Atormac
briv
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 589  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  » Next article
  » Previous article 
  » Table of Contents
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
  »  Article in PDF (118 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
 »  Abstract
 »  Introduction
 »  Case Report
 »  Discussion
 »  References
 »  Article Figures
 »  Article Tables

 Article Access Statistics
    Viewed5061    
    Printed151    
    Emailed1    
    PDF Downloaded183    
    Comments [Add]    
    Cited by others 9    

Recommend this journal

 


 
CASE REPORT
Year : 2006  |  Volume : 54  |  Issue : 3  |  Page : 306-307

An intradural skull base chordoma presenting with acute intratumoral hemorrhage


Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan

Date of Acceptance05-Feb-2006

Correspondence Address:
Kenji Ohata
Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585
Japan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.27162

Rights and Permissions

 » Abstract 

We present a rare case of skull base chordoma of extraosseous intradural type that presented as acute intratumoral hemorrhage. Surgical removal of the tumor was accomplished using a skull base approach.


Keywords: Echordosis physaliphora, intradural chordoma, intratumoral hemorrhage


How to cite this article:
Uda T, Ohata K, Takami T, Hara M. An intradural skull base chordoma presenting with acute intratumoral hemorrhage. Neurol India 2006;54:306-7

How to cite this URL:
Uda T, Ohata K, Takami T, Hara M. An intradural skull base chordoma presenting with acute intratumoral hemorrhage. Neurol India [serial online] 2006 [cited 2021 Oct 17];54:306-7. Available from: https://www.neurologyindia.com/text.asp?2006/54/3/306/27162



 » Introduction Top


Skull base chordomas are in general extradural tumors and present with slow progressive symptoms over several months. We report a case of skull base chordoma that was intradural in location and presented with acute intratumoral hemorrhage.


 » Case Report Top


A 35-year-old woman suffered a sudden episode of headache and right hemibody hyperalgesia. Investigations showed a hemorrhagic tumor extending intradurally on CT and a contiguous relationship between the tumor and the dural wall of the clivus on enhanced T1-weighted sagittal images [Figure - 1]. No destructive alteration of the clivus was detected on serial high-resolution CT.

A transcondylar approach revealed a gelatinous tumor covered by thickened arachnoid membrane. Internal debulking of the tumor was first accomplished via the space between the 9th and 10th nerve complex and the 7th and 8th nerve complex [Figure - 2]. The tumor appeared to grow invasively into the brainstem. Tumor removal revealed dural attachment of the tumor at the clivus. The tumor was totally intradural and the bony structure of the petroclival area was intact. Subtotal removal of the tumor was accomplished and residual tumor tissue remained in relationship to the brainstem and the dural layer of the clivus. Pathological examination of tumor tissue showed a lobular pattern of physaliphorous cells with abundantly vacuolated cytoplasm [Figure - 3]. Histological examination of the tumor revealed typical features of a chordoma.

Postoperatively the patient was noted to have worsened in consciousness. Postoperative CT scanning revealed the localized hemorrhage in the tumor cavity. Emergency surgery for removal of the hematoma was performed. The second surgery suggested that postoperative hemorrhage was localized in the tumor cavity and was caused by the bleeding from the residual tumor. Three months after surgery, the neurological status of the patient had further improved and she was able to carry on normal activities with some effort. Postoperative MR images, obtained at 3 months after surgery, indicated a small residual tumor [Figure - 1]B. At a six-month follow-up scan, growth of the residual tumor was identified. Adjuvant treatment of stereotactic radiosurgery was administered.


