Spontaneous debulking of middle fossa chordoma extension after transnasal petroclival biopsy--report of a case.

BACKGROUND: Clival chordomas are difficult tumors to treat, particularly when they have already grown beyond the confines of the clivus.

PATIENT: We report the case of a 52-year-old man with a clival mass consistent with a chordoma with a prominent extension into the right middle fossa. At the patient's request, he underwent a simple endonasal biopsy to confirm the diagnosis. A second debulking procedure was planned to debulk the remnant tumor. However, follow-up magnetic resonance imaging showed that much of the middle fossa tumor had decompressed itself through the clival defect into the patient's pharynx.

RESULTS: The patient underwent additional clival debulking and proton-beam therapy. After 44 months of follow-up, he had no clinical or radiographic progression of disease.

CONCLUSION: It is intriguing to think that leaving a path for easy egress for a chordoma from the clivus may prevent it from building up in the bone and spreading.