Chondrosarcoma in the Petrous Apex: Case Report and Review

Introduction Surgical treatment of petrous apex chondrosarcoma is challenging due to the location of the tumor. Using an endoscopic technique for tumor resection is favored since it provides a minimally invasive approach. Case Presentation A 57 years old female was admitted for acute onset of left abducens nerve palsy and occasional headache mainly on the left side of the retro-orbital area with some radiation to the left occiput. Magnetic resonance imaging (MRI) and computed tomography (CT), at the time of admission, were showed lytic lesion on the left petrous apex and left part of the clivus. Results of metastatic workup were negative. The surgical procedure considered was expanded endoscopic endonasal transclival approach to the left of the petrous apex and reconstruction with a pedicled nasoseptal flap with image guidance system. The pathology confirmed chondrosarcoma on myxoid background. The surgical procedure was uncomplicated. The abducens nerve palsy was resolved in few weeks and no new deficits occurred. Postoperative MRI showed complete resection of the tumor. Conclusion Expanded endoscopic endonasal transclival approach to petrous apex and reconstruction appears to be safe and feasible technique, capable of achieving total removal of identified lesions near the petrous apex. Nonetheless, future studies with a greater number of patients are crucial to confirm and consolidate this initial impression.

Download Full-text

A case of ecchordosis physaliphora presenting with an abducens nerve palsy: A rare symptomatic case managed with endoscopic endonasal transsphenoidal surgery

Surgical Neurology International ◽

10.4103/2152-7806.106562 ◽

2013 ◽

Vol 4 (1) ◽

pp. 13 ◽

Cited By ~ 14

Author(s):

Shigetoshi Yano ◽

Takahiro Yamamoto ◽

Takuichiro Hide ◽

Jun-ichi Kuratsu

Keyword(s):

Transsphenoidal Surgery ◽

Nerve Palsy ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Endoscopic Endonasal ◽

Symptomatic Case ◽

Ecchordosis Physaliphora ◽

Endoscopic Endonasal Transsphenoidal Surgery

Download Full-text

CELLULAR SCHWANNOMA OF THE GREATER SUPERFICIAL PETROSAL NERVE PRESENTING WITH ABDUCENS NERVE PALSY AND XEROPHTHALMIA

Neurosurgery ◽

10.1227/01.neu.0000325501.75772.fd ◽

2008 ◽

Vol 63 (4) ◽

pp. E813-E814 ◽

Cited By ~ 8

Author(s):

Giyas Ayberk ◽

Mehmet F. Ozveren ◽

Nuket Uzum ◽

Ozgur Tosun ◽

Emine K. Akcay

Keyword(s):

Nerve Palsy ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Petrous Apex ◽

Clinical Prognosis ◽

Tear Secretion ◽

Pathological Evaluation ◽

Greater Superficial Petrosal Nerve ◽

Extradural Approach ◽

The Right

ABSTRACT OBJECTIVE Cellular schwannomas (CS) are rare in the cranial space. This report is the first of a patient with a greater superficial petrosal nerve CS presenting with abducens nerve palsy and xerophthalmia. CLINICAL PRESENTATION A 16-year-old female patient presented with a 1-month history of diplopia. Neurological examination was normal except for the presence of right abducens nerve palsy. Schirmer's test revealed decreased tear secretion in the right eye. Computed tomography and magnetic resonance imaging showed a mass in the right petrous apex. It was thought that the schwannoma in our patient originated from the greater superficial petrosal nerve, based on the location of the tumor in addition to the absence of partial Horner's syndrome and a persistent decrease in tear secretion. INTERVENTION: The tumor was exposed with the use of a right subtemporal extradural approach and removed entirely. Pathological evaluation of the tumor revealed a CS. CONCLUSION The abducens nerve palsy improved completely in the follow-up period, but the decreased tear secretion did not resolve. CS is one of the subtypes of ordinary schwannomas and exhibits malignant features on microscopic examination, although it has a good clinical prognosis. No adjuvant treatment was applied because of the tumor's benign character. The greater superficial petrosal nerve schwannoma should be considered in the differential diagnosis of the abducens nerve palsy and petrous apex mass.

Download Full-text

Microanatomical Architecture of Dorello's Canal and Its Clinical Implications

Operative Neurosurgery ◽

10.1227/01.neu.0000249229.89988.4d ◽

2007 ◽

Vol 60 (suppl_2) ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Mehmet Faik Özveren ◽

Fatih Serhat Erol ◽

Alpay Alkan ◽

Ayhan Kocak ◽

Cagatay Önal ◽

...

