Takahashi Hiroki, Kinoshita Yasuyuki, Usui Satoshi, Arihiro Koji, Kimura Shuji, Mitsuhara Takafumi, Kurisu Kaoru
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University.
No Shinkei Geka. 2017 Jul;45(7):623-627. doi: 10.11477/mf.1436203561.
A 67-year-old woman was referred to our department with a retroclival lesion including a cyst on MRI. MRI revealed a lesion appearing as an isointense region on a diffusion-weighted image(DWI). Gadolinium(Gd)-DTPA T1-WI showed heterogeneous enhancement of the lesion in the prepontine cistern. Computed tomography(CT)revealed an isodense lesion with no invasion into the clival bone. Based on a preoperative diagnosis of retroclival chordoma, extended trans-sphenoidal surgery(TSS)was performed by a direct endoscopic endonasal approach via the left nostril. We found a round dural defect with a diameter of 5 mm, through which the tumor was incarcerated. However, the tumor had no connection to the clival bone. The lesion was totally removed and histologically diagnosed as a chordoma. Furthermore, the clival bone included no tumor cells. Based on those radiological and histological findings, we diagnosed the lesion as an intradural retroclival chordoma. We should consider intradural retroclival chordoma as a candidate for the differential diagnosis of a retroclival lesion without clival bone invasion.
