Transnasal Endoscopic Technique for Large Pediatric Clival Chordoma with Intradural Extension

Introduction: Clival chordomas comprise only 1 to 2% of all intracranial tumors. They are even more uncommon in the pediatric population. We present a case of an 8-year-old girl who had a large clival chordoma with intradural extension and the minimally invasive surgical management performed.

Case Discussion: An 8-year-old girl with history of vision changes for 3 years, who underwent surgery for amblyopia correction, was found to have a large clival mass with intradural extension. Significant compression of the brainstem, third ventricle, and remaining posterior fossa cerebrospinal fluid aqueductal system resulted in development of multiple cranial nerve palsies and obstructive hydrocephalus. Using a transnasal endoscopic technique, only the tumor was resected with resolution of the hydrocephalus and improvement of cranial nerve deficits.

Conclusion: A transnasal endoscopic approach under the appropriately trained surgeon allows for aggressive removal of clival chordomas with intradural extension in the pediatric population. Furthermore, this report helps to illustrate that this type of minimally invasive skull base approach can be safely performed in the appropriately structured medical center in the private sector.