Abstract
Background
Intracranial chondrosarcoma is a rare malignant tumor with high local recurrence rates, presenting significant clinical challenges. We report a case of intracranial chondrosarcoma primarily involving the cavernous sinus treated using a transorbital approach.
Case Presentation
A 34-year-old male with no medical history presented with a one-month history of headache. Imaging revealed a mass lesion in the left middle cranial fossa, prompting referral to our institution. Neurological examination was unremarkable. Head CT demonstrated an approximately 40mm mass in the left middle cranial fossa continuous with the cavernous sinus, showing internal calcification and surrounding bone destruction. MRI revealed hypointensity on T1-weighted images, hyperintensity on T2-weighted and diffusion-weighted images with ADC map correlation, and heterogeneous contrast enhancement. Based on patient age and imaging characteristics, we primarily suspected chondrosarcoma. Tumor resection was performed via an endoscopy-assisted transorbital approach and we achieved subtotal resection. Postoperative histopathological examination confirmed mesenchymal chondrosarcoma. The patient developed transient oculomotor nerve palsy postoperatively, which showed gradual improvement. Postoperative radiation therapy is planned.
Discussion
Intracranial chondrosarcoma represents an extremely rare brain tumor with no established standard treatment protocol. Local recurrence is the most significant prognostic factor affecting overall survival. Combined postoperative radiation therapy significantly reduces recurrence rates compared to surgery alone. Literature suggests no significant difference in recurrence rates between gross total resection and subtotal resection. For clival chondrosarcomas, endoscopic endonasal approaches have demonstrated effectiveness. Our treatment strategy combined maximal safe resection via transorbital approach with planned postoperative radiation therapy. Given the mesenchymal subtype diagnosis, careful surveillance for recurrence is essential.