Murakami Yuta, Jinguji Shinya, Kishida Yugo, Ichikawa Masahiro, Sato Taku, Fujii Masazumi, Sakuma Jun, Murakami Fumi, Saito Kiyoshi
Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan.
Department of Neurosurgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan.
NMC Case Rep J. 2018 Sep 13;5(4):99-103. doi: 10.2176/nmccrj.cr.2018-0016. eCollection 2018 Oct.
We report a case of a young male who received multiple surgical treatments for repeated recurrence of skull base mesenchymal chondrosarcoma (MC). When the patient was 18 years old, we subtotally removed the skull base MC and he was treated with stereotactic radiosurgery for remnant tumors in the left cavernous sinus. After 30 months, we removed residual tumors that had regrown partially, via combined endonasal endoscopic and orbitozygomatic approaches. Over the next 65 months, the patient refused radical resection, and received six salvage surgeries, two stereotactic radiotherapies, and five stereotactic radiosurgeries for repeated recurrence. At 95 months after initial surgery, the tumors had extended to the skull base and nasal cavities. As a result, the left eye had been blinded and right visual acuity was deteriorated. We performed left anterior-middle cranial base resection, removal of nasal and intradural tumors, high flow bypass, en-bloc resection of the left cavernous sinus and clivus, and reconstruction using an abdominal flap. Even though the main tumors were removed with safety margins, tumors around the right optic nerve were removed by piecemeal to preserve right eye function. Six months after the radical resection, tumors in the right orbital apex recurred because we had been unable to remove the tumor with adequate safety margins. Skull base MC has a high tendency to recur locally, so these tumors should be radically removed with safety margins as early as possible to prevent recurrence.
我们报告一例年轻男性患者，其因颅底间叶性软骨肉瘤（MC）反复复发接受了多次手术治疗。患者18岁时，我们对颅底MC进行了次全切除，并对左侧海绵窦残留肿瘤进行了立体定向放射外科治疗。30个月后，我们通过鼻内镜联合眶颧入路切除了部分复发的残留肿瘤。在接下来的65个月里，患者拒绝根治性切除，因肿瘤反复复发接受了6次挽救性手术、2次立体定向放疗和5次立体定向放射外科治疗。初次手术后95个月，肿瘤已扩展至颅底和鼻腔。结果，左眼失明，右眼视力下降。我们进行了左前中颅底切除术、鼻腔和硬膜内肿瘤切除术、高流量搭桥术、左侧海绵窦和斜坡整块切除术，并使用腹部皮瓣进行重建。尽管主要肿瘤在安全边界内切除，但为保留右眼功能，对右侧视神经周围的肿瘤进行了分块切除。根治性切除术后6个月，右侧眶尖肿瘤复发，因为我们未能在足够的安全边界内切除肿瘤。颅底MC有很高的局部复发倾向，因此应尽早在安全边界内进行根治性切除以防止复发。
