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Clival Chordomas and Chondrosarcomas

Background

Chordomas are slow-growing but aggressive tumors that invade locally, but rarely spread to other parts of the body. Chondrosarcomas are more rapidly growing.

Most common locations for chordomas are in the skull base and spine.

 

Evaluation

The most common symptom of skull base of clival chordomas is double vision. Visual loss, hearing loss, difficulty swallowing and facial numbness can also occur. Incoordination, motor weakness and nasal congestion is rare.

 

Imaging

MRI and CT scans show the extend of tumor and bony invasion, respectively. MR or CT angiogram, visual field testing, and audiograms may be needed.

 

Treatment

Initial treatment for a clival chordoma is with surgical removal.

Most clival chordomas and chondrosarcomas are best removed via an endonasal endoscopic approach.

Complete surgical resection is often not possible. Cyberknife radiosurgery can be helpful in this setting. When the tumor remnants remain too close to the optic nerves, intensity modulated radiation therapy is used.

For chordomas of the spine, Cyberknife or surgery can be curative.

Chemotherapies effective in the treatment of chordomas are still being sought.