Trans-sphenoidal Approach to Midline Extradural Clival Chordoma: Report of Three Cases

Abstract

Introduction: Clival chordomas represent skull base tumors with epithelial and mesenchymal aspects that show a high propensity for local recurrence and distant metastases through both the systemic and cerebrospinal routes. Even today these tumors maintain a high recurrence rate after surgery, especially in those cases involving the anterior cranial fossa and facial structures. The most effective first-line treatment for clival chordomas is surgery, but some studies demonstrated that a combined multimodality therapy including surgery and chemoradiotherapy may prolong the survival rate of these patients. To date, a trans-sphenoidal approach to treat clival chordomas, as well its technical variants, offers an excellent alternative to standard skull base approaches achieving the avoidance of a prolonged exposure time and brain retraction. The paper reports three cases of midline extradural clival chordomas operated via trans-sphenoidal approach and their clinical outcomes.