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How I do it: Surgical Resection of a Recurrent Chondromyxoid Fibroma by Micro-Endoscopic Combination Technique

  • How I Do it - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract 

Background

The surgical resection of the tumor spreading into the cavernous sinus (CS) is complicated and challenging.

Method

We report a left recurrent CS chondromyxoid fibroma occupying the clival-petrous apex-parasellar-suprasellar area, which was totally removed by the micro-endo combination technique via the middle cranial fossa extradural approach.

Conclusion

This case demonstrates the value of the micro-endoscopic combination technique for complicated skull base surgery.

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Acknowledgements

This study was sponsored Shanghai Rising-Star Program (18QA1400900) and CAMS Innovation Fund for Medical Sciences (CIFMS, 2019-I2M-5-008). The authors thank Jianbin Shi for brain imaging processing and Geng Xu for intraoperative electrophysiological monitoring support.

Author information

Author notes

  1. Zixiao Yang and Jiajun Cai contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China

    Zixiao Yang, Jiajun Cai & Jianping Song

  2. National Center for Neurological Disorders, Shanghai, 200040, China

    Zixiao Yang, Jiajun Cai & Jianping Song

  3. Neurosurgical Institute of Fudan University, Shanghai, 200040, China

    Zixiao Yang, Jiajun Cai & Jianping Song

  4. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China

    Zixiao Yang, Jiajun Cai & Jianping Song

  5. State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200040, China

    Zixiao Yang, Jiajun Cai & Jianping Song

  6. Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences (CAMS), Shanghai, 200040, China

    Zixiao Yang, Jiajun Cai & Jianping Song

  7. Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China

    Zunguo Du

  8. Department of Neurosurgery, Fudan University Huashan Hospital Fujian Campus, Fujian Medical University The First Affiliated Hospital Binhai Campus, National Regional Medical Center, Fuzhou, 350209, Fujian, China

    Jianping Song

Authors
  1. Zixiao Yang
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  2. Jiajun Cai
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  3. Zunguo Du
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  4. Jianping Song
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Corresponding author

Correspondence to Jianping Song.

Ethics declarations

Disclosure of potential conflicts of interest

None.

Research involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Huashan Hospital Institutional Review Board (HIRB), Fudan University, Shanghai, China.

Informed consent

It represents a video of a surgical case. The patient gave approval for this publication.

Conflict of interest

The authors declare that they have no conflict of interest.

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Key points

1. The CS tumor resection is highly challenging because of the complicated neurovascular relationships.

2. The CS has four dural walls surrounding a venous plexus that receives the tributaries of multiple veins drainage.

3. Knowing the extradural and intradural triangles of the CS is essential for CS tumor operation.

4. The CMF is a rare tumor with extensive skull base involvement.

5. The orbitozygomatic extradural approach is a standard skull base technique to access the CS.

6. The Doppler ultrasound probe helps locate the ICA during CS tumor resection.

7. Care should be taken not to injure the ICA, and the direct violation of the ICA by the curettage should be avoided.

8. The wide-angle endoscope helps detect and remove the tumor around the corners covered by the eroded bony structure.

9. Since the dura is intact, gradually “pushing” the paraseller and suprasellar CMF out to the surgical cavity is useful to ease tumor removal.

10. The micro-endoscopic combination technique is helpful in selected complicated skull base surgery.

This article is part of the Topical Collection on Brain Tumors

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Yang, Z., Cai, J., Du, Z. et al. How I do it: Surgical Resection of a Recurrent Chondromyxoid Fibroma by Micro-Endoscopic Combination Technique. Acta Neurochir 164, 1961–1965 (2022). https://doi.org/10.1007/s00701-022-05185-y

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  • DOI: https://doi.org/10.1007/s00701-022-05185-y

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