Surgical Strategies and Outcomes for Intracranial Chondromas: A Retrospective Study of 17 Cases and Systematic Review

Abstract

ObjectiveTo improve the diagnosis and treatment of intracranial chondromas (ICDs) by discussing the clinical manifestations and imaging characteristics of ICDs, as well as surgical methods and treatment strategies.MethodsWe retrospectively analyzed 17 patients diagnosed with ICDs who underwent microsurgery or endoscopic transsphenoidal surgery at the Tangdu Hospital of Air Force Military Medical University and the Mianyang Central Hospital from January 2010 to November 2021. Clinical manifestations, imaging examinations, surgical treatments, and prognosis of these patients were analyzed.ResultsICDs had often been misdiagnosed as craniopharyngioma, chordoma, schwannoma, cavernous hemangioma, pituitary adenoma, and meningioma before surgery. Of the 17 cases, gross total resection (GTR) was performed in 10 cases, subtotal resection (STR) in 5, and partial resection in 2. GTR of tumor was achieved in eight cases via the endoscopic endonasal transsphenoidal approach (EETA) or the extended endoscopic endonasal transsphenoidal approach (EEETA), and the remaining patients underwent craniotomies. Clinical symptoms were assessed 1 week after surgery, 10 cases were relieved at varying degrees, and four cases had no improvement. Postoperative complications included right-limb hemiparesis, diplopia, eyelid ptosis, pulmonary infection, subcutaneous hydrops, cerebrospinal-fluid leakage (CSFL), and intracranial infection (ICI). One patient received gamma knife treatment at 3 months after surgery, two patients died due to tumor progression, and the remaining patients had no tumor recurrence.ConclusionsICDs lack typical imaging features and are often misdiagnosed. The EETA or EEETA helps improve the surgical outcomes and GTR rates of ICDs at different sites.

Preoperative peripheral inflammatory markers are predictors of postoperative central diabetes insipidus in craniopharyngioma patients: a retrospective study

“…One possible reason of this inconsistency may depend on definition of the extent of tumor resection. Although we defined GTR as more than 95% of tumor resected and defined STR as 80–95% of tumor resected in this study [ 17 , 18 ], majority of the reported investigations were stood on another standard as GTR as 100% and STR as more than 90% [ 37 – 40 ]. This may reflect the inconsistency between our study and previously reported statistical results.…”

Giant skull base periosteal chondroma treated with endonasal endoscopic surgery: illustrative case

“… 17 Furthermore, other studies have reported that gross-total resection for a craniotomy was performed in 22.7% to 36.7% of affected cases, whereas EES was used in 58.8%. 18 , 19 This procedure has a few advantages. First, a chondroma is usually located in the epidural space, where it can be easily reached and removed without causing injury to surrounding structures such as arteries and nerves.…”

A multicenter retrospective analysis of clinical outcomes of intracranial chondrosarcoma in 26 patients

“…Chondrosarcoma shows a heterogeneous signal on T2-weighted images, with a “honeycomb” appearance after enhancement. However, there are no specific imaging findings in some intracranial chondrosarcomas, and they need to be differentiated from meningiomas, schwannoma, chordomas, and chondromas 7 , 12 – 14 . Based on the data from three hospitals in the past 12 years, CT showed that almost all the lesions had varying degrees of erosion and destruction, 15 cases with mixed high- and low-density shadows and 10 cases with irregular soft tissue shadows.…”

“…Chordoma, chondroma, and chondromyxoid fibroma are similar to chondrosarcoma in terms of location, imaging presentation, and pathological morphology. Compared with chondrosarcoma, chondroma is more differentiated and less likely to have binucleated cells; chordoma is more likely to immunohistochemically express CK and EMA; chondromyxoid fibroma is positive for S100, and positive to desmin and CD34 to varying degrees 7 , 34 , 38 . Among our 26 cases, 24 were chondrosarcoma grade I, two were chondrosarcoma grade II, and there was no mesenchymal chondrosarcoma.…”

“…Preoperative CT angiography (CTA), magnetic resonance angiography (MRA), and magnetic resonance venography (MRV) were used to evaluate chondrosarcoma in relation to blood vessels and venous sinuses. The degree of surgical resection included the following three options: gross total resection (GTR), no tumor residue; subtotal resection (STR), > 90% of tumor removed; and partial resection (PR), 50–90% of tumor removed 7 . Follow-up was conducted every 3–6 months by outpatient or telephone interview.…”