Chondrosarcoma in the Petrous Apex: Case Report and Review

Background The surgical treatment of petrous apex chondrosarcoma is challenging due to the location of the tumor. Using an endoscopic technique for this tumor resection is becoming a preferred procedure since it provides a minimally invasive approach.

Objectives To assess the feasibility and safety of using expanded endoscopic endonasal transclival approach to petrous apex and reconstruction in a case of chondrosarcoma of petrous apex.

Case Presentation A 57-year-old female patient admitted for acute onset of left abducens nerve palsy and occasional headache mainly on the left side of the retro-orbital area with some radiation to the left occiput. Admission MRI and CT showed lytic lesion on the left petrous apex and left part of the clivus. Results of metastatic work-up were negative. The surgical procedure considered was expanded endoscopic endonasal transclival approach to the left of the petrous apex and reconstruction with a pedicled nasoseptal flap with image guidance system. The pathology confirmed chondrosarcoma on myxoid background.

Results The surgical procedure was uncomplicated. The abducens nerve palsy resolved in few weeks and no new deficits occurred. Patient was discharged on postoperative day 3. Postoperative MR showed complete resection of the tumor.

Conclusion Expanded endoscopic endonasal transclival approach to petrous apex and reconstruction appears to be safe and feasible technique, capable of achieving total removal of identified lesions near the petrous apex. Nonetheless, future studies with a greater number of patients are crucial to confirm and consolidate this initial impression.