Endonasal endoscopic approach to clival and posterior fossa chordomas

Clival chordomas are rare tumors that become symptomatic by slow growth and local invasion of adjacent cranial nerves, typically abducens (CN VI), and brainstem structures. These tumors have been treated with extensive resections, with or without radiotherapy. Due to their location in the ventral midline skull base, the transnasal endoscopic approach to the clivus avoids cerebral retraction, reduces the incidence of injury to the lower cranial nerves, avoids external scars, is relatively quick, helps preserve the anatomical structures and appears to have good surgical outcomes. This article describes the “endoscopic binostril (transeptal/transeptal) approach” to resection of clival chordomas.