A multidisciplinary team approach to skull base chondrosarcomas

Crockard, H A; Cheeseman, A. D.; Steel, Timothy; Révész, T; Holton, JL; Plowman, Nick; Singh, Akhilesh Kumar; Crossman, John

doi:10.3171/jns.2001.95.2.0184

Cited by 101 publications

(38 citation statements)

References 20 publications

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“…31,32 Although chondrosarcomas often involve the clivus, patients with these lesions typically present with more lateral extensions, which are not ideal indications for purely midline approaches, and thus transcranial routes are often preferred. 1,10,45,58 A minimally invasive technique, such as the EEE approach, is appealing as it exploits an anatomical corridor (nasal cavities and sinuses) to reach deep-seated structures without the need for craniotomy and brain retraction and their associated morbidity. An endoscope allows a significantly wider and better-illuminated field of view.…”

Section: Current State Of the Art In Surgical Approaches For Clival Lmentioning

confidence: 99%

Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach

Carrabba¹,

Dehdashti²,

Gentili³

2008

FOC

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Object Clival lesions pose significant challenges with regard to their surgical management. The expanded endoscopic endonasal (EEE) approach is a promising minimally invasive technique for lesions of the central skull base. The authors' aim in the current paper was to discuss the surgical treatment of clival lesions and to present the technical details, indications, and limitations of the EEE approach. Data from a recent endoscopically treated group will be compared with findings in a previous cohort of patients treated via classic open anterior and lateral approaches. Methods Since June 2005, 17 patients with clival lesions underwent surgery via the EEE approach. Suitable candidates were chosen according to lesion characteristics, clinical parameters, and surgical goals. Neurological outcomes, Karnofsky Performance Scale scores, the extent of lesion resection, and complications were evaluated among these patients. Eighteen percent of the patients in the endoscopic group presented with recurrent disease. Another series of 43 patients, who had undergone resection of clival lesions via an anterior (rhinotomy, maxillectomy, microscopic transsphenoidal surgery, or transoral surgery) or lateral (pterional, frontoorbitozygomatic, or combined suprainfratentorial retrosigmoid) approach, was similarly reviewed. Twenty-three of these patients (53%) presented with recurrent disease and thus had undergone prior surgery. Results Following the EEE approach, 11 (79%) of 14 patients who had presented with neurological symptoms experienced improvement, and gross-total resection was achieved in 59% of the patients and subtotal removal in 41%. Complications included CSF leakage (24%), tension pneumocephalus (6%), and intracranial hematoma (6%). The patient with the latter complication was the only one who experienced permanent neurological worsening. In the open resection group, neurological worsening occurred in 33% of the patients (14 of 43). Total and grosstotal removals were achieved in 84% of patients and subtotal removal in 14%. Conclusions The EEE approach has been shown to be a safe and effective technique for the resection of clival lesions with limited lateral extension. The choice of surgical approach must be tailored according to both patient and tumor characteristics. Although the 2 patient series featured in this paper are not comparable—because of a selection bias—higher rates of neurological morbidity and total and gross-total resections were observed in the open resection group. Given the long survival of some patients, the EEE approach should be favored whenever reasonable.

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Section: Current State Of the Art In Surgical Approaches For Clival Lmentioning

confidence: 99%

Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach

Carrabba¹,

Dehdashti²,

Gentili³

2008

FOC

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“…These same normal tissue structures also impose a limitation on the external-beam RT dose, which adds additional difficulty. The combination of surgery and RT appears to be the best treatment for these tumors [53][54][55]. The use of razoxane as a radiosensitizing agent along with conventional RT was explored in a small series and showed a trend for superior local control [56].…”

Section: Radiation Therapymentioning

confidence: 99%

Chordoma: The Nonsarcoma Primary Bone Tumor

Chugh

Tawbi

Lucas³

et al. 2007

The Oncologist

332

236

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Chordomas are rare, slowly growing, locally aggressive neoplasms of bone that arise from embryonic remnants of the notochord. These tumors typically occur in the axial skeleton and have a proclivity for the spheno-occipital region of the skull base and sacral regions. In adults, 50% of chordomas involve the sacrococcygeal region, 35% occur at the base of the skull near the spheno-occipital area, and 15% are found in the vertebral column. Craniocervical chordomas most often involve the dorsum sella, clivus, and nasopharynx. Chordomas are divided into conventional, chondroid, and dedifferentiated types. Conventional chordomas are the most common. They are characterized by the absence of cartilaginous or additional mesenchymal components. Chondroid chordomas contain both chordomatous and chondromatous features, and have a predilection for the spheno-occipital region of the skull base. This variant accounts for 5%-15% of all chordomas and up to 33% of cranial chordomas. Dedifferentiation or sarcomatous transformation occurs in 2%-8% of chordomas. This can develop at the onset of the disease or later. Aggressive initial therapy improves overall outcome. Patients who relapse locally have a poor prognosis but both radiation and surgery can be used as salvage therapy. Subtotal resection can result in a stable or improved status in as many as 50% of patients who relapse after primary therapy. Radiation therapy may also salvage some patients with local recurrence. One series reported a 2-year actuarial local control rate of 33% for patients treated with proton beam irradiation. The Oncologist 2007;12:1344 -1350

