Endoscopic endonasal transpterygoid transnasopharyngeal management of petroclival chondrosarcomas without medial extension

Abstract

Chondrosarcomas of the skull base are malignant tumors for which surgery is the primary therapeutic option. Gross-total resection has been demonstrated to improve survival in patients with these tumors. Chondrosarcomas arising from the petroclival synchondrosis harbor particularly unique anatomical considerations that have long been a barrier to achieving such a resection. Endoscopic endonasal transpterygoid approaches have been recently used to gain improved access to such lesions; however, these approaches have classically relied on a medial to lateral transclival trajectory, which provides limited exposure for complete resection of lateral disease. In this paper the authors describe an endoscopic endonasal transpterygoid transnasopharyngeal approach that provides comprehensive access to the petroclival region through dissection of the eustachian tube with resection of the cartilaginous torus tubarius. Of note, the authors have previously demonstrated the superior outcomes and validity of this approach relative to other cranial base techniques for petroclival chondrosarcomas. Surgical outcomes in 5 cases of chondrosarcoma without medial extension are detailed. Gross-total resection was achieved in 4 of 5 patients. Postoperative complications included transient palatal numbness in all patients and eustachian tube dysfunction due to the approach. With tympanostomy tube placement, no patient had persistent hearing loss. Overall, this approach appears to be a safe and effective technique for resection of petroclival chondrosarcomas.

Endoscopic surgical treatment with nasal cavity approach for chondrosarcoma of paranasal sinus and the skull base

“…This suggests that the tumor has certain characteristics in imaging, but because of the low incidence, imaging doctors lack of diagnostic experience, it is easy to misdiagnose; and if the tissue for pathology is not su cient, it is also easy to mislead the diagnosis of pathology. Although radiotherapy may play a supporting role in the treatment of skull base ChSa, surgery is the most effective method to eradicate or prolong the patient's life because the tumors' character which rarely metastasizes, shows expansive and invasive growth, and has clear borders [1,9,16].…”

Endoscopic surgical treatment with nasal cavity approach for chondrosarcoma of paranasal sinus and the skull base

“…character which rarely metastasizes, shows expansive and invasive growth, and has clear borders [1,9,16].…”

“…The overall current consensus for initial treatment of ChSa is maximal safe surgical resection. Gautam et al pointed out surgery is the primary therapeutic option and endoscopic endonasal approaches have been proposed for some skull base ChSa [9]. The extent of tumour resection is very important to skull base ChSa prognosis.…”

The Impact of Expanded Endoscopic Approaches on Long Term Outcomes for Clival Malignancies - A Case Series

“…Clival malignancies require a multidisciplinary approach and pose particular surgical challenges due to the complex skull base anatomy [3]. Regardless of anatomic location, surgical resection entails an anatomic resection of all invaded bone plus resection of extraosseous extension into adjacent soft tissue compartments [4][5][6][7][8][9][10]. Multiple surgical approaches have been reported for clival pathology.…”

“…The expansion of endoscopic approaches in the coronal plane with, for example transpterygoid modi cations or contralateral transmaxillary approaches, have also enhanced the ability to tackle midline clival lesions with lateral extension [10,19,22].…”