Pediatric clival chordoma masquerading as meningioma: Diagnostic challenges and surgical considerations. A case report

Pediatric clival chordomas are rare, malignant skull base tumors known for significant diagnostic and therapeutic challenges. We present a case of a 16-year-old male with progressive headaches and left sixth cranial nerve palsy whose clival mass was initially misdiagnosed as a meningioma by neuroimaging. Intraoperative findings and subsequent histopathology, however, confirmed a conventional chordoma (characterized by physaliferous cells, immunopositivity for cytokeratin, EMA, and S100, with a Ki-67 index of 5–10%). This case underscores that pediatric clival chordomas can mimic more common lesions, emphasizing the critical role of early, accurate histopathological evaluation and a personalized multidisciplinary strategy for optimizing long-term patient outcomes.