Endonasal Endoscopic Approach for Petroclival Chondrosarcoma

Objective: Skull base chondrosarcomas are rare entities; originated from petroclival synchondrosis. Symptoms usually occur after displacement of important neurovascular structures due to tumor compression. Slow grown pattern of these tumors may cause significant dimensions before any symptom given and leads delay in diagnosis. The aim of this report is to discuss minimal invasive approaches to skull base and to describe technical notes of this surgery.

Methods: We present a case with petroclival chondrosarcoma operated via a endonasal transsphenoidal endoscopic approach using image guidance.

Result: A 23-year-old male presented to our clinic with 2-year history of diplopia. Neurologic examination revealed cranial (abducens) nerve VI palsy on left side. Imaging studies demonstrated a 2.1 × 2.3 × 2.5 cm mass destructed clivus, extended cavernous sinus and displaced ICA. Tumor involved petrous apex, compressed slightly temporal lobe mediobasal segment and pons. Endonasal transsphenoidal surgery was performed with image guidance and intraoperative Doppler. Near total tumor removal was achieved in a piecemeal fashion without causing any injury to adjacent neurovascular structure. During surgery an inevitable CSF leak occur which repaired with multilayer technique at the end of surgery.

Conclusion: In our hands, endonasal endoscopic approach has showed its value in the treatment of petrous apex lesions with less morbidity. It appears to be an effective and viable technique for these lesions in most cases. However, each case should be evaluated individually for suitability.