J Neurol Surg B Skull Base 2016; 77 - LFP-09-07
DOI: 10.1055/s-0036-1592604

A Contemporary Surgical Series of Skull Base Chondrosarcomas: A Review of Clinical Characteristics, Surgical Technique, and Patient Outcomes

Moujahed Labidi 1, Anne-Laure Bernat 1, Damien Bresson 1, Kentaro Watanabe 1, Philippe Herman 2, 3, Schaharzed Bouazza 1, Marc Polivka 4, Homa Adle-Biassette 3, 4, Jean-Pierre Guichard 5, Loic Feuvret 6, Etienne Gayat 7, Bernard George 1, Sébastien Froelich 1, 3
  • 1Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
  • 2Departement of ENT, Hôpital Lariboisière (AP-HP), Paris, France
  • 3Paris VII-Diderot University;
  • 4Department of Pathology, Hôpital Lariboisière (AP-HP), Paris, France
  • 5Department of Neuroradiology, Hôpital Lariboisière (AP-HP), Paris, France
  • 6Department of Proton Therapy, Institut Curie
  • 7Department of Anesthesiology, Hôpital Lariboisière (AP-HP), Paris, France

Introduction: The long-term outcome of skull base chondrosarcomas is difficult to assess because of their slow growth and propensity for late recurrence after treatment. We describe our recent surgical experience with chondrosarcomas, through both the lateral transcranial (LTC) and the endoscopic endonasal approach (EEA), and examine the long-term outcomes achieved.

Methods: We performed a retrospective analysis of all consecutive cases of skull base chondrosarcomas treated surgically in our institution between 2004 and 2015.

Results: Over an 11-year period, 41 patients underwent 55 operations. Six (14.6%) were previously operated in other institutions and one had already been irradiated (2.4%). The EEA was favored as a standalone procedure in 20 patients (48.8%) and was part of a combined strategy in 4 (9.8%). There was no statistically significant difference in resection rate between patients operated initially through an EEA (GTR 9.76%, STR 22.0%) or through a LTC (GTR 14.6%, STR 14.6%) (p = 0.60). Infectious complications and CSF leak were more frequent in LTC than EEA (12.2 vs. 0%, p = 0.01 and 9.76 vs. 0%, p = 0.024, respectively). Thirty-one patients (75.6%) received postoperative proton beam therapy. Mean follow-up time was 40.4 months. During follow-up, one patient presented a tumor recurrence (2.4%) and there was one perioperative mortality (2.4%).

Conclusion: With careful patient selection, an EEA or a LTC can provide long-term tumor control. In certain cases, a combined surgical strategy may allow for higher resection rates. However, the recurrence rate and tumor growth being both very low, a more conservative approach may be justified.