Keyword(s):

Cavernous Sinus ◽

Subarachnoid Space ◽

Nerve Palsy ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Petrous Apex ◽

Arachnoid Membrane ◽

Petroclival Region ◽

Dorello’S Canal ◽

Mri Scans

Abstract Objective: We investigated the membranous architecture of the abducens nerve at the petroclival region and describe the characteristics of this area in cadaveric specimen and two children with hydrocephalus and sixth nerve palsy using magnetic resonance imaging (MRI). Materials And Methods: Five adult cadaver heads were used to investigate the petroclival part of the abducens nerve. The heads were injected with colored latex for microsurgical dissection, and the length of the dural sleeve of the abducens nerve and its width at the apex were measured. In one cadaver head, the area between the petroclival entrance porus of the abducens nerve and the cavernous sinus was histologically studied under light microscopy. In two patients with hydrocephalus and abducens nerve palsy, the petroclival area was screened by using the MRI fat suppression technique. Results: In the cadavers, the arachnoid membrane on the clivus extended within the dural sleeve as far as the petrous apex, as an extension of the subarachnoid space. The average length of the dural sleeve was 9.5 mm and the average width was 1.5 mm at the apex, where the nerve entered the cavernous sinus. MRI scans showed that the cerebrospinal fluid distance of the petroclival region was 5 mm in the first patient and 7 mm in the second. Conclusion: The subarachnoid space inside the dural sleeve of the abducens nerve can be defined by using thin-slice MRI scans. Enlargement of the dural sleeve at the petroclival region may coexist with the abducens nerve palsy. It has been documented in this study that the arachnoid membrane forms a membraneous barrier between the subarachnoid and subdural spaces within Dorello's canal.

Download Full-text

Endoscopic transsphenoidal anterior petrosal approach for locally aggressive tumors involving the internal auditory canal, jugular fossa, and cavernous sinus

Journal of Neurosurgery ◽

10.3171/2016.1.jns151979 ◽

2017 ◽

Vol 126 (1) ◽

pp. 212-221 ◽

Cited By ~ 12

Author(s):

Masahiro Shin ◽

Kenji Kondo ◽

Shunya Hanakita ◽

Hirotaka Hasegawa ◽

Masanori Yoshino ◽

...

Keyword(s):

Hearing Loss ◽

Cavernous Sinus ◽

Facial Palsy ◽

Nerve Palsy ◽

Internal Auditory Canal ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Petrous Apex ◽

Lateral Part ◽

Jugular Fossa

OBJECTIVE Reports about endoscopic endonasal surgery for skull base tumors involving the lateral part of petrous apex remain scarce. The authors present their experience with the endoscopic transsphenoidal anterior petrosal (ETAP) approach through the retrocarotid space for tumors involving the internal auditory canal, jugular fossa, and cavernous sinus. METHODS The authors performed the ETAP approach in 10 patients with 11 tumors (bilateral in 1 patient) that extensively occupied the lateral part of petrous apex, e.g., the internal auditory canal and jugular fossa. Eight patients presented with diplopia (unilateral abducens nerve palsy), 3 with tinnitus, and 1 with unilateral hearing loss with facial palsy. After wide anterior sphenoidotomy, the sellar floor, clival recess, and carotid prominence were verified. Tumors were approached via an anteromedial petrosectomy through the retrocarotid triangular space, defined by the cavernous and vertical segments of the internal carotid artery (ICA), the clivus, and the petrooccipital fissure. The surgical window was easily enlarged by drilling the petrous bone along the petrooccipital fissure. After exposure of the tumor and ICA, dissection and resection of the tumor were mainly performed under direct visualization with 30° and 70° endoscopes. RESULTS Gross-total resection was achieved in 8 patients (9 tumors). In a patient with invasive meningioma, the tumor was strongly adherent to the ICA, necessitating partial resection. Postoperatively, all 8 patients who had presented with abducens nerve palsy preoperatively showed improvement within 6 months. In the patient presenting with hearing loss and facial palsy, the facial palsy completely resolved within 3 months, but hearing loss remained. Regarding complications, 3 patients showed mild and transient abducens nerve palsy resolving within 2 weeks, 3 months, and 6 months. Postoperative CSF rhinorrhea requiring surgical repair was observed in 1 patient. No patient exhibited hearing deterioration, facial palsy, or symptoms of lower cranial nerve palsy after surgery. CONCLUSIONS The ETAP approach can offer a simple, less invasive option for invasive skull base tumors involving petrous regions, including the internal auditory canal, jugular fossa, and cavernous sinus. The ETAP approach can reach more extensive areas in the extradural regions around the petrous bone. The authors' results indicate that the transsphenoidal retrocarotid route is sufficient to approach the petrosal areas in select cases. Further expansion of the surgical field is not always necessary. However, experience with intradural lesions remains limited, and the extent of tumor resection largely depends on tumor characteristics. Application of the ETAP approach should thus be carefully determined in each patient, taking into consideration the size of the retrocarotid window and tumor characteristics.

Download Full-text