Chordoma
Diagnostic and therapeutic problems. The chordoma is a rare mesodermic tumor derived from the notochord which arises and growths inside the vertebral bodies. It is a slow development tumor with late clinical manifestations, rarely metastatic often with local reoccurrences. The treatment of choice of this tumor is surgical and the access must be individualized to the single clinical case: anterior, posterior or combined antero-posterior respect to the spine. Recently videolaparoscopy has been proposed when an anterior approach is indicated without increased morbidity or mortality. Chemotherapy is not indicated because low tumoral responsness. Radiotherapy is indicated as a palliative procedure when a surgical approach ca't be radical. Its application is useful to treat pains and to control the post-operative course increasing the disease-free interval. The authors report the case of an old symptomatic lady with a chordoma in the sacral region. The patient underwent subtotal absportation an anterior transperitoneal approach. Because the extension of the tumor, its biological characteristics and the patient's age the authors adopted this less invasive approach.