Chordomas and Chondrosarcomas of the Skull Base

Abstract Skull base chordomas and chondrosarcomas are often approached anteriorly but with tumor extension posterolateral to the intrapetrous carotid artery, or intradural posterior fossa extension, lateral approaches afford improved access and/or reduce morbidity. The lateral approaches to skull base chordomas and chondrosarcomas include transpetrosal (retrolabyrinthine, translabyrinthine, or transcochlear), transjugular, far lateral approach to foramen magnum, and combined approaches (middle fossa and transpetrosal; transpetrosal and far lateral approach to foramen magnum; and subtemporal transpetrous apex). Combination of middle fossa and retrolabyrinthine approaches can avoid the hearing loss resulting from translabyrinthine or transcochlear approaches. Fallopian bridge technique in transjugular approaches can avoid facial nerve rerouting and resulting weakness. Since survival benefits accrue to greater degrees of resection of skull base chordomas and chondrosarcomas, it is important to have a multidisciplinary team to determine the optimal approach(es) for access and cytoreduction while minimizing morbidity.