Transnasal Endoscopic Approach for Clivus Chordoma: Surgical Technique and Experience and Technical Modifications

Abstract

Background: There seems to be a consensus that clivus chordoma (CC) should be surgically attempted and radiated with proton beam therapy. During the last decades, lateral access performed with infratemporal fossa approaches was considered the mainstay for surgical removal. Due to the proximity of vital structures such as the internal carotid and basal arteries and cranial nerves, a wide exposure is mandatory. Moreover, because surgery using a microscope requires a large field of exposure for a small target field (similar to an inverted cone), patients are confronted with significant morbidity only by the surgical approach. The upcoming endoscopic techniques act the other way around (small access and wide target field) and thus seem to be promising. Special surgical skill and anatomic knowledge are required to achieve similar results by the endoscopic technique. In addition, not all tumors can be approached transnasally.