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1
Donald, Paul J., Bernard M. Lyons, and Joao J. Maniglia. "Surgery of the Skull Base for Head and Neck Neoplasms." Otolaryngology–Head and Neck Surgery 112, no. 5 (May 1995): P88. http://dx.doi.org/10.1016/s0194-5998(05)80206-2.
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Educational objectives: To understand the relationship of deep facial structures to the cranial base and the pertinent intracranial anatomy; to perform the comprehensive workup required by skull base surgery patients; and to acquire a working knowledge of the basic skull base procedures in the anterior, middle, and posterior cranial fossa.
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Marzo, Sam J., John P. Leonetti, and Guy Petruzzelli. "Facial paralysis caused by malignant skull base neoplasms." Neurosurgical Focus 12, no. 5 (May 2002): 1–4. http://dx.doi.org/10.3171/foc.2002.12.5.3.
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Object Bell palsy remains the most common cause of facial paralysis. Unfortunately, this term is often erroneously applied to all cases of facial paralysis. Methods The authors performed a retrospective review of data obtained in 11 patients who were treated at a university-based referral practice between July 1988 and September 2001 and who presented with acute facial nerve paralysis mimicking Bell palsy. All patients were subsequently found to harbor an occult skull base neoplasm. A delay in diagnosis was demonstrated in all cases. Seven patients died of their disease, and four patients are currently free of disease. Conclusions Although Bell palsy remains the most common cause of peripheral facial nerve paralysis, patients in whom neoplasms invade of the facial nerve may present with acute paralysis mimicking Bell palsy that fails to resolve. Delays in diagnosis and treatment in such cases may result in increased rates of mortality and morbidity.
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DiNardo, Laurence J., and Robert L. Rumsey. "Management of Malignant Schwannomas of the Paranasal Sinuses and Anterior Skull Base." Ear, Nose & Throat Journal 75, no. 6 (June 1996): 377–80. http://dx.doi.org/10.1177/014556139607500612.
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The evolution of skull base surgery has facilitated the extirpation of previously unresectable tumors. As experience with skull base surgery increases, the feasibility of resection and long-term outcomes is becoming apparent for the more common lesions. Neoplasms such as malignant schwannomas are rare and, therefore, defy single-institution analysis. The treatment and four-year follow-up of a malignant paranasal sinus and anterior skull base schwannoma is described. Analysis of the literature confirms the low incidence of this tumor and supports the efficacy of skull base surgery in its treatment.
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Nikonova, Svetlana Dmitrievna, Maksim Aleksandrovich Kutin, Elizaveta Vladimirovna Shelesko, Pavel Lvovich Kalinin, Nadezhda Alekseevna Chernikova, and Lyudmila Aleksandrovna Fomochkina. "Recovery peculiarities and complications in the nasal cavity caused by skull base reconstruction with nasoseptal flap after transnasal removal of chiasmo-sellar mass lesions." Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery), no. 1 (January 1, 2021): 36–44. http://dx.doi.org/10.33920/med-01-2101-03.
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Today, endoscopic endonasal approach is considered the gold standard in skull base surgery of the chiasmosellar region. Advances in transnasal endoscopic skull base surgery allow conducting more extensive interventions via wider approaches which requires more complicated plastic closure of the skull base defect. In 2006, G. Haddad et al. suggested using a vascularized nasoseptal flap to reconstruct a skull base defect. This method is generally accepted at present due to its reliability and low frequency of postoperative complications. The purpose of this article is to analyze publications on possible complications and pathological conditions of the nasal cavity when using a vascularized nasoseptal flap for skull base surgery after removal of neoplasms of the chiasmo-sellar region. The study included articles found in the Pubmed database (2006–2020) which described frequency and character of complications caused by skull base defect reconstruction by a nasoseptal flap after transnasal removal of chiasmo-sellar neoplasms. According to the literature review, the following complications are reported: cerebrospinal fluid leak, flap necrosis and infectious complications, pathological changes in the nasal cavity: prolonged crusting, synechiae, epistaxis, septum perforation, sinusitis, subatrophic changes of mucosae, nasolacrimal duct obstruction, olfactory dysfunction. The authors conclude that the nasoseptal flap is, undoubtedly, an effective material for reconstruction of dural defects by endoscopic endonasal skull base surgery, because of its good viability due to the preserved blood supply and high tightness of the plasty. However, there is a risk of complications in the nasal cavity. For these reasons, development of effective methods for prevention of nasal complications after using a vascularized flap in endoscopic endonasal surgery is an important issue today.
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Tabaee, Abtin, Gurston Nyquist, Vijay K. Anand, Ameet Singh, Ashutosh Kacker, and Theodore H. Schwartz. "Palliative Endoscopic Surgery in Advanced Sinonasal and Anterior Skull Base Neoplasms." Otolaryngology–Head and Neck Surgery 142, no. 1 (January 2010): 126–28. http://dx.doi.org/10.1016/j.otohns.2009.09.021.
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Schirmer, Clemens M., and Carl B. Heilman. "Hemangiopericytomas of the skull base." Neurosurgical Focus 30, no. 5 (May 2011): E10. http://dx.doi.org/10.3171/2011.2.focus119.
