps, and bilateral nasoseptal flaps were utilized for one patient. All patients received postoperative radiation except for one who declined due to age.

The patient with a combined open and endoscopic resection passed away after a hospital course complicated by stroke and pneumonia. All endoscopic-only patients are currently alive and without recurrence. One patient with cavernous sinus invasion had a postoperative CN VI palsy; there were no other postoperative complications. No postoperative CSF leaks were noted.

Conclusion: We demonstrate that endoscopic resection is a safe procedure with favorable outcomes for appropriate tumors. The nasoseptal flap is an effective technique for closure.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021