Role of Endoscopic Endonasal Surgery in the Multidisciplinary Management of Petroclival Chondrosarcomas: Single-Center Experience

Background: Chondrosarcomas are malignant tumors that originate from areas of endochondral ossification and may affect the spine and skull base. Petroclival chondrosarcomas with midline extension have been resected via endoscopic endonasal surgery in the past 15 years. Due to its location and extension to different parts of the skull base, gross total resection is often not possible.

Objectives: To report the experience of our center with the endoscopic endonasal approach (EEA0 for treatment of petroclival chondrosarcoma as part of the multidisciplinary treatment of those tumors.

Methods: Chart review of patients diagnosed with petroclival chondrosarcomas and treated at the UHN in the 10 last years. Clinical and radiological data was retrieved. Clinical outcomes, extent of resection, disease control and overall survival and complications of treatment were evaluated.

Results: Ten patients (5 men/5 women0 with a mean age of 54.8 ± 14.9 years underwent EEA for treatment of petroclival chondrosarcomas during the inclusion period of the study. Most tumors were larger than 3 cm (8/100 and had extensions into Meckel’s cave (8/100. Cranial nerve deficit was the present in all cases and VI nerve was the most commonly affected (7/100. Surgical treatment consisted of an EEA with drilling of the petrous apex. A transpterygoid extension in selected cases (4/100. Gross total, subtotal, and partial resection were achieved in 20, 20, and 60% of cases, respectively. All cases were diagnoses as conventional chondrosarcomas. No intraoperative complications were observed and the mean LOS was 8.7 days. All patients but one case that had GTR underwent adjuvant IMRT (70 Gy/ 35 sessions0. Only one case presented with a recurrence during FU (mean FU 37.6 months0 and no mortality was observed.

Conclusion: endoscopic endonasal approach is a safe and effective approach for treatment of chondrosarcomas. Complete resection is often not possible and radiation adjuvant treatment is an important additional optional to achieve long-term control of these tumors.

No conflict of interest has been declared by the author(s).