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Object Intracranial hemangiopericytomas are frequently located along the dural sinuses along the skull base and represent rare, aggressive CNS neoplasms that are difficult to distinguish from meningiomas based on both imaging and gross characteristics. The authors of this study describe 3 patients with these lesions and review the pertinent literature. Methods Two men and 1 woman, whose median age at the time of the initial presentation was 37 years (range 20–53 years), constitute this series. They underwent multimodal treatment consisting of resection, embolization, radiation therapy, and in 1 case chemotherapy. Results Two of the 3 patients treated were alive after a mean follow-up of 93 months (range 4–217 months). One patient died 217 months after the initial diagnosis. The longest tumor progression–free interval after the initial or secondary resection was 43 months (range 4–84 months). Conclusions Hemangiopericytomas have been reclassified as mesenchymal nonmeningothelial tumors. They have an inevitable tendency to recur locally and metastasize distally. The mainstay of therapy remains an aggressive attempt to achieve gross-total resection at the initial surgery. Postoperative adjuvant radiotherapy should be offered to all patients, regardless of the degree of resection achieved. Diligent long-term follow-up is paramount as local recurrences and distal metastases can develop sometimes years after the initial treatment.
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Kanamori, Hiroki, Yohei Kitamura, Tokuhiro Kimura, Kazunari Yoshida, and Hikaru Sasaki. "Genetic characterization of skull base chondrosarcomas." Journal of Neurosurgery 123, no. 4 (October 2015): 1036–41. http://dx.doi.org/10.3171/2014.12.jns142059.
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OBJECT Although chondrosarcomas rarely arise in the skull base, chondrosarcomas and chordomas are the 2 major malignant bone neoplasms occurring at this location. The distinction of these 2 tumors is important, but this distinction is occasionally problematic because of radiological and histological overlap. Unlike chordoma and extracranial chondrosarcoma, no case series presenting a whole-genome analysis of skull base chondrosarcomas (SBCSs) has been reported. The goal of this study is to clarify the genetic characteristics of SBCSs and contrast them with those of chordomas. METHODS The authors analyzed 7 SBCS specimens for chromosomal copy number alterations (CNAs) using comparative genomic hybridization (CGH). They also examined IDH1 and IDH2 mutations and brachyury expression. RESULTS In CGH analyses, the authors detected CNAs in 6 of the 7 cases, including chromosomal gains of 8q21.1, 19, 2q22-q32, 5qcen-q14, 8q21-q22, and 15qcen-q14. Mutation of IDH1 was found with a high frequency (5 of 7 cases, 71.4%), of which R132S was most frequently mutated. No IDH2 mutations were found, and immunohistochemical staining for brachyury was negative in all cases. CONCLUSIONS To the best of the authors' knowledge, this is the first whole-genome study of an SBSC case series. Their findings suggest that these tumors are molecularly consistent with a subset of conventional central chondrosarcomas and different from skull base chordomas.
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Chaitanya, S. H., C. Basker Rao, and G. Krishnan. "Transfacial approaches in the management of anterior and middle skull base neoplasms." International Journal of Oral and Maxillofacial Surgery 36, no. 11 (November 2007): 997. http://dx.doi.org/10.1016/j.ijom.2007.08.077.
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Boyle, Jay O., Kinner C. Shah, and Jatin P. Shah. "Craniofacial resection for malignant neoplasms of the skull base: An overview." Journal of Surgical Oncology 69, no. 4 (December 1998): 275–84. http://dx.doi.org/10.1002/(sici)1096-9098(199812)69:4<275::aid-jso13>3.0.co;2-1.
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Carpenter, Patrick S., Ryan C. Burgette, John P. Leonetti, and Sam J. Marzo. "Auricular Complications in Parotid, Temporal Bone, Infratemporal Fossa, and Lateral Skull Base Surgery." Ear, Nose & Throat Journal 96, no. 2 (February 2017): E27—E31. http://dx.doi.org/10.1177/014556131709600216.
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Neoplasms located in the parotid region, temporal bone, infra-temporal fossa, and lateral skull base represent a challenge due to their difficult anatomic location and surrounding neurovascular structures. A variety of surgical approaches are appropriate to access this area, although several of them can place the auricular blood supply in danger. If the auricular blood supply is compromised, ischemia and, eventually, avascular necrosis of the auricle can occur. Auricular necrosis often can cause patients a delay in adjuvant radiation therapy and result in the need for additional reconstructive procedures. There-fore, it is imperative to identify risk factors associated with the development of this disabling complication. We conducted a retrospective review of 32 individuals undergoing treatment of benign and malignant lesions in the parotid gland, infratemporal fossa, and lateral skull base. To identify potential risk factors for auricular necrosis, the patients were analyzed based on the type of neoplasm (malignant or benign), risk factors affecting blood flow (diabetes mellitus, smoking history, prior radiation, prior surgery), body mass index, and the length of surgery. In our population examined, 3 instances of auricular necrosis occurred. None of the potential risk factors proved to be statistically significant (although malignant pathology approached significance at p = 0.07). Two of the patients required an auriculectomy with reconstruction. The third had multiple postoperative clinic visits for surgical debridement. Although no potential risk factors were statistically significant, surgeons should remain cognizant of the auricular blood supply while performing surgery via preauricular and postauricular approaches to this area.
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Mickey, Bruce, Lanny Close, Steven Schaefer, and Duke Samson. "A combined frontotemporal and lateral infratemporal fossa approach to the skull base." Journal of Neurosurgery 68, no. 5 (May 1988): 678–83. http://dx.doi.org/10.3171/jns.1988.68.5.0678.
