Introduction: The endonasal corridor has gained popularity as a means for accessing midline pathologies of the anterior skull base particularly as it allows access to areas where traditional lateral skull base approaches will not suffice. We present our experience with endoscopic endonasal surgery (EES) for recurrent and residual petroclival chondrosarcoma on patients who previously underwent open procedures.
Methods: The charts and radiographs of all patients who underwent an endoscopic endonasal skull base approach for resection of chondrosarcoma were reviewed. Attention was paid to recurrent/residual tumors and evaluation of extent of resection and the need for further therapy.
Results: Sixteen patients underwent endonasal resection of skull base chondrosarcomas. Of these 16, four (4) had received prior surgical treatment. The mean age of these 4 patients was 36.4 years. Prior approaches were: pterional craniotomy (n=1), extended anterior transpetrosal approach (n=2) and repeat orbitozygomatic craniotomies (n=1). One patient had adjuvant stereotactic radiosurgery following craniotomy. The mean time between open and EES was 5.25 years.
Gross total resection was achieved in 2 patients (50%) and near total (>95%) resection in a third. The remaining patient’s very large (49.5cc), recurrent calcified tumor (Figure-1) was debulked (13.8cc residual, 72.2% resection) achieving the goal of alleviating brain stem compression.
At a mean follow-up of 44.2 months all patients are alive and no patient has required further surgical treatment. Two patients underwent adjuvant proton beam therapy. The only recurrence occurred 42 months after EES and is currently scheduled to undergo stereotactic radiosurgery.
Conclusions: The endonasal corridor can safely enable the removal of some select chondrosarcomas with residual or recurrent midline tumor. The goal of any operation should be gross total resection or maximal debulking when total resection is not feasible.
Patient Care: Understand the utility of endoscopic endonasal skull base surgery as a management strategy for recurrent chondrosarcoma of the skull base
Learning Objectives: By the conclusion of this session participants should be able to: 1)Describe the role of endonasal surgery in the resection of recurrent petro-clival chondrosarcoma. 2)Understand the multi-modal management of recurrent chondrosarcoma