[Combination of posterior median and transoral approaches in surgical treatment of giant chordoma of the craniovertebral junction].

BACKGROUND

Surgical treatment of skull base and craniovertebral junction chordomas remains a challenging task in modern neurosurgery. Currently, various anterior and posterior approaches are used to remove such lesions.

OBJECTIVE

To present a 14-year-old patient with giant chordoma at the level of intact clivus and C1-C3 vertebrae. Surgery implied combination of approaches without disturbing stability of craniovertebral junction.

RESULTS. T: Umor in lateral parts of spinal canal was removed via posterior median access, and ventral fragment was excised through transoral access. Resection of lower sections of clivus (5 mm) and upper edge of anterior C1 semicircle (2 mm) expanded the angle of surgical action from 7 to 110 and accessibility zone necessary for maximum tumor removal and decompression of brainstem and upper cervical spinal cord without compromising stability of craniovertebral junction.

CONCLUSION

Patients with giant neoplasms of craniovertebral junction require a personalized approach. Total resection of craniovertebral junction chordoma is often accompanied by unreasonably high risk of impaired quality of life. In our opinion, maximum possible resection safe for quality of life with brainstem decompression and subsequent radiotherapy is advisable.