Cerebellopontine Angle Chondrosarcomas: Endoscopic Endonasal Management

Introduction: Although skull base chondrosarcomas are tumors with an indolent growth and low metastatic potential, their usual location in the paraclival area renders them difficult to treat pathologies. Because of the critical surrounding neurovascular structures, their surgical treatment can be complex, extensive, and often hazardous, possibly resulting in significant morbidity. The expanded endonasal endoscopic approaches (EEAs) have recently become an appealing alternative in skull base surgery, offering a direct anterior corridor to these lesions, allowing thorough resections while minimizing surgical morbidity.

Methods: The authors retrospectively analyzed 19 consecutive cases of patients diagnosed with skull base chondrosarcomas, operated on through EEAs, at the neurosurgical department of The Ohio State University in Columbus, Ohio, United States. Patient data were reviewed regarding lesion size and grading, degree or resection, number and of surgical procedures, techniques employed, clinical outcome, and follow-up.

Results: In all the present cases, safe tumor removal was accomplished; there was no new or worsened cranial neuropathy or vascular events. The degree of resection was compatible to that presented in literature. Although limited, follow-up thus far has not detected any recurrence; small residuals have remained stable after proton beam therapy.

Conclusion: EEAs appear to offer a minimally invasive alternative for achieving maximal safe surgical resection, providing adequate cytoreduction, with decreased morbidity due to the surgical manipulation. These results seem comparable to standard “open” skull base techniques. Further follow-up and larger series are necessary to determine if these preliminary results are valid.