title: Spontaneous debulking of middle fossa chordoma extension after transnasal petroclival biopsy--report of a case.
abstract: BACKGROUND
  Clival chordomas are difficult tumors to treat, particularly when they have already grown beyond the confines of the clivus.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  The patient underwent additional clival debulking and proton-beam therapy. After 44 months of follow-up, he had no clinical or radiographic progression of disease.
  
  
  CONCLUSIONS
  It 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.
authors.affiliation: Division of Neurological Surgery , Barrow Neurological Institute , St. Joseph’s Hospital and Medical Center , Phoenix, Arizona 85013 , USA.
authors.forename: G
authors.initials: G
authors.lastname: Singh
authors.forename: P
authors.initials: P
authors.lastname: Nakaji
authors.forename: F
authors.initials: F
authors.lastname: Chen
authors.forename: M
authors.initials: M
authors.lastname: Garrett
authors.forename: A
authors.initials: A
authors.lastname: Little
authors.forename: J
authors.initials: J
authors.lastname: Milligan
mesh_terms: D001706:Biopsy / Q000379:methods; D002817:Chordoma / Q000473:pathology / Q000601:surgery*; D035301:Cranial Fossa, Middle / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology / Q000517:prevention & control*; D044583:Neuroendoscopy / Q000295:instrumentation / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*