The Role of Endoscopic Endonasal Surgery in Petroclival Chondrosarcoma

Introduction: The endonasal corridor has gained popularity as a means for accessing midline pathologies of the anterior skull base. Its use as a primary treatment modality, as well as in conjunction with open approaches, has led to improved surgical outcomes for some of these. The purpose of this study was to evaluate its use in the resection of petroclival chondrosarcomas.

Methods: The charts and radiographs of 16 consecutive patients who underwent an endonasal skull base approach for resection of chondrosarcoma were reviewed. Attention was paid to extent of resection and the need for further therapy.

Results: The mean age of the 16 patients was 45.5 years. Four (25%) of the tumors were recurrent tumors that had been previously operated on via craniotomy. Two of these patients also had prior radiation therapy. Gross total resection was achieved in eight patients (50%), and near total resection was achieved in six (37.5%). One surgery was aborted due to carotid perforator avulsion and significant blood loss. In patients who did not have a gross total resection, the most common place for residual tumor was the inferolateral margins of the resection. Of patients with a residual tumor, one (6.2%) patient required an open operation for recurrence in the parapharyngeal space.

Conclusion: The endonasal corridor can safely enable the removal of some select chondrosarcomas of the skull base. In cases where complete removal of tumor is not possible, other surgical corridors, adjuvant radiotherapy, or observation are reasonable treatment options.