Transoral removal of the skull base chordoma with preliminary occipitospondylodesis (a case from practice)

Shkarubo A.N., Kaznacheev V.M., Fomin B.V., Pakhomov G.A., Bocharov O.V., Bulanova T.V.

(Burdenko Research Neurosurgical Institute, Central Hospital of the Russian Ministry of Internal Affairs, Moscow, Russia)

A patient with chordoma of the skull base, spreading into clival middle and lower segments and C1 and C2 vertebrae, is described. A tumor was a cause of severe neurologic symptoms and craniovertebral transition instability. The patient was subject to staged occipitospondylodesis (an autograft from a shinbone and steel wire were used). Then transoral removal of chordoma was performed. Original instruments, patented by the authors, were used.

The authors has come to a conclusion, that thorough clinical and rentgenologic (including CT and MRI) examinations in a preoperative period allow to achieve extremely reliable information on a tumor volume, a degree of its intra- and extracranial growth, topographic interrelations with anatomic structures of the brain, a degree to which bones of the skull base and upper cervical vertebrae are destructed. It its turn, it permits to work out a suitable plan of surgical intervention and to avoid such severe complications, as liqourrhea, meningitis and spinal instability. A considerable depth of a transoral approach is an embarrassing factor, demanding use of special instruments. Development of new surgical instruments has led to optimization of microsurgical technique, improvement of results of surgical treatment, reduction of a risk of different complications and an increased number of indications for use of the above transoral approach.