gms | German Medical Science

Objective: To get an assessment of the microsurgical treatment of patients presenting with chordomas and chondrosarcomas of the scull base

Methods: Symptoms, endocrinological deficits, tumor location/extension were documented as well as the surgical approach and prior therapies. The direct postoperative clinical condition was assessed regarding neurological and endocrinological deficits and perioperative complications. A broad panel of neuropathological examinations was conducted (Keratin, EMA, D2-40, Brachyury, S 100, Ki67). Patients were followed for adjuvant therapies, clinical status, regular MRI, the overall survival rate with time to recurrence and subsequent therapies.

Results: 27 patients were treated between March 2004 and June 2020. 55,6% (15) were female. 55,6% (15) presented with histologically diagnosed chordoma, 11.1% (3) with chondroid chordoma and 33.3% (9) with chondrosarcoma. Mean age was 42.9 ± 19.8 years. 22.2% (6) were operated using a transcranial approach, the others by the transsphenoidal route. A planned biopsy for histological confirmation of extensive lesions was taken in 18.5% (5), intended partial resection in 63% (17) and 14.8% (4) total resection. For 1 patient grade of resection was not classified. Frozen section was performed in 13 cases, 2 of those did not prove the later diagnosis. Surgery associated complications were seen in 4 patients (18.2%, p=0.21 Fisher’s exact). CSF leaks were seen in 3 of 20 patients with transsphenoidal surgery (15.0%), no leaks were recorded in transcranial operations (p=0.50). 1 patient died due to a severe hemorrhage after transcranial surgery. Follow up was 2.7 (range 0-6) years mean. 63% (17) showed postoperative tumor mass and 14.8% (4) were reoperated during follow up. 7,4% (2) received conventional radiotherapy, 18.5% (5) did not receive adjuvant therapy, 11,1% (3) were treated using heavy ion irradiation and 44,4% (12) received proton irradiation. 3,7% (1) required a VP-Shunt. An adjuvant therapy was initiated in 47.2% of all chordomas and 100% of all chondroid chordomas and chondrosarcomas. 2 more patients died within follow-up

Conclusion: Curative surgery for skull base lesions from the chordoma/chondroid chordoma/chondrosarcoma group by microsurgery alone is hard to achieve. The majority of patients requires adjuvant radiation treatment which can control the disease. Intraoperative frozen section is helpful to guide surgical aggressiveness for these difficult lesions

Table 1 [Tab. 1]