Patient outcome at long-term follow-up after aggressive microsurgical resection of cranial base chondrosarcomas

被引:67
作者
Tzortzidis, Fotios
Elahi, Foad
Wright, Donald C.
Temkin, Nancy
Natarajan, Sabareesh K.
Sekhar, Laligam N.
机构
[1] Univ Washington, Dept Neurosurg, Seattle, WA 98104 USA
[2] Virginia Hosp Ctr, Dept Neurosurg, Arlington, VA USA
关键词
chondrosarcoma; cranial base; microsurgery; radiotherapy;
D O I
10.1227/01.NEU.0000215892.65663.54
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: To evaluate patient clinical outcome and survival at long-term follow-up after aggressive microsurgical resection of chondrosarcomas of the cranial base. METHODS: Over a 20-year period, 47 patients underwent 72 operative procedures for resection of cranial base chondrosarcomas. Thirty-three patients were previously untreated, whereas 14 patients previously had undergone surgery or radiation. Twenty-three patients had a single operation and 24 underwent staged (more than one) operations because of extensive disease. Patients who underwent subtotal resection also underwent radiotherapy or radiosurgery. Patients were evaluated at follow-up clinically and by imaging studies. RESULTS: Gross total resection was accomplished in 29 (61.7%) patients, and subtotal resection was accomplished in 18 patients (38.3%). The resection was better in patients who underwent a primary operation (gross total resection, 68.8 versus 46.7%) rather than a reoperation. Patients who underwent incomplete resection underwent postoperative radiotherapy, which included proton beam radiotherapy (15.6%), radiosurgery (68%), and fractionated radiation (15.6%). There were no operative deaths. Postoperative complications (cerebrospinal fluid leakage, quadriparesis, infections, cranial nerve palsies, etc.) were observed in 10 patients (18%). The follow-up ranged from 2 to 255 months, with an average of 86 months. At the conclusion of study, 36 (76.6%) patients were alive, and 21 (44.7%) patients were alive without disease. Recurrence-free survival was 32% at 10 years in all patients, 42.3% in primary patients and 13.8% in those who underwent reoperation. The Karnofsky performance score was 82.4 +/- 9.8 before surgery, 85 +/- 12.5 at 1 year after surgery, and 85.3 +/- 5.8 at the latest follow-up. Two patients died as a result of radiotherapy complications (malignancy, radiation necrosis). CONCLUSION: Cranial base chondrosarcomas can be managed well by complete surgical resection or by a combination of surgery and radiotherapy. The study cannot comment about the efficacy of radiotherapy. Approximately half of the patients survived without recurrence at long-term follow-up (> 132 mo). The functional status of the surviving patients was excellent at follow-up.
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页码:1090 / 1097
页数:8
相关论文
共 28 条
[1]  
ALMEFTY O, 2005, AANS C NEW ORL APR 1
[2]   FRACTIONATED PROTON RADIATION-THERAPY OF CHORDOMA AND LOW-GRADE CHONDROSARCOMA OF THE BASE OF THE SKULL [J].
AUSTINSEYMOUR, M ;
MUNZENRIDER, J ;
GOITEIN, M ;
VERHEY, L ;
URIE, M ;
GENTRY, R ;
BIRNBAUM, S ;
RUOTOLO, D ;
MCMANUS, P ;
SKATES, S ;
OJEMANN, RG ;
ROSENBERG, A ;
SCHILLER, A ;
KOEHLER, A ;
SUIT, HD .
JOURNAL OF NEUROSURGERY, 1989, 70 (01) :13-17
[3]  
BEALS SP, 1995, CLIN PLAST SURG, V22, P491
[4]  
BERKEN YM, CLIN RADIOL, V19, P327
[5]   DOES CHONDROID CHORDOMA EXIST [J].
BROOKS, JJ ;
LIVOLSI, VA ;
TROJANOWSKI, JQ .
ACTA NEUROPATHOLOGICA, 1987, 72 (03) :229-235
[6]   Chordomas and chondrosarcomas of the cranial base: Results and follow-up of 60 patients [J].
Crockard, A .
NEUROSURGERY, 1996, 38 (02) :420-420
[7]   A multidisciplinary team approach to skull base chondrosarcomas [J].
Crockard, HA ;
Cheeseman, A ;
Steel, T ;
Revesz, T ;
Holton, JL ;
Plowman, N ;
Singh, A ;
Crossman, J .
JOURNAL OF NEUROSURGERY, 2001, 95 (02) :184-189
[8]   Evaluation of a new concept for the management of skull base chordomas and chondrosarcomas [J].
Feigl, GC ;
Bundschuh, O ;
Gharabaghi, A ;
Safavi-Abassi, S ;
El Shawarby, A ;
Samii, M ;
Horstmann, GA .
JOURNAL OF NEUROSURGERY, 2005, 102 :165-170
[9]   CHORDOMAS AND CHONDROSARCOMAS OF THE CRANIAL BASE - RESULTS AND FOLLOW-UP OF 60 PATIENTS [J].
GAY, E ;
SEKHAR, LN ;
RUBINSTEIN, E ;
WRIGHT, DC ;
SEN, C ;
JANECKA, IP ;
SNYDERMAN, CH .
NEUROSURGERY, 1995, 36 (05) :887-896
[10]   Working area and angle of attack in three cranial base approaches: Pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach [J].
Gonzalez, LF ;
Crawford, NR ;
Horgan, MA ;
Deshmukh, P ;
Zabramski, JM ;
Spetzler, RF .
NEUROSURGERY, 2002, 50 (03) :550-555