Turkish Neurosurgery 2015 , Vol 25 , Num 1
Intrasellar Chordoma Associated with a Primitive Persistent Trigeminal Artery
Marta NAVAS1, Pedro MARTINEZ1, Sophia F. SHAKUR2, Antonio BARBOSA3, Eduardo BARCENA3, Carlos GORDILLO4, Javier FRAGA4, Concepcion BLANCO5, Rafael G. SOLA1
1La Princesa University Hospital, Department of Neurosurgery, Madrid, Spain
2La Princesa University Hospital, Department of Neuroradiology, Madrid, Spain
2La Princesa University Hospital, Department of Pathology, Madrid, Spain
4Principe de Asturias University Hospital, Department of Endocrinology, Madrid, Spain
5The University of Chicago Medical Center, Department of Neurosurgery, Chicago, USA
DOI : 10.5137/1019-5149.JTN.8759-13.1 Chordomas located primarily in the sellar region are uncommon, and may be misdiagnosed non-functioning pituitary adenoma. Furthermore, the association of a persistent primitive trigeminal artery (PPTA) with an intrasellar chordoma is extremely rare, and no similar cases have been reported in the literature to date. The coexistence of intrasellar chordoma (ISC) and PPTA makes safe and complete tumor resection challenging, and preoperative endovascular occlusion of this artery may be helpful.

We report a case of a 32-year-old man who developed right hemifacial paresthesias and a cranial nerve six palsy. MRI study demonstrated the presence of a primary ISC associated with a PPTA. Angiographic balloon test occlusion of the PPTA revealed no neurological changes, so this vessel was endovascularly occluded by coiling. The lesion was subtotally removed through a sublabial transsphenoidal approach, without intraoperative bleeding complications. Histological examination of the lesion was consistent with the diagnosis of chordoma.

Detailed preoperative neurovascular evaluation may be useful to detect vascular anomalies associated with intracranial chordomas, such as PPTA. In this report we emphasize the importance of appropriate treatment of vascular anomalies prior intrasellar lesions resection that may facilitate surgery and avoid potential hazardous intraoperative bleeding complications. Keywords : Chordoma, Intracranial mass, Persistent primitive trigeminal artery, Sellar lesion, Skull base

Corresponding author : Marta Navas, m_navas_garcia@hotmail.com