Case of Clival Chordoma

Mr. D. G. is a 5I year old fair, stout person, he came to the clinic with complaints of Clival Chordoma, on 14-5-07. His Pin Number is L-8669. He had complaints of left temporomandibular joint pain, pain in the left side of the face, inability to masticate, inability to chew solid food, inability to open his mouth completely. Patient was mostly on soft diet, he had restricted mobility of the jaws, continuous dull pain, necessitating him to take pain killers three times a day.

History: Patient developed this complaint first in August 2002. It started with sudden diplopia [ double vision ]. MRI revealed a Clival Chordoma. He was operated upon on 21-8-2000 by a Trans sphenoidal approach. After 6 months, a MRI was repeated, and it revealed a slow growing tumor, so a preventive surgery was performed in February 2003 to reduce the size of the tumor. In February 2005 he had mild eye drooping, and a MRI suggested increase in the size in the tumor and so an aggressive craniotomy was performed. Again in October 2005 he developed visual disturbances, so on 28-12-05, a fourth surgery was performed and the right sided tumor was almost completely removed, the left sided tumor was left untouched.

Since June 2006 (i.e. after 6 months after the fourth major surgery), patient again developed the above mentioned symptoms. A neurologist diagnosed this as Trigeminal Neuralgia secondary to Clival Chordoma. At this stage, patient opted for Homeopathy.

His case details were taken:
Physical Characteristics: He has craving for spicy, sweets and fruits.

He has perspiration on palms and soles. His sweat is offensive.

He could tolerate heat better. He couldn’t tolerate cold, winter. Sleep was sound.

Mental Characteristics: He described himself as a sensitive, irritable, egoistic, helpful, perfectionist, fastidious and anxious person. He was punctual and liked clock-like precision. Even if a frame was not kept properly he would adjust it properly.

If the furniture was not properly arranged he would align it. He always kept all his things in their proper place, and expected the family members also to do so, or else he would shout on them and get angry.

Family History:
Father was suffering from Asthma, mother had a history of breast cancer. His paternal grandfather had history of prostate cancer. His paternal aunt had history of uterine cancer.

He is working as a Chief Mechanical Engineer in a very senior position for a Government Organization. He stays with his wife and two children.

Based on his case details, Dr. Shah prescribed Arsenic Alb as the constitutional remedy and Carcinocin as the Intercurrent remedy.

Treatment was started with Arsenic Alb 200 C 4 pills three times a day on 14-7-06

Follow Up:
1-8-06: Pain in temples reduced, Pain in left TM (Temporomandibular joint) and left cheek reduced. His ability to chew food improved. He still complained of pain on trying to chew solid food. Numbness reduced a lot.

11-8-06: All pains were reduced further.

25-9-06: Pains are almost gone and he has stopped using pain killers. He can open the mouth much widely and can chew solid food without any difficulty.

15-12-06: No pain. No difficulty in chewing food. He can yawn freely. He had repeated a MRI which noted no further growth in the tumor in last 4 months. His neurologist deferred his surgery, as it was not needed anymore.

Overall patient was asymptomatic.

21-03-07: No complaints. Patient is better. He developed cold which promptly responded to Pulsatilla.

29-05-07: No complaints. Patient repeated a MRI and it showed that the tumor was stationary and showed no further growth.

A 10-months follow up with 2 MRI scan’s and neurological opinions proved that not only did the symptoms of the tumor disappear, but also the tumor did not grow and a major surgery was averted.

MRI Skull Base (plain and contrast). [ Report dated 12-7-06]

There is a multilobulated enhancing soft tissue with the epicenter in the clivus and extending in the left parasellar and infra temporal region. There is mild increase in the size of the infratemporal component lesion which measures 38 x 32 mms in its cranio caudal trans dimensions. Interiorly it extends in left pterygomaxillary fissure which is widened and through which occupying the posterior part of maxillary sinus.

There is left parasellar , where it is encasing the left cavernous sinus, left intracavernous ICA and occupying the Meckel’s cave. The left trigeminal nerve is marginally thickened in the cisternal segment. There is early extension in the pre pontine cistern, however no significant indentation of the brainstem. The left temporal lobe is marginally indented. The sphenoid sinus cavity is occupied by the soft tissue and post operative packing material. No evidence of intra or suprasellar extension. There is evidence of partially empty sella.


Conclusion:
Residual clival chordoma with morphology and extent as described. Mild increase in the size of infratemporal component with no significant change in size of intrasphenoid and left parasellar component.

Left parasellar extension , where it is encasing the left cavernous sinus, left intracavernous ICA and occupying the meckel’s cave [ trigeminal ganglion ]. Left trigeminal nerve is marginally thickened in the cisternal segment.

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