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P165: "SKULL BASE CHONDROSARCOMA" ANALYZING A RARE PATHOLOGY.
Andres Cervio, Neurosurgeon¹; Mauro E Ruella, Neurosurgeon¹; Jazmin A Fraire, MD¹; Lucila Domecq, MD¹; Ruben Mormandi, Neurosurgeon¹; Francisco Marco del Pont, Neurosurgeon¹; Ricardo Marengo, ENT²; ¹Fleni; ²Cemic

Introduction: Chondrosarcomas are malignant tumors that develop from cells derived from chondrocytes. They constitute about 20% of cancers of the skeletal system and affect people between 40 and 70 years old

Only 2% are located at the skull base and the petroclival location is the most common. Symptoms vary depending on the location of the tumor.

Materials and Methods: Retrospective, monocentric study of a cohort of patients operated on for skull base chondrosarcomas at our institution in the last 10 years. Their clinical, imaging, and surgical characteristics were analyzed. A bibliographic research was carried out to compare with other series, management and results.

Results: Eleven patients were included. The average age of 45.6 years (range 23-72) and predilection for the male sex (8:3). The average follow-up was 51 months (range 8-138).

The most common symptoms were cranial nerve involvement and the most common topography was parasellar.

An endoscopic endonasal approach (EAA) was performed in 8 patients and 5 underwent craniotomy. One patient underwent re-operation and 67% were treated with postoperative radiotherapy/radiosurgery.

The outcome was favorable with a mean KPS of 90.

Conclusion: Chondrosarcomas are rare tumors of the CNS and involve the skull base even more. Surgical resection is the gold standard for treatment as they are usually resistant to adjuvant. Thorough preoperative evaluation of images, appropriate selection of the approach as well as neuroanatomical knowledge are of vital importance. Endoscopic endonasal resection has been reported only in exceptional cases.

Figure 1. An illustration that depicts the most frequent locations of chondrosarcomas in our experience. Clival and para sellar topography were the most frequently seen, making the EEA approach the most selected one.

Figure 2. T1 weighted MRI with contrast demonstrating a huge espheno-ethmoid-orbitoclival lesion with heterogeneous enhancement and bony erosion.

Figure 3. CT scan and MRI with susceptibility-weighted images (SWI) aid in analyzing bony erosion and calcifications of the tumor.

Figure 4. Intraoperative EEA images of patients with chondrosarcoma. This type of tumor usually requires the uncovering of ICA (A) to access tumors with parasellar extension and CS involvement (A and B). It is also often necessary to extend the approach into the anterior fossa (C-D) or transpterygoid approaches for adequate tumor exposure.

Keywords: Chondrosarcomas; Skull base; Endoscopic endonasal approach; parasellar

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