Artikel
Chondromas of the skull base: clinical presentation, surgical technique, and outcome in 3 cases
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Autoren
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Jens Lehmberg
- Klinik für Neurochirurgie, Technische Universität München
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Florian Ringel
- Klinik für Neurochirurgie, Technische Universität München
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Bernhard Meyer
- Klinik für Neurochirurgie, Technische Universität München
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Chondromas of the skull base are very rare tumors arising from cartilage rests of synchondroses of the skull. Most of these very slow growing masses present in the parasellar region. Symptomatic chondromas may be eligible for surgical resection. The clinical presentation, surgical technique, and follow-up of 3 cases are described.
Method: Between 2010 and 2014, 3 patients (2 female/1 male) were treated. A 35-year-old female presented with massive headaches and a weak contrast enhancing mass of the lesser sphenoid wing. A 19-year-old female presented with headaches and abducens palsy. A 16x9x13mm non-enhancing mass in the cavernous sinus was found. In a 55-year-old male, a unilateral tongue atrophy was found incidentally. Additionally, a progressive vocal cord paralysis was diagnosed. The MR showed a weak contrast enhancing mass of the occipital condyle and the jugular foramen.
Results: The osteolytic mass of the lesser sphenoid wing was subtotally resected via a standard pterional approach. The remnant shows no progression during the 54 months follow-up. The headaches resolved. The cavernous sinus mass was biopsied via a transnasal endoscopic approach and thereafter subtotally resected via a pterional approach including an anterior clinoidectomy in 2 surgeries. The abducens palsy and the headaches resolved. The remnant was progession free during 40 months follow-up. The mass of the occipital condyle and jugular foramen was gross totally resected via an extreme lateral, infralabyrinthine, transcondylar approach. The X and XII cranial nerve palsy did not improve during a 2 weeks follow-up. No new cranial nerve or functional deficit, CSF leak or infection was encountered in neither patient.
Conclusions: Chondromas of the skull base may arise from different synchondroses. According to the location, the neurologic symptoms are variable. In the cavernous sinus chondroma, the abducens palsy resolved completely, indicating that prompt surgery may be considered. A wait and scan policy should be restricted to asymptomatic patients.
