Endonasal fusion imaging-assisted navigated resection of a clival chordoma -Augmented Reality in Endoscopic Skull Base Surgery

Introduction Clival chordoma is a rare, locally infiltrating, and destructively growing tumor of the skull base. Gross total resection (GTR), in combination with concomitant radiotherapy, is usually pursued. GTR may be difficult due to the close anatomic relationship to surrounding structures at risk and is largely dependent on the experience of the surgeon. Despite significant advances through endoscopic endonasal resection techniques, the overall prognosis for cranial chordomas is still poor with a disease-specific 5-year survival rate of only 60-70%.

Case An 82-year-old female patient presented with an incidental finding on magnetic resonance imaging (MRI) of the head and neck region of an approximately 1.7 x 1.6 x 1.5 cm mass in the nasopharyngeal region with contact to the clivus. A biopsy revealed evidence of a clival chordoma. As part of resection planning, we performed computed tomography (CT)/MRI fusion imaging to visualize the tumor margins more accurately. We used the feature of our navigation system (NAV1TM optical; Karl Storz, Tuttlingen, Germany) designed to highlight risk structures in the image dataset, in order to define the resection margins. With the help of navigated instruments as well as acoustic and visual support for the exact preservation of the previously defined safety margins, a GTR could be performed while protecting the surrounding structures.

Conclusion Fusion imaging-based navigation can add another dimension to the endoscopic view in the context of clival chordoma resection and increase the safety of GTR to improve long-term treatment success.

Publication History

Article published online:
12 May 2023