Chordomas are rare malignant tumors arising from embryonic remnants of the primitive
notochord, around which the skull base and vertebral column develop. They are locally
aggressive but metastasize rarely. To our knowledge, this is the first reported case
of synchronous intraosseous chordomas. A 32-year-old man presented with intermittent
double vision secondary to a right-side abducent nerve palsy. Imaging revealed a clivus
chordoma and an asymptomatic synchronous second primary chordoma in the fifth lumbar
vertebra. Both chordomas were surgically excised: the clivus using the endonasal,
endoscopic route and the L5 vertebra by total vertebral excision and replacement with
a titanium prosthesis. The patient made an uneventful and complete recovery. We have
modified our departmental practice as we believe that all patients diagnosed with
chordoma should have magnetic resonance imaging of their entire spinal tract to exclude
a second primary chordoma.
Clivus chordoma - synchronous - multiple - imaging - endonasal excision - abducent
nerve palsy
