The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas.
OBJECTIVE
We report our experience with endoscopic transsphenoidal or extended endoscopic transsphenoidal approaches for the treatment of cranial base lesions such as clival chordomas and chondrosarcomas.


METHODS
Between May 1998 and April 2004, 11 patients (four were recurrences because they previously had been treated with surgery and/or radiotherapy) underwent transnasal transsphenoidal endoscopic surgery for cranial base chordomas and chondrosarcomas at the Neurosurgical Department of Bellaria Hospital in Bologna. The transsphenoidal endoscopic approach and the ethmoid-pterygo-sphenoidal endoscopic approach were used to accomplish resection of the lesions involving the clivus and extending up to the parasellar region and to the petrous apex, or within the cavernous sinus.


RESULTS
Patient follow-up periods ranged from 15 to 69 months (mean, 27 mo). Three patients died of chordoma progression at 20, 14, and 10 months, respectively, after endoscopic treatment. One patient experienced two recurrences; the first was treated using a new endoscopic approach, whereas the second, 1 year later, was treated by means of a far lateral approach. Four patients underwent postoperative proton beam radiotherapy, whereas one underwent a conventional megavoltage x-radiation therapy. However, postoperative radiotherapy was not administered in the two patients treated for cranial base chondrosarcoma.


CONCLUSIONS
The flexibility of this new technique with respect to the classical microscopic transsphenoidal approach permits us to widen the horizon of surgical management of aggressive cranial base tumors such as clival chordomas and chondrosarcomas.
Frank
Giorgio
G
Department of Neurosurgery, Bellaria Hospital, Azienda Unita Santiaria Locale Città di Bologna, Bologna, Italy.
Sciarretta
Vittorio
V
Calbucci
Fabio
F
Farneti
Giovanni
G
Mazzatenta
Diego
D
Pasquini
Ernesto
E
D000328:Adult; D000368:Aged; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery; D002813:Chondrosarcoma / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery*; D002817:Chordoma / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery*; D018450:Disease Progression; D042241:Early Diagnosis; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D009777:Occipital Bone / Q000473:pathology / Q000601:surgery; D009886:Ophthalmoplegia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery*; D013101:Sphenoid Sinus / Q000033:anatomy & histology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome