A chordoma is an uncommon tumour usually locatd in the sacrum and clivus. Growth is slow but they are considered biologically aggressive because of their reproductive capacity.
Depending on their location they may bring about different neurological symptoms:
- Clivus: headaches, nausea, vomiting and affectation cranial pairs (disorders of facial mobility, swallowing, double vision, etc.).
- Sacrum: back pain accompanied by anorectal, vesicle signs and/or sciatica.
The test of choice is magnetic resonance imaging for correct assessment of the lesion and neurosurgical planning.
The treatment of choice is surgical resection and the first surgery is of vital importance for ensure complete resection and reduce the probability of relapse. Endoscopic techniques are on the rise for the exeresis of this type of tumours when they are located in the clivus as complete resection is possible with a lower number of complications.
It is essential to have intraoperative neurophysiology for resection with the least possible number of complications due to the relationship of the tumour with different cranial pairs and/or nerve roots.
In the situations where complete exeresis of the tumour is not possible, adjuvant treatment with radiotherapy and/or the use of heavy charged particles (protons) is applied.