岩斜软骨肉瘤经硬膜外前方岩骨切除术治疗的功能和肿瘤学结果。单中心经验。

Functional and oncological outcome of petroclival chondrosarcoma operated on through an extradural anterior petrosectomy approach. A single center experience.

机构信息

Department of Neurosurgery, North University Hospital, APHM-AMU (Aix-Marseille University), Marseille, France.

出版信息

Neurochirurgie. 2023 Jul;69(4):101430. doi: 10.1016/j.neuchi.2023.101430. Epub 2023 Apr 28.

DOI:10.1016/j.neuchi.2023.101430

PMID:37121214

Abstract

BACKGROUND

Management of skull base chondrosarcoma (SBC) remains challenging due to its deep location and complex growth pattern. Non-total resection and postoperative residual mass are common features, with controversy regarding the need to offer systematic postoperative radiation therapy or additional surgery.

METHODS

A single-center retrospective cohort study was conducted on 10 consecutive patients harboring petroclival chondrosarcomas that were operated on between May 2007 and March 2019. After resection, the patients were allocated to a wait-and-rescan policy.

RESULTS

Patients were operated on through an extradural anterior petrosectomy (EAP). Subtotal tumor resection was achieved in all patients. The mean duration of follow-up was 70 months (range 25-137/median 67 months). Clinical outcomes dramatically improved in three (30%) patients, while five patients retained preoperative cranial nerve (CN) disturbances after surgery (50%). Two patients reported transient postoperative worsening of their symptoms (20%). All of the postoperative CN new deficits improved within one year, except in one patient who showed permanent facial nerve palsy. The preoperative median Karnofsky Performance Scale (KPS) score was 80 (range 70-100), and then it became 90 (range 70-100) postoperatively. Patients harboring a tumor residue were included in a wait-and-rescan policy. With this regimen, tumor control was obtained in seven patients (70% of cases until the last follow-up). Three patients (30%) showed progression of the residual; two of them were treated with adjuvant therapy, while an extra cranial growth residue was observed in the third.

CONCLUSION

Optimal and reasonable surgical resection of petroclival chondrosarcomas could be achieved with good to excellent functional outcomes through an EAP. In spite of a significant percentage of regrowth, only one patient required additional salvage surgery.

摘要

背景

由于颅底软骨肉瘤（SBC）的位置深且生长方式复杂，其治疗管理仍然具有挑战性。非全切除和术后残留肿块是常见特征，对于是否需要提供系统的术后放射治疗或额外的手术存在争议。

方法

对 2007 年 5 月至 2019 年 3 月期间连续收治的 10 例累及岩斜区软骨肉瘤患者进行了单中心回顾性队列研究。切除后，患者被分配到等待和复查策略。

结果

所有患者均通过硬膜外前岩骨切除术（EAP）进行手术。所有患者均实现了肿瘤次全切除。中位随访时间为 70 个月（范围 25-137/中位数 67 个月）。3 名患者（30%）的临床结果显著改善，5 名患者术后仍保留术前颅神经（CN）障碍（50%）。2 名患者报告术后短暂性症状恶化（20%）。所有术后新出现的 CN 缺陷均在 1 年内得到改善，除了 1 名患者出现永久性面神经瘫痪。术前中位 Karnofsky 表现量表（KPS）评分为 80（范围 70-100），术后为 90（范围 70-100）。有肿瘤残留的患者纳入等待和复查策略。通过这种方案，7 例患者（70%的病例直至最后一次随访）获得肿瘤控制。3 名患者（30%）出现残留肿瘤进展，其中 2 名患者接受了辅助治疗，而第 3 名患者观察到颅外生长残留。