INVITED PAPER Corridor surgery: the current paradigm for skull base surgery Stephen M. Pirris & Ian F. Pollack & Carl H. Snyderman & Ricardo L. Carrau & Richard M. Spiro & Elizabeth Tyler-Kabara & Amin B. Kassam Received: 23 October 2006 / Published online: 17 January 2007 # Springer-Verlag 2007 Abstract Introduction Clival chordomas are rare tumors, especially in the pediatric population. In this report, we present the case of a 3-year-old boy who was found to have a large posterior pharyngeal, clival, and posterior fossa tumor detected on a CT scan after a closed head injury. Discussion Further questioning revealed a history of ataxia and dysphagia. Imaging confirmed severe extrinsic brain stem compression. The tumor was resected in multiple stages utilizing a minimally invasive endoscopic endonasal technique along with open transfacetal, transcondylar approach through the carotid–vertebral window. The child suffered no permanent complications as a result of our treatment and his dysphagia significantly improved. Al- though a complete resection was not feasible due to vascular encasement by the tumor, extensive decompres- sion was obtained with minimal morbidity. Conclusion We present this case to illustrate a new paradigm of skull base surgical approaches for large clival lesions in pediatric patients that allows aggressive resection with minimal morbidity. Keywords Chordoma . Endoscopic endonasal approach . Clival tumors . Pediatric skull base tumors . Carotid–vertebral window Introduction Chordomas are rare tumors believed to arise from the embryonic notochord. They are destructive neoplasms occurring at either end of the axial skeleton. Although considered histologically benign, these tumors can have a malignant course due to their location, invasiveness, and tendency to encase critical neurovascular structures. Diagnosis is often delayed due to vague symptoms. Most patients present with headache and diplopia due to sixth nerve palsy. If there is lower clival involvement, neck pain may also be reported in conjunction with lower cranial neuropathies from brain stem compression [9]. We present a patient with a particularly extensive clival chordoma who came to clinical attention after a mild closed head injury, but suffered from symptoms due to pharyngeal mass effect along with lower cranial nerve, brainstem, and cerebellar compression. The primary consideration during cranial base surgery is minimalization of critical neurovascular manipulation. This has been the underlying premise resulting in the creation of multiple modular approaches consisting of the disarticula- tion of critical bony elements creating surrounding into the lesion while minimizing disruption to the neurovascular structures. In the case of midline lesions, this is particularly difficult given the general location of these critical struc- Childs Nerv Syst (2007) 23:377–384 DOI 10.1007/s00381-006-0281-6 S. M. Pirris : I. F. Pollack : R. M. Spiro : E. Tyler-Kabara : A. B. Kassam Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA C. H. Snyderman : R. L. Carrau Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA R. L. Carrau : A. B. Kassam (*) Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street PUH B-400, Pittsburgh, PA 15213, USA e-mail: kassamab@upmc.edu