Surgical treatment of clival chordomas

Abstract Introduction Clival chordomas are benign neoplastic tumours displaying high morbidity and mortality rates. The difficulties involved in obtaining a total resection and its infiltrative nature explain this aggressiveness. Materials and method We present a retrospective clinical series of 8 cases of clival chordomas treated surgically at our department from 1993 to 2006. Results All 8 patients underwent a total of 14 surgical procedures, 6 of which were anterior approaches (5 transmandibular), 2 subtemporal-preauricular, 2 from the extreme lateral transcondylar and 2 transcochlear. In 7 patients, the surgery was performed with curative intent. In 2 cases, it was necessary to perform the surgery sequentially, in two steps. Total resection was achieved in 58% of patients. Average follow up was 40 months. Two patients died due to local recurrence, one patient died in the postoperative period and another died due to causes not related with the tumour. Discussion The low incidence of clival chordomas makes it difficult to carry out random clinical studies of its management. The treatment of choice is surgery, supplemented by radiotherapy in selected cases. We prefer the transmandibular approach, combined with extreme lateral transcondylar approach when the occipital condyle is infiltrated. For lateral extensions, we use the subtemporal-preauricular or transpetrosal approaches. New radiotherapy modalities provide an effective treatment of tumour residues. Conclusions Extradural approaches imply anatomical regions familiar for otolaryngologists. Specific knowledge about the limitations of each approach is essential to avoid unnecessary morbidity and incomplete resections.