Surgical Strategies and Outcomes for Intracranial Chondromas: A Retrospective Study of 17 Cases and Systematic Review

Abstract

Objective: To improve the diagnosis and treatment of intracranial chondromas (ICDs) by discussing the clinical manifestations and imaging characteristics of ICDs, as well as surgical methods and treatment strategies.

Methods: We retrospectively analyzed 17 patients diagnosed with ICDs who underwent microsurgery or endoscopic transsphenoidal surgery at the Tangdu Hospital of Air Force Military Medical University and the Mianyang Central Hospital from January 2010 to November 2021. Clinical manifestations, imaging examinations, surgical treatments, and prognosis of these patients were analyzed.

Results: ICDs had often been misdiagnosed as craniopharyngioma, chordoma, schwannoma, cavernous hemangioma, pituitary adenoma, and meningioma before surgery. Of the 17 cases, gross total resection (GTR) was performed in 10 cases, subtotal resection (STR) in 5, and partial resection in 2. GTR of tumor was achieved in eight cases via the endoscopic endonasal transsphenoidal approach (EETA) or the extended endoscopic endonasal transsphenoidal approach (EEETA), and the remaining patients underwent craniotomies. Clinical symptoms were assessed 1 week after surgery, 10 cases were relieved at varying degrees, and four cases had no improvement. Postoperative complications included right-limb hemiparesis, diplopia, eyelid ptosis, pulmonary infection, subcutaneous hydrops, cerebrospinal-fluid leakage (CSFL), and intracranial infection (ICI). One patient received gamma knife treatment at 3 months after surgery, two patients died due to tumor progression, and the remaining patients had no tumor recurrence.

Conclusions: ICDs lack typical imaging features and are often misdiagnosed. The EETA or EEETA helps improve the surgical outcomes and GTR rates of ICDs at different sites.

Keywords: endoscopic endonasal transsphenoidal approach; imaging features; intracranial chondromas; prognosis; surgical approach.

Figure 1

Flow chart outlining literature search using PRISMA.

Figure 2

Left side of the medulla oblongata showed a round mixed short T2 signal shadow within which speckled long T2 signal was seen (A). Sagittal contrast-enhanced MRI showed that medulla oblongata was compressed by confounding signal mass located in foramen magnum (B). Six months after surgery, enhanced MRI showed that the tumor had not recurred (C). Pathological results at 200× magnification showed mature chondrocytes of different sizes and vacuolar formation in some cells (D).

Figure 3

Preoperative CT showed medium-high mixed density in the sella (A). Preoperative MRI showed long T1 (B) and long T2 (C) signals in the left parasella. Multiple patchy short T2 signals were seen in the lesion (C). After enhancement, the lesion showed heterogeneous enhancement (D). Intraoperative drilling of anterior wall of sphenoid sinus and sella floor by EEETA (E). Resection of tumor located in sella turcica (F). Resection of tumor in the left parasella (G). Descent of sellar diaphragm after removal of tumor (H). Postoperative axial, coronal, and sagittal MRI enhancement showed that the tumor was completely removed and there was no residual tumor in surgical area (I–K). Histopathological examination (hematoxylin and eosin [H&E] staining) at 200× magnification showed tumors in the myxoid matrix background consisting of hyaline chondrocytes with irregular lobules, spindle cells, and chondrocytes with homogeneous micronuclei (L). Immunohistochemical staining at 400× magnification showed vimentin (+, M), Ki-67 (6%, N), SOX-9 (+, O), and S-100 (+, P). EEETA, extended endoscopic endonasal transsphenoidal approach; SD, sellar diaphragm.

Figure 4

MRI showed irregular long T2 signal and punctate low T2 signal at the base of the right-middle cranial fossa and posterior cranial fossa (A). The tumor communicated intracranially and extracranially. MRA showed compression and displacement of the right ICA by the tumor (B). The tumor showed uneven enhancement (C). Coronal T2 image (D) and coronal T1 (E) and axial T1 (F) contrast-enhanced images on postoperative MRI showed that the tumor was resected completely. Drilling the petroclival bone and exposing the tumor (G). Resection of petroclival tumor (H). After resection of tumor, right internal carotid artery and petroclival fissure were exposed (I). Histopathology results at 200× magnification revealed chondrocytes of varying sizes and cytoplasmic intermediate vacuole formation (J). Immunohistochemical staining at 400× magnification showed vimentin (+, K) and S-100 (+, L). LOCR, lateral opticocarotid recess; R-ICA, right internal carotid artery.