Transoral transpalatal removal of a giant premesencephalic clivus chordoma.

Due to their surgical inaccessibility and resistance to radiotherapy, clivus chordomas represent a formidable therapeutic challenge. The transoral approach to chordomas of the clivus has been usually restricted to relatively small or midsized neoplasms, located at the lower end of the clivus or at the anterior clival-cervical junction. In this report the transoral transpalatal transclival removal of a giant recurrent chordoma occupying the whole length of the clivus with considerable premesencephalic extension and brain stem compression is described. Regression of preoperative symptoms without additional postoperative morbidity could be achieved by radical transoral tumour extirpation documented by magnetic resonance imaging.