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Updated: Mar 25, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
A multicorridor strategy including the infralabyrinthine route for extensive skull base chondrosarcoma: illustrative
Masakazu Mitsunobu1, Takafumi Mitsuhara1, Hiroki Takahashi1
1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima.
Background:
Skull base chondrosarcomas (SBCs) are rare tumors with limited responsiveness to chemotherapy and radiation therapy, making surgery the primary treatment option. In cases in which lesions widely extend from the middle cranial fossa to the petrous bone, jugular foramen, and extracranial skull base, no single approach can achieve sufficient exposure or safety margins. A multicorridor strategy can enable safe resection in such cases, even for large and complex tumors; this involves selecting the optimal approach for each anatomical region and simultaneously performing anterior and posterior approaches.
Observations:
A woman in her 50s had a chondrosarcoma involving five distinct regions: the cavernous sinus/Meckel's cave, petroclival-petrous area, jugular foramen, cerebellopontine angle, and extracranial skull base. A single-stage, simultaneous anterior-posterior approach combining the transcavernous, anterior transpetrosal, presigmoid infralabyrinthine, and transjugular-condylar fossa corridors enabled > 95% tumor resection with complete cranial nerve preservation.
Lessons:
In cases of SBCs with broad, multidirectional extension, integrating multiple anatomically tailored surgical corridors with a simultaneous anterior-posterior approach can achieve maximal exposure while maintaining safety. In particular, the infralabyrinthine corridor was valuable for providing secure access to the jugular foramen and deep petroclival regions, serving as a crucial link between the combined approaches. https://thejns.org/doi/10.3171/CASE2618.
