CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2022; 83(S 03): e625-e626
DOI: 10.1055/s-0041-1726018
Skull Base: Operative Videos

Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma

1   Department of Biotechnology and Life Sciences, Division of Neurosurgery; University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
,
Alberto Campione
1   Department of Biotechnology and Life Sciences, Division of Neurosurgery; University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
,
Fabio Pozzi
1   Department of Biotechnology and Life Sciences, Division of Neurosurgery; University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
,
1   Department of Biotechnology and Life Sciences, Division of Neurosurgery; University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
2   Scuola di specializzazione in Neurochirurgia, Università degli studi di Pavia, Italia
,
Martina Venturini
1   Department of Biotechnology and Life Sciences, Division of Neurosurgery; University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
,
Edoardo Agosti
1   Department of Biotechnology and Life Sciences, Division of Neurosurgery; University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
,
Sergio Balbi
1   Department of Biotechnology and Life Sciences, Division of Neurosurgery; University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
,
Paolo Battaglia
3   Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
,
Davide Locatelli
1   Department of Biotechnology and Life Sciences, Division of Neurosurgery; University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
› Author Affiliations
 

Abstract

Objective We illustrate a cavernous sinus chondrosarcoma treated with an endoscopic endonasal transethmoidal-transsphenoidal approach.

Design Case report of a 15-year-old girl with diplopia and esotropia due to complete abducens palsy. Preoperative images showed a right cavernous sinus lesion with multiple enhanced septa and intralesional calcified spots ([Fig. 1]). Considering tumor location and the lateral dislocation of the carotid artery, an endoscopic endonasal approach was performed to relieve symptoms and to optimize the target geometry for adjuvant conformal radiotherapy.

Setting The study was conducted at University of Insubria, Department of Neurosurgery, Varese, Italy.

Participants Skull base team was participated in the study.

Main Outcome Measures A transethmoidal-transsphenoidal approach was performed by using a four-hand technique. We used a route lateral to medial turbinate to access ethmoid and the sphenoid sinus. During the sphenoid phase, we exposed the medial wall of the cavernous sinus ([Fig. 2]) and the lesion was then removed using curette. Skull base reconstruction was performed with fibrin glue and nasoseptal flap.

Results No complications occurred after surgery, and the patient experienced a complete recovery of symptoms. A postoperative magnetic resonance imaging showed a small residual tumor inside the cavernous sinus ([Fig. 1]). After percutaneous proton-bean therapy, patient experienced only temporary low-grade toxicity with local control within 2 years after treatment completion.

Conclusion Endoscopic endonasal extended approach is a safe and well-tolerated procedure that is indicated in selected cases (intracavernous tumors, soft tumors not infiltrating the vessels and/or the nerves). A tailored approach according to tumor extension is crucial for the best access to the compartments involved.

The link to the video can be found at: https://youtu.be/TsqXjqpuOws.


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Zoom Image
Fig. 1 Pre- and postoperative T1-weighted postgadolinium magnetic resonance imaging.
Zoom Image
Fig. 2 Intraoperative images of the surgical field. (A) Anatomical landmarks. (B) The cavernous sinus after tumor removal. CS, cavernous sinus; LOCR, lateral opticocarotid recess; ON, optic nerve.

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Quality:

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Conflict of Interest

None declared.

Address for correspondence

Gianluca Agresta, MD
Department of Biotechnology and Life Sciences, Division of Neurosurgery; University of Insubria, Ospedale di Circolo e Fondazione Macchi
Via Guicciardini, 132–21100, Varese
Italy   

Publication History

Received: 28 July 2020

Accepted: 03 November 2020

Article published online:
03 May 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Rüdigerstraße 14, 70469 Stuttgart, Germany

Zoom Image
Fig. 1 Pre- and postoperative T1-weighted postgadolinium magnetic resonance imaging.
Zoom Image
Fig. 2 Intraoperative images of the surgical field. (A) Anatomical landmarks. (B) The cavernous sinus after tumor removal. CS, cavernous sinus; LOCR, lateral opticocarotid recess; ON, optic nerve.