Outcomes of Skull Base Chondrosarcoma Surgery: A Retrospective Analysis of Multicenter Registry

Introduction: Skull base chondrosarcomas are formidable tumors given the difficult-to-access location and frequent involvement of major vessels and cranial nerves. The surgical resection remains the mainstay of the treatment; however, with the development of endoscopic endonasal technique and the understanding of endoscopic anatomy, a shift toward the endoscopic endonasal approach (EEA) has been noted. As a combination of these techniques allows for a 360-degree approach we aimed at comparing both techniques in terms of efficacy and complications.

Methods: Patients treated for skull base chondrosarcoma at three tertiary referral academic centers in the United States with a high volume of chondrosarcomas treated between 1983 and 2022. All patients with histologically proven chondrosarcoma were included. A retrospective analysis of a prospectively maintained database was performed and records queried for patient demographics, pathological type/grade, tumor characteristics, radiological characteristics, and treatment modalities administered.

Results: We identified 149 patients (61 [40.9%] males) who underwent 218 surgeries, with a mean age of 47.32 (range: 7–82, IQR: 30.5) years and a mean follow-up of 77.78 (range: 1.4–309, IQR: 71.7) months. The mean preoperative tumor volume was 33.91 mL (range: 0.70–265, IQR: 36.6). A gross total resection (GTR) was achieved in 92 (42.2%) and a subtotal resection (STR) in 121 (57.8%) surgeries. Residual tumors were located most frequently in the cavernous sinus (n = 23, 19.0%), petrous apex (n = 20, 16.5%), along the internal carotid artery (n = 9, 7.4%), jugular foramen (6.6%), and in the subdural space (n = 5, 4.1%). There were no data available for 22 patients (18.2%). We did not find any difference in the extent of resection between combined (EEA + open), open and EEA (p = 0.37) or between EEA and open surgery alone (p = 0.40). There was no statistical difference between the frequency of residual tumors in the five most frequent locations and the approach chosen—open, EEA, and combined (p = 0.82). Interestingly, vimentin positive tumors had lower percentage of GTR (p = 0.0001). In contradiction, histological subtype was not associated with the extent of resection (p = 0.86).

Shorter time to first recurrence was noted in STR compared to GTR in treatment-naive patients (p = 0.047). A significant difference between postoperative complication rate in favor of EEA was noted between EEA, open, and combined approaches (p = 0.001). Similarly, a significant lower complication rate was noted in EEA compared to the open surgery alone (p = 0.0098). We found a similar complication rate between the primary and revision surgeries (p = 0.84). There was no difference in the extent of resection between and after a primary or recurrence surgery (p = 0.23).

Conclusion: Based on our current data, both techniques seem to be equivalent in terms of the extent of resection; however, the complication rate is significantly lower in the EEA group. Further stratification based on preoperative tumor extension is necessary.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025