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✓ A variety of neoplasms involve both the infratemporal fossa and the base of the middle cranial fossa, in medial proximity to the cavernous sinus and orbital apex. To provide simultaneous access to both the intracranial and extracranial aspects of these tumors, a temporal or frontotemporal craniotomy may be combined with a lateral exposure of the infratemporal fossa. The approach, which is readily achieved by a neurosurgeon and an otolaryngologist acting as a team, involves a unilateral frontotemporal incision extended inferiorly onto the neck, a lateral facial flap reflected anteriorly, and transection of the zygoma followed by its reflection inferolaterally with the temporalis muscle. This exposure provides excellent visualization of both the intradural and extradural aspects of the anterior portion of the cavernous sinus, allowing for an aggressive resection of neoplasms involving this region. Experience with this procedure is reported here in the management of nine patients: three with nasopharyngeal angiofibromas, three with low-grade malignancies of the upper aerodigestive tract, and three with sphenoid ridge meningiomas.
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Seifert, V., and H. Dietz. "Combined orbito-frontal, sub- and infratemporal fossa approach to skull base neoplasms." Acta Neurochirurgica 114, no. 3-4 (September 1992): 139–44. http://dx.doi.org/10.1007/bf01400603.
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Cohen, Alan R., and Paul B. Tartell. "Transnasal illumination to guide the craniofacial resection of anterior skull base neoplasms." Surgical Neurology 40, no. 5 (November 1993): 420–23. http://dx.doi.org/10.1016/0090-3019(93)90224-o.
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Ben-Ari, Oded, Anat Wengier, Barak Ringel, Narin Carmel Neiderman, Zvi Ram, Nevo Margalit, Dan Fliss, and Avraham Abergel. "Nasoseptal Flap for Skull Base Reconstruction in Children." Journal of Neurological Surgery Part B: Skull Base 79, no. 01 (January 11, 2018): 037–41. http://dx.doi.org/10.1055/s-0037-1617435.
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Objective The endoscopic endonasal approach is being increasingly used for the resection and reconstruction of anterior skull base (ASB) lesions. Vascularized nasoseptal flaps (NSF) have become the workhorse for the reconstruction of ASB defects, resulting in a significant decrease in the incidence of cerebrospinal fluid (CSF) leaks. The objective of this study was to investigate the efficacy and safety of NSF in children. Methods This is a retrospective analysis of the medical records of all patients under the age of 18 years who underwent endoscopic repair of ASB lesions with the use of NSF at our tertiary medical center between 1/2011 and 8/2016. Results Twelve children underwent ASB defect repair for both benign and malignant neoplasms using the endoscopic endonasal NSF technique. Four children had previously undergone ASB surgery. The male-to-female ratio was 1:1, the average age was 12.3 years, the average hospitalization time was 8.3 days, and the maximum follow-up period was 24 months, during which craniofacial growth appeared to be unimpaired. A lumbar drain was used postoperatively in six cases. Crust formation and synechia were observed in two cases. There was one case of a major long-term complication (a CSF leak followed by meningitis). Conclusions Endoscopic endonasal NSF was both an effective and a safe technique for ASB defect reconstruction in 12 children for both benign and malignant neoplasms. It had a high success rate and a low complication rate. No apparent negative influence on craniofacial growth was observed in our series.
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Brusati, Roberto, Federico Biglioli, Pietro Mortini, Mirco Raffaini, and Mario Goisis. "Reconstruction of the orbital walls in surgery of the skull base for benign neoplasms." International Journal of Oral and Maxillofacial Surgery 29, no. 5 (October 2000): 325–30. http://dx.doi.org/10.1016/s0901-5027(00)80045-4.
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Brusati, Roberto, Federico Biglioli, Pietro Mortini, Mirco Raffaini, and Mario Goisis. "Reconstruction of the orbital walls in surgery of the skull base for benign neoplasms." International Journal of Oral and Maxillofacial Surgery 29, no. 5 (October 2000): 325–30. http://dx.doi.org/10.1034/j.1399-0020.2000.290502.x.
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Batra, Pete S. "Minimally invasive endoscopic resection of sinonasal and anterior skull base malignant neoplasms." Expert Review of Medical Devices 7, no. 6 (November 2010): 781–91. http://dx.doi.org/10.1586/erd.10.61.
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Schuller, David E., Mary C. Hart, and Joseph H. Goodman. "The surgery of benign and malignant neoplasms adjacent to or involving the skull base." American Journal of Otolaryngology 10, no. 5 (September 1989): 305–13. http://dx.doi.org/10.1016/0196-0709(89)90104-x.
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Zada, Gabriel, Rose Du, and Edward R. Laws. "Defining the “edge of the envelope”: patient selection in treating complex sellar-based neoplasms via transsphenoidal versus open craniotomy." Journal of Neurosurgery 114, no. 2 (February 2011): 286–300. http://dx.doi.org/10.3171/2010.8.jns10520.
