Total Resection of Clival Chordoma with Brainstem Invasion via Endoscopic Transnasal Approach: Technical Note

Objective: Clival chordomas with brainstem invasion are extremely rare; only 5 cases have been reported in the literature. In such cases total tumor resection is associated with high intraoperative risks and is a notable challenge for the neurosurgeon. However, it is the quality of surgical treatment that influences the future prognosis, despite the efficacy of proton therapy. Methods: We describe the clinical case of a 39-year-old male patient with the sudden onset of double vision and left trochlear nerve paresis, who was diagnosed with a clival chordoma with brainstem invasion. Results: The tumor was successfully resected via unilateral left mononostril endoscopic transnasal approach. The patient had a mild paresis of the left abducens nerve that improved during the postoperative period. Conclusions: Clival chordomas with brainstem invasion are extremely rare. In some circumstances, total tumor resection can be achieved.