Endoscopic Endonasal Surgery for Cranial Base Chondrosarcomas: Comparison to Open Approaches

Introduction: Chondrosarcomas are neoplastic lesions representing ∼6% of all cranial base tumors. Maximum cytoreductive surgery, through a variety of cranial abase approaches, is the initial treatment in many cases. The advent of endoscopic endonasal techniques for cranial base pathologies has brought a new perspective for the treatment of these tumors. The goal of this study is to evaluate the outcomes of endoscopic endonasal approaches (EEA) and compare them with traditional open approaches for cranial base chondrosarcomas (CBCs) emphasizing early outcomes.

Methods: A retrospective analysis of a series of 27 patients harboring CBC that were treated at our institution with purely an EEA. The extent of resection and complications were noted. These results were compared with those previously published in major recent series where only open cranial base approaches were used.

Results: Total resection via EEA was achieved in 18 of our patients (66.7%). Perioperative complications were observed in 9 patients (33.4%) and included new neurological deficits, vascular injuries, cerebrospinal fluid leak, meningitis, hydrocephalus, deep venous thrombosis and other general medical conditions. Review of the literature identified 132 patients who underwent open resection. Total resection was achieved in 83 patients (62.9%) and complications were reported in 42 patients (37.5% - 20 patients were excluded due to lack of comparable data).

Conclusions: The use of EEA for resection of CBC shows similar early results when compared with open cranial base approaches. Depending on tumor location, an EEA may be preferred.