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Object Endonasal approaches have become the gold standard intervention for many anterior and middle skull base tumors. The authors aimed to define some of the existing limitations of these approaches by reviewing their experience with complex sellar region tumors that were initially considered for both transsphenoidal and open skull base approaches and were thus deemed tumors at “the edge of the envelope.” Methods Between April 2008 and April 2010, 250 transsphenoidal operations were performed at Brigham and Women's Hospital. All cases were retrospectively reviewed to identify patients with complex sellar region tumors that were initially considered for, or soon thereafter required, an open craniotomy as the definitive treatment. The anatomical tumor characteristics that posed limitations to performing safe and effective endonasal skull base operations were reviewed. Results Thirteen cases exemplifying some of the existing limitations to achieving optimal surgical outcomes via transsphenoidal-based approaches are presented. The following 8 factors are separately discussed that repeatedly limited the extent of resection, increased the risk of the operation, and contributed to perioperative complications: significant suprasellar extension, lateral extension, retrosellar extension, brain invasion with edema, firm tumor consistency, involvement or vasospasm of the arteries of the circle of Willis, and encasement of the optic apparatus or invasion of the optic foramina. Conclusions Although the ability to approach and resect complex tumors using endonasal skull base techniques has evolved dramatically in recent years, several inherent tumor characteristics mandate extensive preoperative consideration. In selected cases these characteristics may lend support to selecting an open craniotomy as the initial operation.
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Citardi, Martin J., Pete S. Batra, Dennis H. Kraus, and Heinz Richard Stammberger. "Endoscopic Management of Anterior Skull Base Neoplasia." Otolaryngology–Head and Neck Surgery 135, no. 2_suppl (August 2006): P193. http://dx.doi.org/10.1016/j.otohns.2006.06.965.
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Hussain, Ibrahim, Qasim Husain, Soly Baredes, Jean Anderson Eloy, Robert W. Jyung, and James K. Liu. "Molecular genetics of paragangliomas of the skull base and head and neck region: implications for medical and surgical management." Journal of Neurosurgery 120, no. 2 (February 2014): 321–30. http://dx.doi.org/10.3171/2013.10.jns13659.
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Paragangliomas are rare, slow-growing tumors that frequently arise in the head and neck, with the carotid bodies and temporal bone of the skull base being the most common sites. These neoplasms are histologically similar to pheochromocytomas that form in the adrenal medulla and are divided into sympathetic and parasympathetic subtypes based on functionality. Skull base and head and neck region paragangliomas (SHN-PGs) are almost always derived from parasympathetic tissue and rarely secrete catecholamines. However, they can cause significant morbidity by mass effect on various cranial nerves and major blood vessels. While surgery for SHN-PG can be curative, postoperative deficits and recurrences make these lesions challenging to manage. Multiple familial syndromes predisposing individuals to development of paragangliomas have been identified, all involving mutations in the succinate dehydrogenase complex of mitochondria. Mutations in this enzyme lead to a state of “pseudohypoxia” that upregulates various angiogenic, survival, and proliferation factors. Moreover, familial paraganglioma syndromes are among the rare inherited diseases in which genomic imprinting occurs. Recent advances in gene arrays and transcriptome/exome sequencing have identified an alternate mutation in sporadic SHN-PG, which regulates proto-oncogenic pathways independent of pseudohypoxia-induced factors. Collectively these findings demonstrate that paragangliomas of the skull base and head and neck region have a distinct genetic signature from sympathetic-based paragangliomas occurring below the neck, such as pheochromocytomas. Paragangliomas serve as a unique model of primarily surgically treated neoplasms whose future will be altered by the elucidation of their genomic complexities. In this review, the authors present an analysis of the molecular genetics of SHN-PG and provide future directions in patient care and the development of novel therapies.
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Janecka, Iva P., Chandranath Sen, Laligam N. Sekhar, Sai Ramasastry, Hugh D. Curtin, E. Leon Barnes, and Frank D'Amico. "Cranial Base Surgery: Results in 183 Patients." Otolaryngology–Head and Neck Surgery 110, no. 6 (June 1994): 539–46. http://dx.doi.org/10.1177/019459989411000611.
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OBJECTIVE: To learn about the effects of cranial base surgery. DESIGN: Cohort study with a mean follow-up of 30 months. SETTING: Population-based. PATIENTS: A consecutive sample of 183 patients who underwent cranial base surgery; 118 patients had malignant skull base tumors, the majority of which were previously treated; 50 had benign tumors; 9 had congenital malformations of the skull base; 3 had inflammatory lesions, and 3 had traumatic defects of the skull base. MAIN OUTCOME MEASURES: Disease-free Interval, overall survival, and rate of complications and functional status. INTERVENTION: Cranial base surgery was followed by radiotherapy (In previously untreated patients). RESULTS: After completion of follow-up (mean, 30 months), 30 (25.4%) patients had died of their malignant tumors and 8 (6.8%) had died of other causes. One patient (0.84%) was lost to follow-up. The overall cancer survival rate without regard to histologic type was 67% (63% with no evidence of disease). Among the patients who were treated for benign neoplasm, 72% had no evidence of disease at a mean follow-up of 39 months. The group of patients with congenital malformations and inflammatory and traumatic lesions demonstrated successful correction of their presurgical problem with skull base surgery. One patient (who had invasive aspergillosis) died of disease. The overall surgical-medical mortality rate was 2%; the complication rate was 33%, and the Kamofsky performance score was improved or unchanged after surgery in 83% of patients. The average duration of surgery, number of blood transfusions used, and length of the hospital stay were 10 hours, 3 units, and 15 days, respectively. CONCLUSIONS: Cranial base surgery is a valid surgical technique for treatment of cranial base afflictions. In this study It was found to be beneficial In controlling benign and malignant disease and to be the treatment of choice for selected congenital malformations, trauma, and inflammatory lesions.
