Multiple Approaches for Pediatric Chordoma Resection With O-C4 Fusion

Because the natural history of chordomas is one of persistent local recurrence with tumor growth, treatment of chordomas in both adults and children consists of an effort at complete resection whenever possible followed by stereotactic proton beam radiotherapy. The authors present the 3D video of a case of a large pediatric skull base chordoma demonstrating that multiple approaches may be combined to allow for complete resection and that surgical judgment must be based on the patient’s particular anatomy and deficits. An 8-year-old girl presented with 1 week of progressive upper extremity weakness and a 1-year history of neck pain. Magnetic resonance imaging (MRI) demonstrated a very large skull base lesion involving the clivus and upper cervical spine. The initial resection was performed via an endonasal endoscopic and microscopic transclival approach. Because of the fibrous nature of the tumor, gross total resection could not be achieved, and left and right far-lateral approaches with transposition of both vertebral arteries and an occipital cervical fusion were necessary for complete resection of this tumor. This patient’s good outcome emphasizes that management of a complex chordoma often requires multiple approaches to attain a gross total resection providing the patient with improved prognosis.

Видео Multiple Approaches for Pediatric Chordoma Resection With O-C4 Fusion канала NEUROSURGERY Journal