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“…En su localización craneofacial, el condrosarcoma es una entidad de rara aparición (8)(9)(10)(11). En estos casos, y dado su curso indolente, es fácil que se retrase por parte del paciente que lo padece la búsqueda de atención mé-dica, por lo que en la literatura encontramos un retraso promedio de 8 meses entre la presentación de los primeros signos clínicos y el diagnóstico final, tiempo que se dio también en la paciente del caso que presentamos.…”

Section: Discussionunclassified

“…El tratamiento de este tipo de tumoración es esencialmente quirúrgico, mediante cirugía radical con márgenes amplios de tejido sano, lo que supone la única posibilidad de curación (11). Suelen ser tumores radiorresistentes, por lo que la radioterapia no se considera como terapia útil en ninguna de sus fases (1,3,12).…”

Section: Discussionunclassified

Condrosarcoma de maxila en paciente pediátrico

Cruz-Reyes¹,

Palafox-Hernández²,

Flores-Alvarez³

et al. 2014

Cir. plást. iberolatinoam.

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ResumenEl condrosarcoma es un tumor maligno de origen cartilaginoso y etiología desconocida, que se caracteriza histológica-mente por un completo desarrollo de estructuras cartilaginosas maduras con nulo crecimiento de componente óseo. Supone aproximadamente el 10% de todas las neoplasias óseas. Se presenta generalmente en huesos largos, pelvis y costillas, siendo raro en localizaciones craneofaciales (menos del 5%), donde se considera de mayor agresividad debido a su rápido crecimiento y a la mayor capacidad de producir metástasis. Cuando se presenta en esta localización los sitios más afectados en orden de frecuencia son: maxila, mandíbula, tabique nasal y senos paranasales. Los rangos de edad recogidos abarcan desde los 8 meses hasta los 75 años, con una incidencia máxima entre la quinta y séptima décadas de la vida.Presentamos el caso de una niña de 7 años de edad con condrosarcoma de maxila, voluminoso y recurrente. La presentación clínica inicial fue como lesión nodular gingival derecha, asintomática, con crecimiento lento y progresivo durante 8 meses. Realizamos tomografía computarizada que mostró lesión gingival derecha de 3 x 3 cm y efectuamos resección marginal de la lesión que fue informada como condrosarcoma de II grado. La paciente presentó recurrencia tumoral aproximadamente al año, con reingreso hospitalario y recibió 9 ciclos de quimioterapia, para posteriormente efectuar maxilectomía bilateral subtotal con palatectomía y reconstrucción inicial con miniplacas de titanio y prótesis aloplástica. Presentamos imágenes de la valoración inicial, estudios complementarios, análisis histopatológico, procedimiento quirúrgico y estado postoperatorio.Palabras clave Condrosarcoma, Tumores de cabeza y cuello, Tumores en edad pediátrica. Nivel de evidencia científica V AbstractChondrosarcoma is a malignant tumor of cartilaginous origin and unknown etiology, histologically characterized by a complete development of cartilaginous structures with no growth of bone. It represents approximately 10% of all bone neoplasms. It's usually presented in long bones, pelvis and ribs and it's extremely rare in craniofacial locations (less than 5%), where are considered more aggressive because of its rapid growth and a larger proportion of metastasis. When present in these locations, most affected sites in order of frequency are: maxilla, jaw, nasal septum and paranasal sinuses. The reported age ranges are 8 months to 75 years, with its peak incidence between the fifth and seventh decades of life.We present a female 7 year old patient, who presented a chondrosarcoma in the maxilla, bulky and recurrent. Her initial clinical presentation was a nodular right gingival asymptomatic lesion, with slow growth and ongoing for 8 months.Computed tomography showed a 3 x 3 cm tumor in the right maxilla that underwent limited resection; the specimen was reported as a grade II chondrosarcoma that developed recurrence in a year. She received 9 chemotherapy cycles and later, bilateral subtotal maxillectomy and pallatectomy and initial reconstr...

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A multidisciplinary team approach to skull base chondrosarcomas

Cited by 101 publications

References 20 publications

Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach

Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach

Chordoma: The Nonsarcoma Primary Bone Tumor

Condrosarcoma de maxila en paciente pediátrico

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