Surgical Experience with Skull Base Chordomas/Chondrosarcomas

Aims: A retrospective analysis of the surgical results of 43 cases of chordomas and chondrosarcomas operated from January 1980 to August 2007 is presented.

Material and Methods: While most cases (34) involved upper and mid clivus (sphenoid and ethmoid extension in 10, middle fossa/posterior fossa straddling petrous apex in 8, middle fossa with infratemporal extension in 3), the remainder (9) involved the lower clivus. Fifty-two surgical procedures were done in 43 patients. Various procedures included extended frontobasal (12 cases), subtemporal zygomatic (9), frontotemporal with orbitozygomatic transsylvian (7), petrosal approach (4), transsphenoidal (2), subtemporal (4), extreme lateral/transcondylar (5), transoral-transaltopharyngeal (2), mandibular swing retromaxillary (2), extended middle fossa (2), and posterior petrosectomy (3).

Results: We could achieve radical excision (total/near total) in 20 cases (47%), subtotal in 17 (39%), partial in 5 (12%), and biopsy in 1. Thirteen patients underwent adjuvant radiotherapy. There was one operative mortality. During the mean follow-up period of 60 months, 21 cases were independent with cranial nerve deficits, 15 underwent surgery for tumor recurrence, and 6 patients expired.

Conclusion: Due to the lesions' multicompartmental locations and invasiveness, the preoperative analysis of the anatomical extent of the lesion is the most important factor in planning a surgical approach.