Radhouane Khaled, Kammoun Hajer, Chahed Houda, Chkili Ridha, Yedeas Mohamed Dehmani, Kedous Skander
Neurosurgery, Military Hospital, Tunis, Tunisia; ENT, Salah Azaiez Institute of Carcinology and Rabta Hospital, Tunis, Tunisia.
Neurosurgery, Military Hospital, Tunis, Tunisia; ENT, Salah Azaiez Institute of Carcinology and Rabta Hospital, Tunis, Tunisia.
Int J Surg Case Rep. 2025 May;130:111249. doi: 10.1016/j.ijscr.2025.111249. Epub 2025 Apr 1.
Chondrosarcoma is a primary malignancy affecting mainly long bones. The location in the sinonasal tract and in a young female patient is exceptional. We aim through this case report to relate our own experience with a combined endoscopy-navigation approach in the resection of an ethmoidal chondrosarcoma.
We report the case of an 18-year-old girl, who was presenting hyposmia, headache and unilateral retroorbital pain with a normal physical exam. Imageries were performed showing an invasive tissular and calcified ethmoidal tumor recalling a chondrosarcoma. She underwent a macroscopic complete resection of the tumor via a binostril endoscopic endonasal approach using navigation. Postoperative head CT and MRI showed a complete resection of the tumor.
The gold standard treatment is a complete surgical excision with tumor-free margins which is challenging in the ethmoidal location. In literature, the role of navigation in endoscopic surgeries is debated. In our case, the navigation-guided binostril endoscopic approach enabled a precise tumor localization, with a wide field of vision of vital structures nearby and of tumor limits, ensuring an excellent result with an optimal resection.
Chondrosarcomas of the sinonasal tract are rare and represent a compelling diagnostic and treatment challenge. Surgery is the mainstay treatment of sinonasal chondrosarcomas. Endoscopic endonasal surgery associated with surgical navigation offers a great control of the lesion and its margins with good results motivating its adoption as a therapeutic strategy in selected cases.
软骨肉瘤是一种主要影响长骨的原发性恶性肿瘤。发生于鼻窦且患者为年轻女性的情况较为罕见。我们旨在通过本病例报告分享我们在采用联合内镜-导航方法切除筛窦软骨肉瘤方面的经验。
我们报告一名18岁女孩的病例，她嗅觉减退、头痛且单侧眶后疼痛，体格检查正常。影像学检查显示侵袭性组织性钙化性筛窦肿瘤，提示软骨肉瘤。她通过双侧鼻孔鼻内镜入路并借助导航进行了肿瘤的大体完整切除。术后头颅CT和MRI显示肿瘤完全切除。
金标准治疗是进行切缘无肿瘤的完整手术切除，这在筛窦部位具有挑战性。在文献中，导航在内镜手术中的作用存在争议。在我们的病例中，导航引导的双侧鼻孔鼻内镜入路能够精确确定肿瘤位置，对附近重要结构和肿瘤边界有广阔视野，确保了最佳切除效果。
鼻窦软骨肉瘤罕见，是一个具有挑战性的诊断和治疗难题。手术是鼻窦软骨肉瘤的主要治疗方法。鼻内镜手术联合手术导航能很好地控制病变及其边界，效果良好，促使其在特定病例中被采用为治疗策略。
