Stent-assisted coil embolization of a basilar artery dissecting aneurysm involved in skull base chordoma before endoscopic transsphenoidal transclival resection: a case report

Background: Skull base chordomas occasionally penetrate the clival dura mater and extend into the prepontine cistern, involving the basilar artery. Few reports have described skull base chordoma accompanying dissecting aneurysm of the basilar artery, and treatment strategies remain largely unknown.

Case description: A 28-year-old man was referred to our hospital complaining of severe headache. Skull base chordoma involving a basilar artery dissecting aneurysm was diagnosed. We initially performed endovascular surgery for the dissecting aneurysm under dual antiplatelet therapy before surgical resection of the tumor, which was successfully achieved without complications. Follow-up angiography 3 months after endovascular surgery disclosed obliteration of the dissecting aneurysm. We then stopped dual antiplatelet therapy, and performed judicious resection with an endoscopic transclival approach. The residual tumor was treated with radiosurgery. As of last follow-up, the patient was stable and the tumor remained sufficiently controlled.

Conclusions: We experienced a case of dissecting aneurysm of the basilar artery with clival chordoma. Our case suggests that chordoma with intradural vascular encasement has potential to invade the vessel wall. To avoid rupture of those critical vascular structures, treatment strategies that minimize stress on the involved arteries and offer safe and sufficient surgical resection should be considered.

Keywords: basilar artery dissection; chordoma; stent-assisted coiling.