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

Moujahed Labidi; Anne-Laure Bernat; Damien Bresson; Kentaro Watanabe; Philippe Herman; Schaharzed Bouazza; Marc Polivka; Homa Adle-Biassette; Jean-Pierre Guichard; Loic Feuvret; Etienne Gayat; Bernard George; Sébastien Froelich

doi:10.1055/s-0036-1592604

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

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

Abstract

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.