Endoscopic endonasal removal of laterally extended clival chordoma using side-viewing scopes

The transsphenoidal approach provides a straight and direct route to the clival chordoma, but has limitations for removing the tumor compartment extending laterally into the space posterior to the paraclival internal carotid artery. To overcome the limitations, a side-viewing endoscope and malleable/steerable instruments were employed. Four clinical cases with clival chordoma extending into the retro-carotid space were analyzed for extent of resection, complications and clinical outcome. The retro-carotid tumor compartment was removed in all cases under 30- and 70-degree side-viewing endoscopes using a malleable dissector and/or steerable forceps, resulting in gross total removal of the entire tumor. Single cases were complicated by transient abducens nerve palsy and cerebrospinal fluid leakage, which required surgical revision. All patients have been symptom free without tumor recurrence during the mean postoperative follow-up of 21.3 months. Though a longer follow-up is needed to evaluate its effectiveness in long-term tumor control, the surgical maneuver using the side-viewing endoscope is effective for removing laterally extended clival chordomas.