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Minim Invasive Neurosurg 2011; 54(03): 135-137
DOI: 10.1055/s-0031-1283128
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Spontaneous Debulking of Middle Fossa Chordoma Extension after Transnasal Petroclival Biopsy – Report of a Case

G. Singh
1   Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
,
P. Nakaji
1   Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
,
F. Chen
1   Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
,
M. Garrett
1   Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
,
A. Little
1   Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
,
J. Milligan
2   Division of Otorhinolaryngology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
23 August 2011 (online)

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Abstract

Background:

Clival chordomas are difficult tumors to treat, particularly when they have already grown beyond the confines of the clivus.

Patient:

We report the case of a 52-year-old man with a clival mass consistent with a chordoma with a prominent extension into the right middle fossa. At the patient’s request, he underwent a simple endonasal biopsy to confirm the diagnosis. A second debulking procedure was planned to debulk the remnant tumor. However, follow-up magnetic resonance imaging showed that much of the middle fossa tumor had decompressed itself through the clival defect into the patient’s pharynx.

Results:

The patient underwent additional clival debulking and proton-beam therapy. After 44 months of follow-up, he had no clinical or radiographic progression of disease.

Conclusion:

It is intriguing to think that leaving a path for easy egress for a chordoma from the clivus may prevent it from building up in the bone and spreading.

Key words

chordoma - endonasal biopsy - minimally invasive procedure
 

  • References

  • 1 Fraser JF, Nyquist GG, Moore N et al. Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. Neurosurgery 2010; 67: 150-158
    PubMedGoogle Scholar
  • 2 Ito E, Saito K, Okada T et al. Long-term control of clival chordoma with initial aggressive surgical resection and gamma knife radiosurgery for recurrence. Acta Neurochir (Wien) 2010; 152: 57-67
    CrossrefPubMedGoogle Scholar
  • 3 Okamoto K, Ito J, Ishikawa K et al. Diffusion-weighted echo-planar MR imaging in differential diagnosis of brain tumors and tumor-like conditions. Eur Radiol 2000; 10: 1342-1350
    CrossrefPubMedGoogle Scholar
  • 4 Catton C, O’Sullivan B, Bell R et al. Chordoma: long-term follow-up after radical photon irradiation. Radiother Oncol 1996; 41: 67-72
    CrossrefPubMedGoogle Scholar
  • 5 Stippler M, Gardner PA, Snyderman CH et al. Endoscopic endonasal approach for clival chordomas. Neurosurgery 2009; 64: 268-277
    CrossrefPubMedGoogle Scholar
  • 6 Van Lierop AC, Fagan JJ, Taylor KL. Recurrent chordoma of the palate occurring in the surgical pathway: a case report. Auris Nasus Larynx 2008; 35: 447-450
    CrossrefPubMedGoogle Scholar