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Jeon, Jun W., Steve S. Cho, Shayoni Nag, Love Buch, John Pierce, YouRong S. Su, Nithin D. Adappa, et al. "Near-Infrared Optical Contrast of Skull Base Tumors During Endoscopic Endonasal Surgery." Operative Neurosurgery 17, no. 1 (August 16, 2018): 32–42. http://dx.doi.org/10.1093/ons/opy213.
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Abstract BACKGROUND Near-infrared (NIR) tumor contrast is achieved through the “second-window ICG” technique, which relies on passive accumulation of high doses of indocyanine green (ICG) in neoplasms via the enhanced permeability and retention effect. OBJECTIVE To report early results and potential challenges associated with the application of second-window ICG technique in endonasal endoscopic, ventral skull-base surgery, and to determine potential predictors of NIR signal-to-background ratio (SBR) using endoscopic techniques. METHODS Pituitary adenoma (n = 8), craniopharyngioma (n = 3), and chordoma (n = 4) patients received systemic infusions of ICG (5 mg/kg) approximately 24 h before surgery. Dual-channel endoscopy with visible light and NIR overlay were photodocumented and analyzed post hoc. RESULTS All tumors (adenoma, craniopharyngioma, chordoma) demonstrated NIR positivity and fluoresced with an average SBR of 3.9 ± 0.8, 4.1 ± 1.7, and 2.1 ± 0.6, respectively. Contrast-enhanced T1 signal intensity proved to be the single best predictor of observed SBR (P = .0003). For pituitary adenomas, the sensitivity, specificity, positive predictive value, and negative predictive value of NIR-guided identification of tumor was 100%, 20%, 71%, and 100%, respectively. CONCLUSION In this preliminary study of a small set of patients, we demonstrate that second-window ICG can provide NIR optical tumor contrast in 3 types of ventral skull-base tumors. Chordomas demonstrated the weakest NIR signal, suggesting limited utility in those patients. Both nonfunctional and functional pituitary adenomas appear to accumulate ICG, but utility for margin detection for the adenomas is limited by low specificity. Craniopharyngiomas with third ventricular extension appear to be a particularly promising target given the clean brain parenchyma background and strong SBR.
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McDermott, Michael W., and Philip H. Gutin. "Image-Guided Surgery for Skull Base Neoplasms Using the ISG Viewing Wand: Anatomic and Technical Considerations." Neurosurgery Clinics of North America 7, no. 2 (April 1996): 285–95. http://dx.doi.org/10.1016/s1042-3680(18)30393-0.
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Stib, Matthew T., Michael Johnson, Alan Siu, M. Isabel Almira-Suarez, Zachary Litvack, Ameet Singh, and Jonathan H. Sherman. "High-grade glioma with anterior skull base erosion and intranasal extension: case report." Journal of Neurosurgery 126, no. 5 (May 2017): 1484–87. http://dx.doi.org/10.3171/2016.4.jns151724.
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The authors describe the case of a large WHO Grade III anaplastic oligoastrocytoma extending through the anterior skull base and into the right nasal cavity and sinuses. Glial neoplasms are typically confined to the intracranial compartment within the brain parenchyma and rarely extend into the nasal cavity without prior surgical or radiation therapy. This 42-year-old woman presented with progressive headaches and sinus congestion. MR imaging findings revealed a large intracranial lesion with intranasal extension. Endoscopic nasal biopsy revealed pathology consistent with an infiltrating glioma. The patient subsequently underwent a combined transcranial/endonasal endoscopic approach for resection of this lesion. Pathological diagnosis revealed a WHO Grade III oligoastrocytoma. This report reviews the mechanisms of extradural glioma extension. To the authors' knowledge, it is the second report of a high-grade glioma exhibiting nasal extension without prior surgical or radiation treatment.
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Leonetti, John P., and Derald E. Brackmann. "Glomus Vagale Tumor: The Significance of Early Vocal Cord Paralysis." Otolaryngology–Head and Neck Surgery 100, no. 6 (June 1989): 533–37. http://dx.doi.org/10.1177/019459988910000601.
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Glomus body tumori most frequently originato in the middle ear (tympanlcum) or on the Jugular bulb (Jugulare). Tumors that arise from the vagal body account for less than 2.5% of these unique paraganglionic neoplasms. Otologic manifestations of tympanlcum and Jugulare tumors usually precede or accompany neurologic findings. In reviewing five cases of glomus vagale tumors, the Initial symptom of voice change, caused by vocal cord paralysis, preceded the presenting symptoms of hearing loss and tinnitus by an average of 2.5 years. The concept of early cranial nerve Involvement by glomus vagale tumors Is supported in a literature review. The evaluation of “Idiopathic” vocal cord paralysis must Include radiographic Inspection of the skull base, whereas an accurate, temporal account of presenting symptoms may help distinguish vagal body tumors from other vascular neoplasms of this region.
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Leonetti, John P., Peter G. Smith, Vinod K. Anand, G. Robert Kletzker, and James M. Hartman. "Subtotal Petrosectomy in the Management of Advanced Parotid Neoplasms." Otolaryngology–Head and Neck Surgery 108, no. 3 (March 1993): 270–76. http://dx.doi.org/10.1177/019459989310800311.
