Discussion on the surgical technique of resection of lower clivus involved chordoma via endoscopic transnasal extreme medial approach

Abstract

Objective To explore the experience and technical key points of endoscopic transnasal extreme medial approach for resection of chordoma involving the lower clivus. Methods and Results The clinical data and follow⁃up data of 8 patients with chordoma involving the lower clivus admitted to The First Affiliated Hospital of Zhengzhou University from June 2022 to June 2024 were retrospectively analyzed. All patients underwent endoscopic transnasal extreme medial approach tumor resection and received triple cranial base reconstruction including fascia lata suture sealing + rigid cranial base reconstruction + mucosa flap application. All 8 patients successfully completed the surgery, with a success rate of 8/8. Postoperative 7 d imaging reexamination showed that 6 patients underwent gross total resection of tumor, and 2 patients underwent subtotal resection. At one month after surgery, the headache symptom was relieved in 3 patients (3/4), and nerve dysfunction relief was observed in 4 patients (4/5). The surgical⁃related complications included cerebrospinal fluid rhinorrhea (2 cases) and intracranial drug⁃resistant bacterial infection (one case). One death occurred, and the cause of death was brain herniation secondary to cerebrospinal fluid rhinorrhea and intracranial infection. Two recurrences occurred, and one recurrence was treated with proton radiotherapy + secondary surgical resection, while the other recurrence was treated with secondary surgical resection. Conclusions The endoscopic transnasal extreme medial approach provides a good technical means for gross total resection of chordoma involving the lower clivus. During the operation, adequate exposure of the tumor can be achieved by referring to important bony landmarks, which can effectively resect chordoma involving the lower clivus.

doi：10.3969/j.issn.1672⁃6731.2025.04.002