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Surgical treatment of skull base chondrosarcomas

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Abstract

Skull base chondrosarcomas are rare tumors and individual experience with their management is limited. We present a series of such tumors treated at our institution. Particular attention was paid to their extension pattern, choice of surgical approach, and outcome. Twenty-five patients were operated consecutively over a period of 19 years. Their clinical presentation, radiological features, surgical treatment, early and late treatment outcome, as well as survival rate were analyzed. The most frequent initial symptom was abducent palsy. The typical bone destruction of the petrous apex was found in 83%. Chondrosarcomas extended in 92% to the posterior cranial fossa. Total number of surgeries was 39. The operative approach was tailored to each case. The retrosigmoid approach was used in 30.8%, the pterional in 23%, and the transethmoid in 15.4%. Total tumor removal was achieved in 19 of the surgeries. New neurological deficits immediately after surgery appeared in 33.3%. The perioperative mortality was 0%. The average Karnofsky performance score at last follow-up was 91%, and 5- and 10-year survival rates were 95%. Individually tailored approach in skull base chondrosarcomas allows radical removal with low morbidity rates and without mortality. Given the good long-term prognosis, surgical treatment should not deteriorate significantly patients’ quality of life.

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Correspondence to Amir Samii.

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Comments

Damianos Sakas, Athens, Greece

This report describes a reasonably big series of patients with a rare and difficult to manage tumor, of whom the great majority was managed by the same surgeon over a time period of 19 years. It is noteworthy that the authors conclude that neither the radicality of tumor resection nor the adjunct radiotherapy was found to affect the survival rates. Due to their histopathological origin, i.e., from tissue layers covering the cranial base, these tumors frequently not only displace or distort critical neurovascular structures but encase them for a considerable length. This makes radical excision of chondrosarcomas very difficult. It is important that the authors also found that the most important variables that have predictive value with respect to a less satisfactory outcome are the large tumor size and the tumor’s proximity to critical neurovascular structures. Based on the senior authors long-lasting experience, the contribution of the article in the relevant literature would be much greater if useful surgical tips on the management of these challenging tumors were provided. Nevertheless, the report of these patients treated by a distinguished surgeon, who is well-known for his highly successful radical surgical philosophy, is very useful; it confirms, with respect to this particular tumor, that the right approach is the more cautious one, namely the approach of safe cytoreduction, i.e., individualized subtotal resection combined with radiotherapy.

Takeshi Mikami, Tomakomai, Japan

In this report, the authors present a series of patients with chondrosarcoma of the skull base. Chondrosarcoma originating along the skull base is extremely rare, so this case series is exceptionally valuable.

The surgical results and long-term follow-up prognosis are extremely good, and the authors have even mentioned the correlation between extension pattern and surgical approach. This paper will allow readers to learn about surgical strategy and long-term management from experienced surgeons.

In this study, the authors have not included any conclusions on radiotherapy that were based on data, yet some of their cases must have received some benefit from radiotherapy. This leaves the door open for further developments in the management of chondrosarcoma, specifically in the use of multimodality treatment.

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Samii, A., Gerganov, V., Herold, C. et al. Surgical treatment of skull base chondrosarcomas. Neurosurg Rev 32, 67–75 (2009). https://doi.org/10.1007/s10143-008-0170-4

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