Endoscopic Endonasal Surgery of Clival Chordomas: Preliminary Results

  • Davide Soloperto
  • Cristoforo FabbrisEmail author
  • Stefano De Rossi
  • Angelo Musumeci
  • Daniele Marchioni
Original Article


Chordomas are rare malignant tumors, often affecting the clival region. Traditionally, they are removed via craniotomic approach but the introduction of the endoscopic endonasal technique (EEA) allowed to control this area. This article shows a series of patients affected by clival chordomas treated with endoscopic approach. Patients who underwent EEA or transoral approach (TO) for clival chordomas at our Skull Base Referral Center, have been retrospectively examined. Clinical symptoms, preoperative neuroradiological evaluation, surgical approach, complications and postoperative results were evaluated. Nine patients (4 females and 5 males; age range 45–82 years, mean 61 years) were included. Chordomas involved upper clivus in 4/9 cases, with (2) or without (2) extension to the middle clivus, middle clivus alone in 2/9, lower clivus in 2/9, and the whole clivus in 1/9. Tumors were totally (4/9) or subtotally (5/9) removed. Skull base reconstruction was performed with a multilayer technique (6/9) or a gasket-seal closure (1/9), using pedicled nasoseptal flaps, middle turbinate and mucoperichondrial grafts, fascia lata and synthetic fascia. No reconstruction was performed in 2 cases. Recurrence occurred in 4 cases, who underwent a new operation. All the other patients underwent proton-beam radiotherapy with no documented tumor growth at the last follow-up (median: 24.9 months; range: 7–36 months). EEA and TO resulted to be safe procedures for treatment of clival chordomas. These approaches may be used as an alternative to the traditional approaches, according to the extension of the pathology.


Chordomas Clivus Endoscopic approach Pedicled flaps Radiotherapy 


Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Human and Animal Rights

This research involved human participants, who all signed an informed consent before any further treatment.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Department of OtolaryngologyUniversity Hospital of VeronaVeronaItaly
  2. 2.Department of NeurosurgeryUniversity Hospital of VeronaVeronaItaly

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