Preliminary Exploration of the Diagnosis and Treatment of Skull-Based Chondromyxoid Fibromas

How I do it: Surgical Resection of a Recurrent Chondromyxoid Fibroma by Micro-Endoscopic Combination Technique

BACKGROUND

The surgical resection of the tumor spreading into the cavernous sinus (CS) is complicated and challenging.

METHOD

We report a left recurrent CS chondromyxoid fibroma occupying the clival-petrous apex-parasellar-suprasellar area, which was totally removed by the micro-endo combination technique via the middle cranial fossa extradural approach.

CONCLUSION

This case demonstrates the value of the micro-endoscopic combination technique for complicated skull base surgery.

Craniofacial Chondromyxoid Fibromas: A Systematic Review and Analysis Based on Anatomic Locations

BACKGROUND

Craniofacial chondromyxoid fibromas (CMF) are a rare benign tumor of cartilaginous origin. They are commonly misdiagnosed due to the paucity of information on tumor characteristics. We performed a systematic review to characterize CMF located in different regions of the craniofacial skeleton.

METHODS

A search of the literature was executed using the search phrase "chondromyxoid fibroma" and included articles from 1990 - 2020. Sixty-eight articles met the inclusion criteria, with a total of 91 patients with analyzable data (22 with calvarial and 69 with sinonasal tumor locations). Descriptive analyses were performed to compare pre-selected characteristics between the two groups.

RESULTS

Sinonasal CMF frequently presented with cranial nerve palsy and expectedly had a high rate of nasal symptoms. Calvarial tumors frequently presented with an external mass and headache. Gross total resection (GTR) was achieved in a higher proportion of cases in the calvarial group versus the sinonasal group (83.3% vs 53.1%). Overall recurrence rate at 17.7% was higher in sinonasal CMF compared to the calvarial tumors at 8.3%. Recurrences after GTR were similar in the sinonasal and calvarial groups (9.7% vs 9.1%). In patients who did not achieve GTR, recurrence was higher in the sinonasal compared to the calvarial group (27.6% vs 0%).

CONCLUSION

Craniofacial CMF in calvarial and sinonasal locations have distinct clinical characteristics and response to treatment. Sinonasal lesions tend to have higher recurrence compared to calvarial CMF. Performance of GTR is associated with decreased recurrence in all CMF.