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Circumferential growth of parotid neoplasms may involve the external auditory meatus posteriorly, the floor of the middle cranial fossa superiorly, and the neurovascular structures of the jugular foramen medially. Inadequate tumor resection in these anatomically complex regions will result in local disease recurrence at the lateral skull base. A subtotal petrosectomy approach has been combined with a standard total parotidectomy in the management of 27 patients with aggressive parotid tumors. Twenty-two patients had malignant lesions and 10 individuals had recurrent disease. The resultant conductive hearing loss is outweighed by the following advantages of this technique: (1) the ability to obtain tumor-free bony margins, (2) proximal intratemporal facial nerve identification, (3) vascular control of the jugular bulb and petrous carotid artery, and (4) the dissection and protection of cranial nerves IX through XII. Our series of 27 patients will be detailed with an emphasis on surgical technique and overall patient results.
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Zada, Gabriel, Mustafa K. Başkaya, and Mitesh V. Shah. "Introduction: surgical management of skull base meningiomas." Neurosurgical Focus 43, videosuppl2 (October 2017): Intro. http://dx.doi.org/10.3171/2017.10.focusvid.intro.
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Meningiomas represent the most common primary intracranial neoplasm treated by neurosurgeons. Although multimodal treatment of meningiomas includes surgery, radiation-based treatments, and occasionally medical therapy, surgery remains the mainstay of treatment for most symptomatic meningiomas. Because of the intricate relationship of the dura mater and arachnoid mater with the central nervous system and cranial nerves, meningiomas can arise anywhere along the skull base or convexities, and occasionally even within the ventricular system, thereby mandating a catalog of surgical approaches that neurosurgeons may employ to individualize treatment for patients. Skull base meningiomas represent some of the most challenging pathology encountered by neurosurgeons, on account of their depth, invasion, vascularity, texture/consistency, and their relationship to bony anatomy, cranial nerves, and blood vessels. Resection of complex skull base meningiomas often mandates adequate bony removal to achieve sufficient exposure of the tumor and surrounding region, in order to minimize brain retraction and optimally identify, protect, control, and manipulate sensitive neurovascular structures. A variety of traditional skull base approaches has evolved to address complex skull base tumors, of which meningiomas are considered the paragon in terms of both complexity and frequency.In this supplemental video issue of Neurosurgical Focus, contributing authors from around the world provide instructional narratives demonstrating resection of a variety of skull base meningiomas arising from traditionally challenging origins, including the clinoid processes, tuberculum sellae, dorsum sellae, petroclival region, falco-tentorial region, cerebellopontine angle, and foramen magnum. In addition, two cases of extended endoscopic endonasal approaches for tuberculum sellae and dorsum sellae meningiomas are presented, representing the latest evolution in accessing the skull base for selected tumors. Along with key pearls for safe tumor resection, an equally important component of open and endoscopic skull base operations for meningiomas addressed by the contributing authors is the reconstruction aspect, which must be performed meticulously to prevent delayed cerebrospinal fluid leakage and/or infections. This curated assortment of instructional videos represents the authors’ optimal treatment paradigms pertaining to the selection of approach, setup, exposure, and principles to guide tumor resection for a wide spectrum of complex meningiomas.
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Baker, Shan R., and Joseph T. Latack. "Magnetic Resonance Imaging of the Head and Neck." Otolaryngology–Head and Neck Surgery 95, no. 1 (July 1986): 82–89. http://dx.doi.org/10.1177/019459988609500116.
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Magnetic resonance imaging (MR) has already gained wide acceptance in the evaluation of intracranial and spinal canal abnormalities. MR also provides excellent resolution of certain tumors of the head and neck and is particularly useful for the evaluation of neoplasms in the vicinity of the skull base. The absence of a bone signal prevents the streaking artifact so troublesome with computerized axial tomography (CT) and allows better definition of tumor. MR does not use ionizing radiation and appears to be an innocuous imaging mode—thus multiple examinations in young patients are not objectionable with MR. The ability to obtain images in multiple planes by control of the magnetic gradients allows for axial, sagittal, and coronal imaging, without changing the supine position of the patient. Multiple projections are helpful in providing better preoperative assessment of the extent and size of certain neoplasms Of the neck.
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Raza, Shaan M., Ahmed Habib, Wei-Lien Wang, Paul W. Gildey, Anthony P. Conley, Marc-Elie Nader, Ehab Y. Hanna, Shirley Y. Su, and Franco DeMonte. "Surgical Management of Primary Skull Base Osteosarcomas: Impact of Margin Status and Patterns of Relapse." Neurosurgery 86, no. 1 (September 12, 2019): E23—E32. http://dx.doi.org/10.1093/neuros/nyz360.
