Endoscopic transnasal surgery for clival chordoma

Abstract

Clival chordoma is still one of the most challenging diseases in the fi eld of the neurosurgery. The lesion exists at the deepest part of the skull base and is surrounded by the various vital vascular and neural structures. Among various approaches, the extradural anterior approach seems to be the most rational for its direct route to the lesion and capability to preserve the dura if needed. The approach, however, tends to become deep and narrow, and suffi cient surgical view is often diffi cult to obtain under the operating microscope [ 15 ]. The endoscope was thus applied with the expectation to overcome such limitation. The recent evolution of the endoscopic skull base surgery made in fact certain types of the clival lesion amenable to the treatment through the transnasal route [ 12 ]. The technique not only allowed the surgeons to overcome the visual limitation of the conventional anterior approach but also provided newdimension in the surgical procedure, namely, microsurgical maneuver in the deepest intradural space and in the lateral compartment behind the carotid artery. In this chapter the authors summarize the current state of the endoscopic transnasal surgery for clival chordoma based on their own experience, as well as on the previously reported cases, and demonstrate its future perspectives.