Combined Endoscopic Endonasal and Transoral Surgery for a Chordoma in the Whole Clivus With Marked Caudal Extension

Abstract

Surgery for chordoma in the craniocervical junction is challenging because tumor occasionally extends below the inferior limit of endoscopic endonasal surgery (EES), which was previously described as the nasopalatine line. To overcome this limitation, several case reports of EES combined with transoral robotics have been reported; however, clinical application of the combined surgery for chordoma patients without using robotics has not been described in detail, therefore, we present here as a surgical video. A patient suffered from chordoma from the upper to lower clivus extending down to the level of the C2 vertebral body in the bilateral parapharyngeal space below the nasopalatine line. After resection of the tumor in the whole clivus by EES, the inverted U-shaped incision on the posterior pharyngeal wall was extended down to the oropharynx, until the entire C1 anterior arch and the lateral masses of C1 and C2 were exposed. Then, the tumor in the bilateral parapharyngeal spaces was resected by endoscopic transoral surgery. Finally, nearly total resection was achieved with preservation of the atlantoaxial joint without any complication. This technique without using robotics can be easily introduced and cost effective. Using this technique, the accessible area is expanded from the posterior clinoid process to the level of the C3 vertebra in the sagittal plane. The combined endoscopic endonasal and transoral surgery can be an effective alternative method to treat a challenging case of extensive clival and craniocervical chordoma. The patient consented to publication of his image. Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opx168 {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Combined Endoscopic Endonasal and Transoral Surgery for a Chordoma in the Whole Clivus With Marked Caudal Extension","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_qtoagi6d"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.