2025 Proffered Presentations
S228: OUTCOMES OF SKULL BASE CHONDROSARCOMA SURGERY: A RETROSPECTIVE ANALYSIS OF MULTICENTER REGISTRY
Ivo Petoe1; Hanna Algattas1; Franco Rubino2; Carl H Snyderman1; Paul A Gardner1; Eric Wang1; Garret Choby1; Vigo Vera3; Franco DeMonte2; Shaan Raza2; Juan Carlos Fernandez-Miranda3; Georgios A Zenonos1; 1University of Pittsburgh; 2MD Anderson Cancer Center; 3Stanford University
Introduction: Skull base chondrosarcomas are formidable tumors given the difficult to access location and a frequent involvement of major vessels and cranial nerves. The surgical resection remains the mainstay of the treatment, however with the development of endoscopic endonasal technique and the understanding of endoscopic anatomy a shift towards the endoscopic endonasal approach (EEA) has been noted. As a combination of these techniques allow for a 360 degree approach we aimed at comparing both techniques in terms of efficacy and complications.
Methods: Patients treated for skull base chondrosarcoma at 3 tertiary referral academic centers in the United States with high volume of chondrosarcomas treated between years 1983-2022. All patients with histologically proven chondrosarcoma were included. A retrospective analysis of prospectively maintained database was performed and records queried for patient demographics, pathological type/grade, tumor characteristics, radiological characteristic and treatment modalities administered.
Results: We identified 149 patients (61 (40.9%) males) that underwent 218 surgeries, with a mean age of 47.32 ( range 7-82, IQR 30.5) years and a mean follow-up of 77.78 (range 1.4-309, IQR 71.7) months. The mean preoperative tumor volume was 33.91 ml (range 0.70 – 265, IQR 36.6). A gross total resection (GTR) was achieved in 92 (42.2%) and a subtotal resection (STR) in 121 (57.8%) surgeries. Residual tumors were located most frequently in the cavernous sinus (n=23,19.0%), petrous apex (n=20, 16.5%), along the internal carotid artery (n=9, 7.4%), jugular foramen (6.6%) and in the subdural space (n=5, 4.1%). There were no data available for 22 patients (18.2%). We did not find any difference in the extent of resection between combined (EEA + open), open and EEA (p=0.37) or between EEA and open surgery alone (p=0.40). There was no statistical difference between the frequency of residual tumors in the 5 most frequent locations and the approach chosen - open, EEA and combined (p = 0.82). Interestingly, vimentin positive tumors had lower percentage of GTR (p=0.0001). In contradiction, histological subtype wasn’t associated with the extent of resection (p=0.86).
Shorter time to first recurrence was noted in STR compared to GTR in treatment naïve patients (p=0.047). A significant difference between postoperative complication rate in favor of EEA was noted between EEA, open and combined approaches (p=0.001). Similarly, a significant lower complication rate was noted in EEA compared to the open surgery alone (p=0.0098). We found a similar complication rate between the primary and revision surgeries (p=0.84). There was no difference in extent of resection between after a primary or recurrence surgery (p=0.23).
Conclusion: Based on our current data, both technique seem to be equivalent in terms of extent of resection, however a complication rate is significantly lower in the EEA group. Further stratification based on preoperative tumor extension is necessary.