# Cervical Spine Chordoma With Tracheal and Vascular Invasion: A Case Report

## TL;DR

This case report describes a rare and aggressive tumor in the cervical spine that caused severe airway and vascular issues, leading to fatal complications.

## Contribution

The paper contributes a detailed case analysis and proposes adaptations to airway management protocols for chordomas involving critical structures.

## Key findings

- The patient's cervical chordoma caused airway obstruction and vascular encasement, leading to failed tracheostomy modifications and recurrent bleeding.
- Multidisciplinary management was required to address the complex airway challenges presented by the tumor.
- The case emphasizes the need for revised difficult airway algorithms in patients with advanced chordomas.

## Abstract

Chordomas are rare, locally aggressive tumors from notochordal remnants, often involving critical neurovascular structures. We present a case of a tracheostomy patient with metastatic cervical chordoma causing significant airway obstruction and vascular encasement, leading to failed attempts to modify her existing tracheostomy, recurrent hemorrhage, and ultimately death. We review the literature on airway-compromising chordomas, detail the multidisciplinary management of this patient's airway, and propose considerations for adapting the difficult airway algorithm in cases involving critical airway compromise. This case highlights the challenges of managing advanced disease and the need for evolving airway management protocols tailored to patients with known critical airways.