Abstract
Background
Tumors of the petroclival region with multicompartment extension can be difficult to address with a single surgical approach.
Method
We present the case of a patient with a large chondrosarcoma centered at the right petroclival fissure with extension into the cavernous sinus, the region beneath the cavernous sinus, cerebellopontine angle with deformation of the pons, and prevertebral space. A staged complete resection was performed using a stage 1 single-incision combined right retrosigmoid craniotomy and extended middle fossa craniotomy, followed by a stage 2 endoscopic transnasal approach.
Conclusion
A combined approach to selected petroclival tumors can maximize safe resection.
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References
Carlson ML, O'Connell BP, Breen JT, Wick CC, Driscoll CL, Haynes DS, Thompson RC, Isaacson B, Gidley PW, Kutz JW, Van Gompel JJ, Wanna GB, Raza SM, DeMonte F, Barnett SL, Link MJ (2016) Petroclival chondrosarcoma: a multicenter review of 55 cases and new staging system. Otol Neurotol 37:940–950. https://doi.org/10.1097/MAO.0000000000001037
Diaz Day J (2012) The middle fossa approach and extended middle fossa approach: technique and operative nuances. Neurosurgery 70:192–201. https://doi.org/10.1227/NEU.0b013e31823583a1
Hofstetter CP, Singh A, Anand VK, Kacker A, Schwartz TH (2010) The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave. J Neurosurg 113:967–974. https://doi.org/10.3171/2009.10.JNS09157
Horgan MA, Anderson GJ, Kellogg JX, Schwartz MS, Spektor S, McMenomey SO, Delashaw JB (2000) Classification and quantification of the petrosal approach to the petroclival region. J Neurosurg 93:108–112. https://doi.org/10.3171/jns.2000.93.1.0108
Komotar RJ, Zacharia BE, McGovern RA, Sisti MB, Bruce JN, D'Ambrosio AL (2010) Approaches to anterior and anterolateral foramen magnum lesions: a critical review. J Craniovertebr Junction Spine 1:86–99. https://doi.org/10.4103/0974-8237.77672
Krisht AF (2005) Transcavernous approach to diseases of the anterior upper third of the posterior fossa. Neurosurg Focus 19(2):E2. https://doi.org/10.3171/foc.2005.19.2.3
Mangussi-Gomes J, Alves-Belo JT, Truong HQ, Nogueira GF, Wang EW, Fernandez-Miranda JC, Gardner PA, Snyderman CH (2022) Anatomical limits of the endoscopic contralateral transmaxillary approach to the petrous apex and petroclival region. J Neurol Surg B Skull Base 83:44–52. https://doi.org/10.1055/s-0040-1716693
Muto J, Prevedello DM, Ditzel Filho LF, Tang IP, Oyama K, Kerr EE, Otto BA, Kawase T, Yoshida K, Carrau RL (2016) Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region. J Neurosurg 125:1171–1186. https://doi.org/10.3171/2015.8.JNS15302
Palmisciano P, Haider AS, Sabahi M, Nwagwu CD, Bin Alamer O, Scalia G, Umana GE, Cohen-Gadol AA, El Ahmadieh TY, Yu K, Pathmanaban ON (2021) Primary skull base chondrosarcomas: a systematic review. Cancers (Basel) 13(23):5960. https://doi.org/10.3390/cancers13235960
Samii M, Alimohamadi M, Gerganov V (2016) Endoscope-assisted retrosigmoid infralabyrinthine approach to jugular foramen tumors. J Neurosurg 124:1061–1067. https://doi.org/10.3171/2015.3.JNS142904
Author information
Authors and Affiliations
Contributions
Robert C. Rennert: Methodology; writing — original draft; visualization
Karol P. Budohoski: Writing — review and editing
Vance R. Mortimer: Visualization, writing — review and editing
William T. Couldwell: Conceptualization, resources, supervision, project administration, writing — review and editing
Corresponding author
Ethics declarations
Ethical approval
Approval from the institutional review board is waived for case reports. All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Utah and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Consent to participate
The patient consented to participate.
Consent for publication
The patient consented to the publication of her case in this paper.
Conflict of interest
The authors declare no competing interests.
Additional information
Key points
• Multicompartment tumors may not be resectable from a single approach.
• Petroclival chondrosarcomas may need combined surgical approaches.
• Approach planning requires knowledge of the pros and cons of various surgical options.
• The initial surgery should address critical pathology or the tumor bulk.
• A combined retrosigmoid and middle fossa approach can minimize sinus injury risk.
• Endoscopic transnasal approaches are ideal for the midline anterior skull base.
• Collaboration, as needed, with assisting surgeons is critical.
• For benign lesions, a maximal safe resection is the goal.
• Adjuvant radiation is available for residual tumor.
• Patient understanding of multi-approach treatment plans is critical.
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Rennert, R.C., Budohoski, K.P., Mortimer, V.R. et al. Combined and staged retrosigmoid, extended middle fossa, and endoscopic transnasal approach to a petroclival chondrosarcoma: how I do it. Acta Neurochir 165, 3455–3459 (2023). https://doi.org/10.1007/s00701-023-05749-6
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DOI: https://doi.org/10.1007/s00701-023-05749-6