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Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma
Gianluca Agresta1, Alberto Campione1, Fabio Pozzi1
1Department of Biotechnology and Life Sciences, Division of Neurosurgery; University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
Journal of Neurological Surgery. Part B, Skull Base
|September 7, 2022
Summary
This case report details the successful endoscopic endonasal treatment of a cavernous sinus chondrosarcoma in a young girl. The minimally invasive approach provided symptom relief and facilitated subsequent radiotherapy for local tumor control.
Area of Science:
- Neurosurgery
- Endoscopic Skull Base Surgery
- Oncology
Background:
- Chondrosarcoma is a rare bone tumor that can occur in the skull base, including the cavernous sinus.
- Cavernous sinus tumors can cause significant neurological deficits, such as abducens palsy leading to diplopia and esotropia.
- Surgical access to cavernous sinus lesions is challenging due to surrounding critical neurovascular structures.
Purpose of the Study:
- To illustrate the use of an endoscopic endonasal transethmoidal-transsphenoidal approach for treating a cavernous sinus chondrosarcoma.
- To demonstrate a minimally invasive surgical technique for accessing and resecting intracavernous lesions.
- To optimize tumor geometry for adjuvant radiotherapy and achieve local tumor control.
Main Methods:
- A 15-year-old female patient with a symptomatic cavernous sinus chondrosarcoma underwent surgery.
- An endoscopic endonasal transethmoidal-transsphenoidal approach was utilized, navigating lateral to the medial turbinate to access the ethmoid and sphenoid sinuses.
- The lesion was removed using curettage, followed by skull base reconstruction with fibrin glue and a nasoseptal flap.
Main Results:
- The endoscopic surgery was performed without complications, leading to complete recovery of the patient's symptoms.
- Postoperative imaging revealed a small residual tumor, which was subsequently treated with percutaneous proton-beam therapy.
- The patient achieved local tumor control within two years, with only temporary low-grade toxicity from radiotherapy.
Conclusions:
- The endoscopic endonasal extended approach is a safe and effective treatment option for selected intracavernous tumors, particularly soft tumors not extensively infiltrating vessels or nerves.
- A tailored surgical strategy based on tumor extension is essential for optimal access to involved cranial base compartments.
- This minimally invasive technique offers a viable alternative for managing complex skull base lesions.
