• G Singh, P Nakaji, F Chen, M Garrett, A Little, and J Milligan.
• Division of Neurological Surgery , Barrow Neurological Institute , St. Joseph’s Hospital and Medical Center , Phoenix, Arizona 85013 , USA.
• Minim Invasive Neurosurg. 2011 Jun 1; 54 (3): 135-7.

BackgroundClival chordomas are difficult tumors to treat, particularly when they have already grown beyond the confines of the clivus.PatientWe 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.ResultsThe patient underwent additional clival debulking and proton-beam therapy. After 44 months of follow-up, he had no clinical or radiographic progression of disease.ConclusionIt 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.

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