Background: Chordomas and chondrosarcomas of the skull base are formidable lesions; their often
insidious growth allows them to reach significant sizes, with involvement of the internal
carotid arteries and cranial nerves and extensive erosion and deformity of the surrounding
bone. Recent technological advances and a greater understanding of the anatomical
relations of the ventral skull have enabled endoscopic techniques to be applied to
the resection of these tumors with great success. Nonetheless, these lesions can present
involvement of multiple compartments of the cranial base, thus demanding a combination
of endonasal and transcranial approaches to permit a thorough removal.
Objective: Describe a series of patients harboring extensive skull base chordomas and chondrosarcomas
in which a combination of endonasal and transcranial approaches was employed to allow
maximal resection.
Methods: All pertinent records of chordomas and chondrosarcomas resected through a combination
of endonasal endoscopic (EEA) and transcranial approaches were reviewed. Operative
and pathology reports, pre and postoperative imaging and follow-up data were analyzed.
Results: Analysis of the senior authors' (DMP, RLC) database yielded 7 cases in which combined
approaches were employed, 5 chordomas and 2 chondrosarcomas (4 females, 3 males, mean
age 37.7 years). Surgical strategy was employed as follows: 1) EEA + Far lateral approach + EEA;
2) EEA + middle fossa approach + EEA; 3) EEA + bilateral transcondylar approach with
fusion + EEA; 4) EEA + middle fossa approach + EEA; 5) EEA + transoral approach + retrosigmoid
approach; 6) EEA + cranio-orbito-zygomatic approach; 7) EEA + EEA + infratemporal
fossa approach. Combination of these approaches yielded gross total resection in all
cases; all patients were referred for adjuvant proton beam therapy. Follow-up was
lost in 2 patients; the remaining 5 have been free of recurrence since the end of
their therapy (mean follow-up 12 months).
Conclusion: Despite the local aggressiveness of skull base chordomas and chondrosarcomas, through
meticulous surgical planning and strategy, even large lesions can be thoroughly resected
with minimal morbidity. A combination of various endonasal modules and tailored transcranial
skull base techniques can yield optimal results in these challenging cases.
