Surgical Management and Outcomes of Intracranial Chondromas: a Single-Center Case Series of 66 Patients

Para-Falcine Chondroma: An Entity of Unacquaintance-A Case Report and Review of Literature

Intracranial chondroma is a benign tumor arising from the rests of embryonic cartilages in the dura or dural folds, choroid plexus or the brain parenchyma. It is rare intracranially, but when it does occur, it is predominantly located at the skull base. Among the cohort of intracranial chondroma, the para-falcine location is the rarest. We report a challenging diagnosis and successful management of this rare intracranial para-falcine chondroma in a 53-year-old female patient.

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

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.

Racial disparity in recommendation for surgical resection of skull base chondrosarcomas: A Surveillance, Epidemiology, and End Results (SEER) analysis

INTRODUCTION

There is increased appreciation of racial disparities in the delivery of neurosurgical care. Here, we explore whether race influences surgical recommendations in the management of skull base chondrosarcomas.

METHODS

We identified 493 patients with skull base chondrosarcoma using the Surveillance, Epidemiology, and End Results (SEER) registry (November 2017 submission). Regression analyses were performed to identify demographic variables associated with recommendation against surgery. Univariate and multivariate cox proportional hazards models were used for survival analysis.

RESULTS

In a univariate analysis, we found that the African-American race was associated with an increased likelihood of surgeon recommendation against surgery (OR = 4.416, 95% CI = 1.893-10.302, p = 0.001). This association remained robust in the multivariate model that controlled for other covariates, including age of diagnosis (OR = 5.091, 95% CI = 2.127-12.187, p < 0.001). For patients who received a recommendation against surgery, the likelihood of dying from non-chondrosarcoma causes was comparable between Caucasian and African-American patients, suggesting that the prevalence and severity of medical conditions that increase the risk of death were comparable between these cohorts (HR = 0.466, 95% CI = 0.057-3.802, p = 0.475). The likelihood of dying from chondrosarcoma was comparable between Caucasian and African-American patients who underwent surgery (HR = 0.982, 95% CI = 0.353-2.732, p = 0.973), suggesting absence of race-specific surgical benefits.

CONCLUSION

We identified a racial disparity against African-Americans in recommendations for surgical resection of skull base chondrosarcomas.

Dural Convexity Chondroma Mimicking Meningioma in a Young Female

Intracranial meningeal convexity chondroma is a rare benign lesion hypothesized to stem from remnant chondrocyte precursors of embryonic origin. This lesion often masquerades as meningioma given the similar dural-based attachment and pattern of calcification. We describe the case of a 26-year-old female with incidentally discovered convexity meningeal chondroma, originally presumed to be a meningioma. In this case, we share our diagnostic and operative intervention and outcome and discuss the unique pathologic findings in this lesion that differentiate it from similar appearing lesions. To the authors’ knowledge, there are fewer than 20 cases of convexity meningeal chondroma in the literature; thus, we also provide a brief review of the literature regarding this rare pathology.

Clinical and Radiologic Characteristics, Surgical Outcomes, and Its Possible Origins of Chondroma of the Dural Convexity

Chondroma of the dural convexity (CDC) is a benign and extremely rare type of intracranial chondroma. In this study, we reported five CDCs in a single center and reviewed the available literature to determine the clinical characteristics and surgical outcomes and possible origins of the disease. The clinical data of five patients (4 females) who confirmed to be CDC between 2000 and 2019 in our single center was collected together with 22 cases from literatures. The clinical characteristics and surgical outcomes were reviewed and analyzed. Among all the available CDC cases, the mean age was 31 ± 13.7 years; the mean tumor volume was 42.3 ± 40.9 cm³, showing a female predominance (63% vs. 37%). The tumors showed calcification in 88.2% cases (15/17) on CT scans and hypointense on T1WI (15/19, 78.9%), mixed intense on T2WI (10/18, 55.6%), and inhomogeneous enhancement without dural tail sign after administration of gadolinium (20/21, 95.2%). Almost all the tumors were misdiagnosed as meningiomas preoperatively. In addition, almost all image available CDC lesions (24/25, 96%) located across the cranial sutures indicating that the tumor originated from ectopic chondrocytes from adjacent skull sutures. No tumors recurred after total resection in follow-up. CDCs are characterized with female predominance and may originate from ectopic chondrocytes from adjacent skull sutures. The lesion with inhomogeneous contrast enhancement without dural tail sign and avascular in cerebral angiography are key points to be differentiated from meningioma. The most effective treatment is total resection.