 » Discussion Top


Patients with skull base chordomas generally present with progressive clinical symptoms. We identified 11 documented cases, from the literature, of skull base chordomas presenting with acute intratumoral or intracranial hemorrhage [Table - 1]. Numerous mechanisms have been proposed to explain the etiology of intratumoral or intracranial hemorrhage in conjunction with brain tumors.[1],[2] The growth pattern of skull base chordomas suggests that extraosseous intradural chordomas are different from the classic type. Extraosseous intradural chordomas are hypothesized to originate from the ecchordosis physaliphora.[3] Preoperatively, we did not consider that this hemorrhagic tumor was extraosseous intradural chordoma; therefore, we selected the transcondylar approach. However, for radical resection of a chordoma of this region, extended middle fossa approach described by Goel may have been ideal .[4] Adjuvant therapy after subtotal resection of the skull base chordoma may be indispensable. Conventional radiation therapy, stereotactic radiosurgery and proton beam therapy are alternatives.

 
 » References Top

1.Franquemont DW, Katsetos CD, Ross GW. Fatal acute pontocerebellar hemorrhage due to an unsuspected spheno-occipital chordoma. Arch Pathol Lab Med 1989;113:1075-8.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Levi AD, Kucharczyk W, Lang AP, Schutz H. Clival chordoma presenting with acute brain stem hemorrhage. Can J Neurol Sci 1991;18:515-8.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Mehnert F, Beschorner R, Kuker W, Hahn U, Nagele T. Retroclival ecchordosis physaliphora: MR imaging and review of the literature. AJNR Am J Neuroradiol 2004;25:1851-5.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Goel A. Extended middle fossa approach for petroclival lesions. Acta Neurochir (Wien) 1995;135:78-83.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

    Tables

[Table - 1]

This article has been cited by
1 Intradural cervical chordoma with diffuse spinal leptomeningeal spread: case report and review of the literature
Jing Zhang,Chuan-ping Gao,Xue-jun Liu,Wen-Jian Xu
European Spine Journal. 2018;
[Pubmed] | [DOI]
2 A Hemorrhagic Clival Chordoma with a Long Progression-Free Survival
Marcelo D. Vilela,Hugo A.S. Pedrosa,Marco Antonio Dias Filho
World Neurosurgery. 2017; 105: 1042.e1
[Pubmed] | [DOI]
3 Intradural chordoma presenting with intratumoral bleeding
Eduardo de Arnaldo Silva Vellutini,Matheus Fernandes de Oliveira
Journal of Clinical Neuroscience. 2016; 25: 139
[Pubmed] | [DOI]
4 Skull Base Chondroid Chordoma: Atypical Case Manifesting as Intratumoral Hemorrhage and Literature Review
Satoshi Tsutsumi,Chihiro Akiba,Takamoto Suzuki,Hajime Nakanishi,Hiroshi Izumi,Yukimasa Yasumoto,Masanori Ito
Clinical Neuroradiology. 2014; 24(4): 313
[Pubmed] | [DOI]
5 Intracranial intradural chordoma presenting with intraventricular hemorrhage
Sung Kwon Kim,Yong Hwy Kim,Chul-Kee Park,Min A. Kim,Sung Hye Park
Clinical Neurology and Neurosurgery. 2012; 114(8): 1189
[Pubmed] | [DOI]
6 Intracranial intradural chordoma presenting with intraventricular hemorrhage
Kim, S.K. and Kim, Y.H. and Park, C.-K. and Kim, M.A. and Park, S.H.
Clinical Neurology and Neurosurgery. 2012; 114(8): 1189-1192
[Pubmed]
7 Treatment of chordoma with imatinib complicated by intracranial hemorrhage: a case showing dissociation between biological effect and therapeutic outcome
François Mercier, Marie-Christine Guiot, Michel W. Bojanowski
Journal of Neuro-Oncology. 2011;
[VIEW] | [DOI]
8 Intradural drop metastasis of a clival chordoma
Michael Patrick Martin,Sarah Olson
Journal of Clinical Neuroscience. 2009; 16(8): 1105
[Pubmed] | [DOI]
9 Intradural drop metastasis of a clival chordoma
Martin, M.P., Olson, S.
Journal of Clinical Neuroscience. 2009; 16(8): 1105-1107
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow