Chondromas of the Skull Base: Clinical Presentation, Surgical Technique, and Outcome in Three Cases

Objective: Chondromas of the skull base are very rare tumors arising from cartilage rests of synchondroses of the skull. The clinical presentation, surgical technique, and follow-up of 3 cases are described.

Methods: Between 2010 and 2014, three patients (two females/one male) were treated. A 35-year-old woman presented with massive headaches. A 19-year-old female presented with headaches and abducens palsy. In a 55-year-old male, a unilateral tongue atrophy was found incidentally.

Results: The osteolytic mass of the lesser sphenoid wing was subtotally resected via a standard pterional approach. The remnant shows no progression during the 54 months follow-up. The headaches resolved. The cavernous sinus mass was biopsied via a transnasal endoscopic approach and thereafter subtotally resected via a pterional approach including an anterior clinoidectomy in two surgeries. The abducens palsy and the headaches resolved. The remnant was progression free during 40 months of follow-up. The mass of the occipital condyle and jugular foramen was gross totally resected via an extreme lateral, infralabyrinthine, transcondylar approach. The X and XII cranial nerve palsy did not improve during a 2 weeks follow-up. No new cranial nerve or functional deficit, CSF leak, or infection was encountered in neither patient.

Conclusion: Chondromas of the skull base may arise from different synchondroses. According to the location, the neurologic symptoms are variable. In the cavernous sinus chondroma, the abducens palsy resolved completely, indicating that prompt surgery may be considered. A wait and scan policy should be restricted to asymptomatic patients.