Volume 69, Issue 4, July 2023, 101430Author links open overlay panel, , , , , , AbstractBackground

Management of skull base chondrosarcoma (SBC) remains challenging due to its deep location and complex growth pattern. Non-total resection and postoperative residual mass are common features, with controversy regarding the need to offer systematic postoperative radiation therapy or additional surgery.

Methods

A single-center retrospective cohort study was conducted on 10 consecutive patients harboring petroclival chondrosarcomas that were operated on between May 2007 and March 2019. After resection, the patients were allocated to a wait-and-rescan policy.

Results

Patients were operated on through an extradural anterior petrosectomy (EAP). Subtotal tumor resection was achieved in all patients. The mean duration of follow-up was 70 months (range 25–137/median 67 months). Clinical outcomes dramatically improved in three (30%) patients, while five patients retained preoperative cranial nerve (CN) disturbances after surgery (50%). Two patients reported transient postoperative worsening of their symptoms (20%). All of the postoperative CN new deficits improved within one year, except in one patient who showed permanent facial nerve palsy. The preoperative median Karnofsky Performance Scale (KPS) score was 80 (range 70–100), and then it became 90 (range 70–100) postoperatively. Patients harboring a tumor residue were included in a wait-and-rescan policy. With this regimen, tumor control was obtained in seven patients (70% of cases until the last follow-up). Three patients (30%) showed progression of the residual; two of them were treated with adjuvant therapy, while an extra cranial growth residue was observed in the third.

Conclusion

Optimal and reasonable surgical resection of petroclival chondrosarcomas could be achieved with good to excellent functional outcomes through an EAP. In spite of a significant percentage of regrowth, only one patient required additional salvage surgery.

Section snippetsAbbreviationsCS

ChondrosarcomaAbbreviations

CSF

cerebro-spinal fluid

EAP

epidural anterior petrosectomy

FN

facial nerve

GKS

gamma-knife surgery

G&R

Gardner & Robertson

HB

House & Brackmann

MRI

magnetic resonance imaging

PFS

progression-free survival

Study design

All consecutive patients who underwent surgical resection of petroclival CS between May 2007 and March 2019 at our institution were included in this retrospective cohort study by means of a computerized search of our institution database registry. The CS diagnosis was histologically confirmed in all cases. Informed consent was obtained from all patients, and the French Neurosurgical College Institutional Review Board approved this study (reference: IRB00011687 College de Neurochirurgie IRB #1:

Population study

The study group consisted of 10 patients. The median age at the time of diagnosis was 50 years (range 27–65). The median age at the time of surgery was 51 years (range 30–66). Three patients (30%) had previously been operated on in another center and showed evidence of continuous tumor regrowth.

Presenting symptoms

As suspected of petroclival tumors, oculomotor nerve affections were the most common presenting symptoms, particularly CN VI palsy, which was found in seven patients (70%), while CN III was found in one

Patient 1

A 31-year-old female patient presented with progressive diplopia due to right-side abducens nerve palsy for five years. A brain MRI showed a voluminous petroclival lesion with pure extradural development. A right-side EAP was used in the same year of diagnosis, and a subtotal resection (more than 90%) was achieved. KPS improved from 80 to 90; however, the postoperative worsening of her diplopia was adequately corrected surgically. The tumor histopathology was a grade I CS. No adjuvant therapy

Discussion

The grading of the CS tumor, localization, and surgical interventions are some factors that can affect the morbidity and mortality of CS [8], [19]. However, recurrence is the most important factor related to the morbidity of CS [9]. Conventional CS have the best prognosis, particularly grades I and II [8], [12], [13], [17]. In our study, all patients had either grade I (70%) or grade II (30%) CS.

Because the spheno-petro-clival junction is the most common site, patients usually present with

Conclusion

The results of our surgical experience for pure petroclival CS suggest the following considerations: Transcranial EAP is safe, carries a limited number of complications, and provides significant functional improvement in some cases. Long-term tumor control was achieved in 70% of cases without the need for adjunctive treatment since the potential of regrowth of the remnant tumor was not foreseeable. A subsequent surgery is feasible with an acceptable risk. The role played by RT remains a subject

Statement of authorship

All authors have made substantial contributions to qualify for authorship and have read and approved the final version of this manuscript.

Submission statement

This manuscript has not been previously published in whole or in part or submitted elsewhere for review.

Disclosure of funding

None of the authors disclose any financial disclosure in relation to this study.

Disclosure of interest

The authors declare that they have no competing interest.

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