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Abstract BACKGROUND Skull base osteosarcomas are aggressive neoplasms characterized by bony invasion and extracompartmental/extra-osseous soft tissue extension that pose obstacles to achieving complete resection. Management is further complicated by the paucity of data regarding the efficacy of surgery within the treatment paradigm. OBJECTIVE To identify the impact of margin status on local progression free survival (PFS) and disease specific survival (DSS). METHODS A retrospective review was performed of 36 patients with osteosarcoma who underwent gross total resection with negative margins (R0), or positive margins (R1). Patient demographics, prior treatments, relapse patterns, and survival were collected. Univariate analysis was performed to determine the impact of margin status on the PFS (primary outcome) and DSS (secondary outcome). RESULTS R0 resection was achieved in 67%, 25% patients had local recurrence, and 19.4% patients had distant metastasis. In assessing the entire cohort, R0 resections had improved DSS (P = .002) and PFS (P = .04). In chemotherapy-naïve patients, R0 resections also had improved impact on PFS (P = .04) and DSS (P = .027). For radiation-naïve patients, improvements in PFS (P = .026) and DSS (P = .031) were also noted. CONCLUSION Skull base osteosarcomas present management challenges in which both local and systemic disease progression is the cause of mortality. Achieving R0 resections significantly improves PFS and DSS in treatment-naïve patients within multimodality treatment paradigms. Salvage surgery may benefit in patients after failing previous radiation and chemotherapy treatments. Further work is needed to determine optimal treatment strategies. These data represent the largest series reported to date.
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Edzhe, M. A., A. Yu Ovchinnikov, and D. O. Semiletova. "Ethmoid labyrinth osteoma: case report." Russian Otorhinolaryngology 20, no. 4 (2021): 83–87. http://dx.doi.org/10.18692/1810-4800-2021-4-83-87.
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Osteomas are common benign slowly growing neoplasms that make up a group of osteogenic tumors, occurring mainly in the lower jaw and the sinonasal region with the involvement of the frontal sinuses in 80–96%, an ethmoid labyrinth in 2–15%, maxillary in 2–5% of cases, and extremely rarely – sphenoid sinuses. Among all benign tumors of the paranasal sinuses, osteomas occur in 3–10% of patients. The tumor can have a different density, as well as grow both on a pedicle and on a broad base, which makes it difficult to extract, especially when located in the frontal sinus. There is also a risk of developing liquorrhea when the osteoma adheres to the base of the skull. Patients and methods: Patient G., 67 years old, with complaints of impaired nasal breathing, postnasal leakage of mucous discharge into the pharynx, and recurrent headache localized in the frontal region, was admitted for planned surgical treatment to the otorhinolaryngological department of the Clinical Medical Center of the Evdokimov Moscow State Medical University. The listed symptoms have been noted over the past year. A computed tomogram of the head revealed a picture of an osteoma of the ethmoid sinus on the right, adjacent to the base of the skull in the area of the lateral lamella of the middle turbinate. Results: A transnasal endoscopic approach to the roof of the ethmoid labyrinth was performed by removing the middle turbinate, resecting the ethmoid bulla. After removal of the tumor, a naked area of the dura mater and pinpoint liquorrhea were visualized. Plastic surgery of the skull base defect was performed using several layers of biodegradable hemostatic material. Conclusion: Osteoma of the paranasal sinuses is a well-visualized tumor on a computed tomography, which usually does not require histological confirmation. At the same time, surgical treatment of this type of tumor may be accompanied by difficulties in their extraction, when located in the frontal sinus, as well as the risk of liquorrhea, when adhering to the base of the skull, which requires the surgeon to have skills in closing defects of the skull base and knowledge of the features of postoperative management.
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Gardner, Paul A., Matthew J. Tormenti, Harshita Pant, Juan C. Fernandez-Miranda, Carl H. Snyderman, and Michael B. Horowitz. "Carotid Artery Injury During Endoscopic Endonasal Skull Base Surgery: Incidence and Outcomes." Operative Neurosurgery 73, no. 2 (May 20, 2013): ons261—ons270. http://dx.doi.org/10.1227/01.neu.0000430821.71267.f2.
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Abstract BACKGROUND: Injury to the internal carotid artery (ICA) during endoscopic endonasal skull base surgery is a feared complication that is not well studied or reported. OBJECTIVE: To evaluate the incidence, to identify potential risk factors, and to present management strategies and outcomes of ICA injury during endonasal skull base surgery at our institution. METHODS: We performed a retrospective review of all endoscopic endonasal operations performed at our institution between 1998 and 2011 to examine potential factors predisposing to ICA injury. We also documented the perioperative management and outcomes after injury. RESULTS: There were 7 ICA injuries encountered in 2015 endonasal skull base surgeries, giving an incidence of 0.3%. Most injuries (5 of 7) involved the left ICA, and the most common diagnosis was chondroid neoplasm (chordoma, chondrosarcoma; 3 of 7 [2% of 142 cases]). Two injuries occurred during 660 pituitary adenoma resections (0.3%). The paraclival ICA segment was the most commonly injured site (5 of 7), and transclival and transpterygoid approaches had a higher incidence of injury, although neither factor reached statistical significance. Four of 7 injured ICAs were sacrificed either intraoperatively or postoperatively. No patient suffered a stroke or neurological deficit. There were no intraoperative mortalities; 1 patient died postoperatively of cardiac ischemia. One of the 3 preserved ICAs developed a pseudoaneurysm over a mean follow-up period of 5 months that was treated endovascularly. CONCLUSION: ICA injury during endonasal skull base surgery is an infrequent and manageable complication. Preservation of the vessel remains difficult. Chondroid tumors represent a higher risk and should be resected by surgical teams with significant experience.
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Kros, Johan M., Herbert van den Berge, Hervé L. J. Tanghe, and Stef L. M. Bakker. "Right temporal lobe glioblastoma presenting in the left orbit." Journal of Neurosurgery 92, no. 4 (April 2000): 702–5. http://dx.doi.org/10.3171/jns.2000.92.4.0702.
