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Chordoma masquerading as a nerve root tumour — a clinical lesson

Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK

Correspondence: Paul Brennan, Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN UK. E-mail: paulmbrennan{at}doctors.org.uk

Chordomas usually arise in bone and are most commonly found in the midline axial skeleton. An accurate pre-operative diagnosis of chordoma is crucial, as survival is optimal when radical en bloc resection is performed at primary surgery. We report a rare case of cervical chordoma masquerading radiologically as an extracranial nerve sheath tumour. A laterally situated chordoma (centred extra-osseously in the neural foramen) was diagnosed radiologically as a neurofibroma pre-operatively. We review the key radiological features for diagnosis of chordoma. We consider the importance of pre-operative diagnosis of chordoma in guiding management and in determining survival.