Patient Outcome at Long-term Follow-up after Aggressive Microsurgical Resection of Cranial Base Chondrosarcomas

Abstract

Cranial base chondrosarcomas can be managed well by complete surgical resection or by a combination of surgery and radiotherapy. The study cannot comment about the efficacy of radiotherapy. Approximately half of the patients survived without recurrence at long-term follow-up (>132 mo). The functional status of the surviving patients was excellent at follow-up.

Efficacy and Safety of Adjuvant Proton Therapy Combined With Surgery for Chondrosarcoma of the Skull Base: A Retrospective, Population-Based Study

“…Tzortzidis et al (7) recommended that RT should be withheld when total tumor resection has been achieved but reported a 10-year recurrence-free survival rate of only 42.3%. Almefty et al (21) analyzed 20 patients after complete CSA resection with or without adjuvant RT.…”

“…In the modern era of skull base surgery, the goal is to perform total gross resection, even when total microscopic resection is not possible owing to the proximity of organs at risk (OARs; ie, major blood vessels, cranial nerves, and brainstem). Despite advanced microsurgical techniques and radical resection, local tumor recurrence is a common event (7). Moreover, after surgery, 25% of patients will exhibit new cranial nerve deficits, 9% will experience cerebrospinal fluid leak, and 14% will present vessel injury (8,9).…”

Skull Base Chondrosarcoma

“…Among a group of combined modern surgical case series for skull-base chondrosarcoma, approximately a third of tumors were resected via an anterior approach, a third via a posterolateral approach, and a third via alternative approaches including transfacial and transsphenoidal approaches. 5,6,13,14,16 Endoscopic transnasal approaches have also been reported with success for specific tumors. 17 Preoperative cranial-nerve deficits are common in cranial chondrosarcoma patients, with the most common presenting symptom being diplopia secondary to dysfunction of cranial nerve VI.…”

The biological basis for modern treatment of chordoma

“…Intralesional resection in sacral chordoma is associated with increased local recurrence [92] and shorter diseasefree survival (17.5 vs 51 months) [93] when compared to en-bloc resections. In a series of 74 patients with cranial base tumors, gross total removal was achieved in 53 (72%) and subtotal removal in 21 (28%) with 31% progressionfree survival at 10 years, indicating that surgery alone is not sufficient for tumor control [94]. In the mobile spine, en-bloc resection was achieved in 17 of 37 patients, with disease-free survival ranging from 51 to 152 months for 12 patients [95].…”