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Category: Volume 09 Issue 12 December 2021
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Title: Anaesthesia Approach for Clival Chordoma with Craniovertebral Instability and Brainstem Compression

Authors: Dr Pratima Kothare, Dr Dipti Madan

 DOI: https://dx.doi.org/10.18535/jmscr/v9i12.32

Abstract

Craniovertebral junction lesions affect the skeleton and the enclosed neuraxis at the junction of the cranium and cervical spine. Up to 25% Chordomas occur at the base of the skull, arising from the clivus. Such lesions are rare, have a difficult anatomical access, are locally invasive and destructive in nature, and are situated in close proximity to the brainstem, thus posing a challenge for both neurosurgeons and anaesthetists.

Hence, it becomes important to formulate an anaesthesia plan, with special regards to intubation and extubation, causing minimal disturbance to the cervicovertebral junction, being prepared for effects of the tumour depending on the location of the tumour, delayed recovery of respiratory function and prolonged ventilation in the postoperative period.

Case in Brief: A 28 years old female, presenting with bilateral upper and lower limb tingling, 2 years after being operated for a clival chordoma. She also had complaints of imbalance while walking for 1 year.

The surgical management was divided in 2 stages; first a posterior occipitocervical fusion was done and then the chordoma was excised via an endoscopic endonasal transsphenoidal approach.

This patient developed cerebrospinal fluid leakage in the immediate postoperative period, which was managed by an endoscopic endonasal surgical repair.

Keywords: recurrent clival chordoma, cervical body erosion, brain stem compression, occipitocervical fixation, endoscopic endonasal skull base surgery.

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Corresponding Author

Dr Dipti Madan

Bombay Hospital Institute of Medical Sciences, 12 New Marine Lines, Mumbai- 400020