When Chondroma Happens in an Unexpected Location: A Case Report of Intra-Axial Intracranial Chondroma

Chondroma is a benign tumor of mature hyaline cartilage that is often found in the long bones and may be rarely diagnosed in other parts of the body. Here, we present a young patient with the definitive diagnosis of intra-axial intracranial chondroma and without dural connection. The presenting symptoms of the patient were headache and impaired vision. The brain magnetic resonance imaging (MRI) revealed a huge enhancing parasagittal brain mass. The diagnosis was confirmed by immunohistochemistry, which was positive for S100.

The distribution of chondromas: Why the hand?

Chondroma is a benign hyaline cartilage tumor and is a relatively common skeletal neoplasm. Uneven distribution of this tumor among the various bones and regions of the skeleton is known but no explanation of this phenomenon followed. The current research aimed to document the exact chondroma distribution in the body. We hypothesized that the cases of all subtypes of chondroma have to be investigated in complex and that obtaining combined data from a large cohort of cases may explain the logic of chondroma distribution and may answer the question of why the hand is the main target of the tumor. We retrospectively analyzed 1529 cases of various subtypes of chondroma. Enchondroma was the most frequent type (65.4%) and the hand was the main target location (49.8% of all cases). The right side of the body was affected in 900 cases (58.9%) and in 629 cases (41.1%) the left side was affected (p = 0.03). The general results for tumor distribution are as follows: head and extremities - 92.8%; head, hands, and feet - 71.8%; and hands and feet - 62.8%. In the hand and the feet, multiple chondromas were distributed along the same digital ray in all cases. The anatomical distribution of various subtypes of chondroma follows "the periphery of the being", the uneven lateral distribution, and the "same digital ray" patterns that permits to suggest that genetic mutations affecting the development of the body during the embryonic period are the main etiological component for this tumor.

An Intracerebral Type of Cranial Chondroma

The vast majority of intracranial chondromas are located in the base of the cranium. Their presentation as an intracerebral neoplasm is considered to be extremely rare. A previously healthy 45-year-old man experienced recurrent seizure attacks over a period of 6 months. Imaging studies of the brain revealed an ovoid and calcified mass which involve the cortex in the left frontal lobe. Intraoperatively, the mass had no adhesion to the dura and arachnoid membrane. The tumor was completely removed and the final diagnosis was intracerebral chondroma. The patient remained free of disease over the period of 18-years follow-up. This communication adds an unusual case to the literature on the chondroma that expressed in the form of an intra-axial space-occupying lesion in the frontal lobe.

Suprasellar Benign Chondroma: A Case Report and Literature Review

Intracranial chondroma is a rare benign tumor comprising only 0.2% of all intracranial tumors. A 27-year-old woman presented with visual dysfunction and headache. Brain computed tomography and magnetic resonance imaging revealed a suprasellar mass lesion with a calcified component. Gross total removal was achieved via a basal interhemispheric approach. Postoperatively, visual function improved to the normal range, and no recurrence was evident 4 years later. Histopathological examination confirmed the diagnosis of benign chondroma. Preoperative differentiation of chondromas from chordomas is clinically important, because of the different treatment and prognostic implications. The only effective treatment for chondroma is total surgical removal. We present a case of gross total resection of a suprasellar chondroma with reference to the literature.

Intracranial Chondroma of the Falx Cerebri: A Rare Case Report with Review of Literature

Intracranial chondromas are extremely rare, benign slow-growing cartilaginous tumors mostly originating from embryonic rests at sphenoethmoidal region and sometimes can originate from the falx, convexity dura, the tentorium, the choroid plexus, or the brain parenchyma. In this article, we present a 22-year-old woman with a chondroma of dural origin. The clinical, radiological, and histopathological findings along with the operative findings and postoperative course are described as well as the pertinent literature regarding intracranial chondromas is reviewed.

Chondroma in the hypoglossal canal: A case report

Background:

Intracranial chondromas are rare tumors arising from the skull base. They are usually accompanied by functional impairments of some cranial nerves. However, hypoglossal nerve dysfunction is rare.

Case Description:

We report on a 57-year-old woman presenting with chondroma of the right hypoglossal canal leading to right hypoglossal nerve palsy.

Conclusions:

This report suggests that chondroma should be considered as a differential diagnosis in cases of hypoglossal lesions.

Intracranial Dural Parafalcine Chondroma: Case Report and Systematic Review of the Literature

Intracranial chondromas are rare, benign neoplasms representing only 0.2%-0.3% of neoplastic intracranial lesions. They commonly originate from the skull base but can infrequently arise from the falx, convexity dura, or ventricular ependyma. Diagnosis requires histopathologic confirmation, as patients present with nonspecific symptoms related to mass effect, and imaging characteristics often resemble meningiomas, oligodendrogliomas, and vascular malformations. We describe the case of a patient harboring a parafalcine dural chondroma that was discovered incidentally and was managed surgically at our institution. We also provide a systematic review of the literature to elucidate incidence, origin, imaging findings, surgical management approaches, and prognosis of this rare tumor.