2025 Poster Presentations
P086: CLIVAL CHORDOMA RESECTION WITHOUT OCCIPITOCERVICAL FUSION: A CASE REPORT
Maxwell A Marino, DO, MPH1; Ali O Jamshidi, MD2; Fernando A Torres, MD3; 1Riverside University Health System, Moreno Valley; 2Kaiser Permanente Medical Center, Woodland Hills; 3Kaiser Permanente Medical Center, Lost Angeles
Clival chordomas are rare, slow-growing aggressive tumors that commonly result in craniocervical instability following resection particularly when the tumor extends through the basion to the ventral cranioverterbral junction (CVJ). However, in certain cases, resection without fusion may be possible without sacrificing stability. This report discusses a case where a clival chordoma involving the anterior arch of C1 and the rostral odontoid was resected using an endoscopic transnasal approach, and stability was preserved without occipitocervical (OC) fusion. .
The patient is a 66-year-old male who presented with a gradually enlarging clival chordoma. Preoperative MRI demonstrated a lobulated mass measuring 2.2 x 1.6 x 1.7 cm in the clivus, with transdural invasion but without significant compromise of the craniocervical junction (CCJ) stability on dynamic imaging. Given the patient's reluctance to undergo fusion and loss of mobility, the decision was made to proceed with resection only.
The patient underwent endoscopic transnasal, transsphenoidal resection of the chordoma. Frameless stereotactic guidance and intraoperative neuromonitoring were employed. The tumor was successfully resected, and a vascularized flap was used for skull base reconstruction. No immediate complications occurred, and postoperative imaging confirmed total resection with no evidence of residual instability at the CCJ. The patient's dynamic cervical films postoperatively showed no abnormal motion, confirming stability. Multiple cervical films were obtained the first two weeks post-operatively.
In cases of clival chordoma, the decision to perform OC fusion is typically based on the extent of bone resection and the integrity of the ligaments at the CCJ. This case demonstrates that in certain scenarios, when preoperative imaging and intraoperative findings suggest preserved ligamentous integrity and when the transverse ligament is not sufficiently violated (i.e. the odontoid was preserved), an upfront OC fusion may not be required. This approach can preserve patient mobility and reduce the morbidity associated with fusion.
This case supports the consideration of chordoma resection without OC fusion when preoperative and intraoperative assessments indicate preserved CCJ stability. Careful preoperative planning and postoperative monitoring are essential to ensure successful outcomes in these cases.