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chondrosarcoma

Chondrosarcoma

Indolent but invasive chondroid malignancy.

The most common sites for chondrosarcoma to grow are the pelvis and shoulder, along with the superior metaphysial and diaphysial regions of the arms and legs.

However, chondrosarcoma may occur in any bone, and are sometimes found in the skull, particularly at its base.

Extradural spinal cord tumor.

Petrous apex lesion.

Cavernous sinus lesion.

Rare in the craniovertebral junction.

see Mesenchymal chondrosarcoma.

see Myxoid chondrosarcoma.

Clinical features

Differential diagnosis

Treatment

Standard management of chondrosarcoma involves surgical resection and adjuvant radiation therapy.

Petroclival chondrosarcomas

Endonasal endoscopic approach for resection of petroclival chondrosarcomas between 2010 and 2014, 8 patients (4 men and 4 women) underwent endonasal endoscopic operations to resect petroclival chondrosarcomas at 2 institutions. The patients' mean age was 44.8 years (range 30-64 years). One of the patients had previously undergone radiation therapy and another a staged craniotomy. Using volumetric software, an independent neuroradiologist assessed the extent of the resections on MRI scans taken immediately after surgery and at the 3-month follow-up. Immediate complications and control of symptoms were also recorded. In addition, the authors reviewed the current literature on surgical treatment of chondrosarcoma.

The mean preoperative tumor diameter and volume were 3.4 cm and 9.8 cm(3), respectively. Six patients presented with cranial neuropathies. Endonasal endoscopic surgery achieved > 95% resection in 5 of the 8 patients and < 95% resection in the remaining 3 patients. One of the 6 neuropathies resolved, and the remaining 5 partially improved. One instance of postoperative cerebrospinal fluid leakage required a reoperation for repair; no other complications associated with these operations were observed. All of the patients underwent adjuvant radiotherapy.

According to the experience of Moussazadeh et al. the endoscopic endonasal route is a safe and effective approach for the resection of appropriately selected petroclival chondrosarcomas 1).

Parafalcine chondrosarcoma

Parafalcine chondrosarcoma is extremely rare, and may be difficult to differentiate preoperatively from falx meningioma. An 18-year-old woman presented with a parafalcine chondrosarcoma incidentally detected as a small lesion 2 years before admission, suggesting falx meningioma. Brain computed tomography and magnetic resonance imaging just before admission revealed the parafalcine lesion had increased by about nine times in volume during the last 2 years. Single-photon emission computed tomography (SPECT) after intravenous administration of both thallium-201 chloride 2).

Case series

Case reports

A 25-year-old female underwent attempted endoscopic endonasal resection of an advanced right-sided chondrosarcoma. During resection of the tumor, brisk arterial bleeding was encountered consistent with focal injury to the right cavernous ICA. Stable vascular hemostasis could not be achieved with tamponade. An intravenous bolus dose of adenosine was administered to induce a transient decrease in systemic blood pressure and facilitate placement of the muscle patch over the direct site of vascular injury. The patient subsequently underwent endovascular deconstruction of the right ICA.

This is the first reported use of adenosine to induce transient hypotension for a major vascular injury sustained during endonasal skull-base surgery. Based on well-established safety data from neurosurgical application, adenosine has the potential to be used as a safe and effective adjunctive technique in similar endonasal circumstances and may represent an additional tool in the armamentarium of the skull-base surgeon. Surgeons should consider having adenosine available when a risk of ICA injury is anticipated 3).

References

1)
Moussazadeh N, Kulwin C, Anand VK, Ting JY, Gamss C, Iorgulescu JB, Tsiouris AJ, Cohen-Gadol AA, Schwartz TH. Endoscopic endonasal resection of skull base chondrosarcomas: technique and early results. J Neurosurg. 2015 Jan 16:1-8. [Epub ahead of print] PubMed PMID: 25594323.
2)
201)TlCl) and N-isopropyl-p-[(123)I]iodoamphetamine ((123)I-IMP) demonstrated no abnormal uptake of either tracer. Histological examination revealed classic low-grade chondrosarcoma. Parafalcine chondrosarcoma should be considered at this site if relatively rapid growth is observed. SPECT using (201)TlCl and (123)I-IMP may be useful to discriminate parafalcine low-grade chondrosarcoma from meningioma or other tumours originating in this region ((Tosaka M, Fukasawa Y, Takahashi A, Sasaki A, Saito N. Incidentally detected parafalcine chondrosarcoma. Acta Neurochir (Wien). 2005 Jul;147(7):795-9; discussion 799. Epub 2005 May 23. PubMed PMID: 15864410.
3)
Fastenberg JH, Garzon-Muvdi T, Hsue V, Reilly EK, Jabbour P, Rabinowitz MR, Rosen MR, Evans JJ, Nyquist GN, Farrell CJ. Adenosine-induced transient hypotension for carotid artery injury during endoscopic skull-base surgery: case report and review of the literature. Int Forum Allergy Rhinol. 2019 Jul 10. doi: 10.1002/alr.22381. [Epub ahead of print] PubMed PMID: 31291066.
chondrosarcoma.txt · Last modified: 2019/07/12 15:10 by administrador