The Endoscopic Endonasal Approach for Removal of Petroclival Chondrosarcomas

Filho, Leo F. S. Ditzel; Prevedello, Daniel M.; Dolci, Ricardo Landini Lutaif; Jamshidi, Ali O.; Kerr, Edward E.; Campbell, Raewyn; Otto, Bradley A.; Carrau, Ricardo L.

doi:10.1016/j.nec.2015.03.008

Cited by 35 publications

(9 citation statements)

References 28 publications

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“…Clival chondrosarcomas develop within synchondroses, especially within the petroclival synchondrosis, and involve the surrounding regions, such as the clivus, sphenoid sinuses and the middle and posterior cranial fossae, even extending to the upper cervical area. These tumors are characterized by low to intermediate signal intensity on T1-weighted imaging and high signal intensity in T2-weighted and FLAIR imaging [32,33].…”

Section: The Radiological Differential Diagnosis To Exclude Other Cli...mentioning

confidence: 99%

A Rare Case of a Primary Leiomyoma of the Clivus in an Immunocompetent Patient and a Review of the Literature Regarding Clival Lesions

Kunicki

Rzewuska

Kunicki³

et al. 2022

Diagnostics

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Leiomyomas are common lesions that are usually located in the genitourinary and gastrointestinal tracts. Primary leiomyomas at the skull base are uncommon. They are composed of well-differentiated smooth muscle cells without cellular atypia. The diagnosis of a leiomyoma has to be confirmed by immunohistochemistry. The tumor tissue is immunoreactive for SMA, S100 and cytokeratin. Leiomyomas mainly occur in immunocompromised patients. Most tumor tissues are positive for EBV. The presented case is that of a 56-year-old immunocompetent woman with a tumor on the clivus. The radiological images suggested chordoma or fibrous dysplasia. Transnasal transsphenoidal surgery was performed. The tumor tissue consisted of well-differentiated smooth muscle cells with elongated nuclei. Immunohistochemistry revealed a positive reaction for desmin, SMA and h-Caldesmon and a negative reaction for S100, beta-catenin, PGR and Ki67. The leiomyoma diagnosis was subsequently established. To the best of our knowledge, the case of a primary leiomyoma on the clivus of an immunocompetent patient is the first to be described. We also extensively reviewed the literature on the immunohistopathological and radiological differential diagnosis of clival lesions.

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Section: The Radiological Differential Diagnosis To Exclude Other Cli...mentioning

confidence: 99%

A Rare Case of a Primary Leiomyoma of the Clivus in an Immunocompetent Patient and a Review of the Literature Regarding Clival Lesions

Kunicki

Rzewuska

Kunicki³

et al. 2022

Diagnostics

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“…With their usually slow growth rate, they are capable of reaching sizable dimensions, promoting bone erosion and significant displacement of neurovascular structures before causing symptomatology. Despite this local aggressiveness, these lesions often spare the dura, compressing and displacing rather than transgressing it 9 . Bone destruction and calcification occur in about 50% of chondrosarcomas and low-grade tumors tend to have more extensive calcification.…”

Section: S44mentioning

confidence: 99%

Clivus pathologies from diagnosis to surgical multidisciplinary treatment. Review of the literature

Pagella

Ugolini

Zoia

et al. 2021

Acta Otorhinolaryngol Ital

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“… 12 Indeed, the potential advantage of EEA for petrous apex chondrosarcomas includes the possibility of accessing multiple skull base compartments, even bilaterally, in a single procedure while also avoiding retraction or manipulation of neurovascular structures. 5 …”

Section: Case Reportmentioning

confidence: 99%

“…Chondrosacromas in the petous apex have been reported to be usually soft and amenable to suction, yet very hard and calcified ones can also be encountered. 5 Once complete tumor resection was achieved including removal of infiltrated bone, copious irrigation of the operative field with warm saline was done. This step promoted hemostasis and removal of any debris.…”

Section: Case Reportmentioning

confidence: 99%

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Chondrosarcoma in the Petrous Apex: Case Report and Review

et al. 2018

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Introduction Surgical treatment of petrous apex chondrosarcoma is challenging due to the location of the tumor. Using an endoscopic technique for tumor resection is favored since it provides a minimally invasive approach. Case Presentation A 57 years old female was admitted for acute onset of left abducens nerve palsy and occasional headache mainly on the left side of the retro-orbital area with some radiation to the left occiput. Magnetic resonance imaging (MRI) and computed tomography (CT), at the time of admission, were showed lytic lesion on the left petrous apex and left part of the clivus. Results of metastatic workup were negative. The surgical procedure considered was expanded endoscopic endonasal transclival approach to the left of the petrous apex and reconstruction with a pedicled nasoseptal flap with image guidance system. The pathology confirmed chondrosarcoma on myxoid background. The surgical procedure was uncomplicated. The abducens nerve palsy was resolved in few weeks and no new deficits occurred. Postoperative MRI showed complete resection of the tumor. Conclusion Expanded endoscopic endonasal transclival approach to petrous apex and reconstruction appears to be safe and feasible technique, capable of achieving total removal of identified lesions near the petrous apex. Nonetheless, future studies with a greater number of patients are crucial to confirm and consolidate this initial impression.

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The Endoscopic Endonasal Approach for Removal of Petroclival Chondrosarcomas

Cited by 35 publications

References 28 publications

A Rare Case of a Primary Leiomyoma of the Clivus in an Immunocompetent Patient and a Review of the Literature Regarding Clival Lesions

A Rare Case of a Primary Leiomyoma of the Clivus in an Immunocompetent Patient and a Review of the Literature Regarding Clival Lesions

Clivus pathologies from diagnosis to surgical multidisciplinary treatment. Review of the literature

Chondrosarcoma in the Petrous Apex: Case Report and Review

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