Resseção Microcirúrgica do Condrossarcoma Recorrente na Base do Crânio Via Abordagem MIPLATTA: Nota Técnica em Vídeo Cirúrgico

Abstract

Introduction: Skull base chondrosarcomas are rare, locally aggressive tumors with a reported recurrence rate of approximately 16% despite maximal safe resection2; recurrent disease after prior surgery poses substantial challenges related to scarring, dural adhesions, and encasement of critical neurovascular structures. So, the objective of this study was to describe, through an illustrative surgical video, the microsurgical resection of a recurrent left parasellar chondrosarcoma using the Minimally Invasive Posterolateral Transcavernous Transtentorial Approach1, together with management of an intraoperative vascular injury and cranial nerve reconstruction. Case Report: A 35-year-old patient, previously treated by endoscopic transsphenoidal resection in 2022 and a second resection via the same approach in October 2024, presented with imaging-confirmed tumor progression. A third microsurgical resection was performed, comprising middle fossa peeling, opening of Meckel's cave, release of dense postoperative adhesions, optic nerve decompression, and progressive internal debulking combined with high-speed drilling of the markedly calcified, petrous bone-infiltrating tumor.3 During dissection near the brainstem, an intraoperative injury to the superior cerebellar artery required temporary and definitive clipping, reinforced with an additional mini-clip and confirmed by intraoperative angiography. The transected third cranial nerve was repaired by microsurgical neurorrhaphy, and a redundant nerve segment was used as an interposition graft to reconstruct the fourth cranial nerve.4 Results: Satisfactory tumor resection was achieved with preserved posterior circulation flow on intraoperative angiography and no immediate vascular or neurological complications; postoperative imaging confirmed adequate resection of the recurrent tumor. Conclusion: Recurrent skull base chondrosarcoma can be safely managed through this approach when extensive bony exposure, meticulous neurovascular dissection, early proximal vascular control, and cranial nerve reconstruction are combined, consistent with contemporary series emphasizing gross total resection as the primary determinant of long-term tumor control2,5.