Background: Chordomas in the clival-cervical region present challenges to the neurosurgical team
due to their encroaching nature, proximity to critical neurovascular structures and
for the presence, often, of cranio-cervical instability. Moreover, giant chordomas
may occur with acute compression of the bulbo-medullary junction and neurological
worsening. In these cases, the first goal of surgery is the decompression of the bulbo-medullary
junction followed by a second stage in which the residual tumor was resected and the
craniocervical junction was reconstructed.
Methods: We presented three cases of giant clival chordomas with extension to the cranio-vertebral
junction and acute compression of neurovascular structure treated first by endoscopic
endonasal transclival approach to decompress directly the central part of the tumors
causing the compression followed by large degloving “open” procedures for the resection
of lateral residual tumor and reconstruction.
Results: The endoscopic endonasal approach guaranteed an adequate bulbo-medullary decompression
in all patients. The extended open transmandibular–transcervical approach allowed
us the complete resection of lateral residual of the tumor and the complete reconstruction
and fixation of craniovertebral junction in all patients.
Conclusion: The endoscopic transnasal approach guarantees a straightforward, saving-time and
minimally invasive natural surgical corridor for promptly decompression of the anterior
craniocervical junction. The subsequent open approaches provided greater lateral exposure
to maximize surgical resection and optimal reconstruction with subsequent improving
of patients survival and quality of life.
