Corridor surgery: the current paradigm for skull base surgery

Abstract

Clival chordomas are rare tumors, especially in the pediatric population. In this report, we present the case of a 3-year-old boy who was found to have a large posterior pharyngeal, clival, and posterior fossa tumor detected on a CT scan after a closed head injury. Further questioning revealed a history of ataxia and dysphagia. Imaging confirmed severe extrinsic brain stem compression. The tumor was resected in multiple stages utilizing a minimally invasive endoscopic endonasal technique along with open transfacetal, transcondylar approach through the carotid-vertebral window. The child suffered no permanent complications as a result of our treatment and his dysphagia significantly improved. Although a complete resection was not feasible due to vascular encasement by the tumor, extensive decompression was obtained with minimal morbidity. We present this case to illustrate a new paradigm of skull base surgical approaches for large clival lesions in pediatric patients that allows aggressive resection with minimal morbidity.