Transsphenoidal approach to extradural midline clival chordomas

Clival chordoma, represents an aggressive tumour arising from remnants of the notochord. These tumours can create local relapses and/or metastases. The paper reports two cases of extradural midline clival chordoma operated on via transsphenoidal approaches and one case in which an assisted endoscopy was associated. In all cases the tumour involved the upper clivus. The tumour sizes ranged from 2.0 to 3.0 centimetres. The patients suffered from headache, diplopia and cranial nerve palsies. In two tumours signs of intracranial hypertension were present. In all patients, neither postoperative complications nor tumour relapses were observed at the three-year follow-up. The discussion analyzes the advantages of transsphenoidal approach with or without assisted endoscopy in the treatment of cases of extradural midline clival chordoma