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✓ Dissemination of gliomas outside the central nervous system without preceding neurosurgery is a rare phenomenon. Glial neoplasms presenting as bone lesions are even more rare. A case of glioblastoma multiforme (GBM) with initial presentation in the orbit following a single generalized seizure is described. Signs of intracranial hypertension resulted from subarachnoid tumor invasion. The patient was treated with whole-dose radiation therapy but survived for only 6 months following the initial presentation. An autopsy revealed a right temporal GBM with extensive subarachnoid spread and invasion in the left orbit and skull base. The literature on dissemination of primary tumors of the brain is reviewed.
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Leonetti, John P., O. Howard Reichman, Ossama Al-Mefty, LI John, and Peter G. Smith. "Neurotologic Considerations in the Treatment of Advanced Clival Tumors." Otolaryngology–Head and Neck Surgery 107, no. 1 (July 1992): 49–56. http://dx.doi.org/10.1177/019459989210700108.
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Head and neck manifestations of advanced clival tumors result from subtle, yet progressive mass effect or direct involvement of multiple cranial nerves. Misinterpretation of clinical or radiographic findings in these patients may result in inappropriate treatment planning, increased patient morbidity, and probable tumor recurrence. Our combined experience in managing 21 patients with advanced clival tumors has shown that preoperative loss of vision, diplopia, or facial hypesthesia suggests superior parasellar disease. Facial twitching or neurotologic symptoms result from posterior central tumor growth, while inferior extension of disease leads to basal cranial nerve deficits with associated speech, voice, and swallowing dysfunctions. The purpose of this article is to correlate the complex anatomy of the clivus, brainstem, and cranial base and the various n eurotologic findings associated with neoplasms in this region. Lateral skull base surgical procedures, based on preoperative clinicoradiographic assessment, will be detailed with particular emphasis on preservation of critical neurovascular structures.
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Simkin, David O., Hugo A. Pardo, Alejandro Rubino, Osvaldo González Aguilar, Gastón Omeñuk, and María Montserrat Pujadas Bigi. "Cáncer palatosinusal t4a/b: extensión de las resecciones oncológicas." Revista Argentina de Cirugía 111, no. 2 (June 1, 2019): 61–70. http://dx.doi.org/10.25132/raac.v111.n2.1390.es.
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Background: the problems of reconstructive surgery for the midface are variable and can be very complex. The anatomical proximity of the midface to the orbit, base of the skull and maxillary sinuses is a challenge for the surgeon who must perform a curative resection. Objective: The aim of this presentation is to report the survival rate and disease-free interval in T4a and T4b neoplasms of the palate and paranasal sinuses consecutively resected over a 30-year period. Material and methods: Surgery was extended to the orbit in 85.2%, the skull in 8.3%, the neck in 18.7% and the parotid gland in 7.3%. Soft tissue reconstruction was performed using free flaps in 32.5%, muscle flaps in 21.6%, local flaps in 20.2%, musculocutaneous flaps in 14.7% and skin flaps in 11.3%. Results: Local and general complications were reported, and 4/203 patients (2%) died. At 5 years, overall survival was 62.5% and disease-free survival was 53%. Univariate analysis revealed that lack of previous treatment was significantly associated with recurrence and squamous cell carcinoma was a predictor of survival. Conclusions: The indication of exenteration is mandatory in the presence of ophthalmoplegia or involvement of the orbital content. Survival at 5 years is acceptable, considering the advanced stages of the disease. In some patients, previous treatments were
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Di Maio, Salvatore, Robert Rostomily, and Laligam N. Sekhar. "Current Surgical Outcomes for Cranial Base Chordomas." Neurosurgery 70, no. 6 (December 6, 2011): 1355–60. http://dx.doi.org/10.1227/neu.0b013e3182446783.
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Abstract BACKGROUND: Chordomas of the skull base are locally aggressive neoplasms for which maximal surgical resection confers prolonged survival. OBJECTIVE: To present the largest consecutive surgical series of cranial base chordomas to date, including complications, functional outcome, and overall (OS) and recurrence-free survival (RFS) in early and late eras of our experience. METHODS: From 1988 to 2011, 95 patients with cranial base chordomas were treated, including 56 patients from 1988 to 1999 and 39 from 2000 to 2011. Mean age and average follow-up were 42.6 ± 16.8 years and 38.3 ± 38.5 months, respectively. A historically controlled study design was implemented comparing both eras with respect to 5-year OS, RFS, Karnofsky performance scale at last-follow-up, and complications. RESULTS: Mean 5-year OS and RFS for the entire cohort was 74% ± 6% and 56% ± 8%, respectively. Complete resection rates were similar between groups (68% and 74%, respectively; P = .494). In the 2000 to 2011 era, overall (26%), cranial nerve (10%), vascular (3%), and systemic (0%) complications were less frequent than in the 1988 to 1999 era. Patients in the 2000 to 2011 era were 1.50 times more likely to have a Karnofsky performance scale ≥70 than in the 1988 to 1999 era (95% confidence interval 1.15-1.94; P = .003). There was no significant difference in 5-year RFS between the 1988 to 1999 and 2000 to 2011 eras. Five-year OS was higher in the 2000 to 2011 era (93% ± 6% vs 64% ± 8% for the 1988-1999 era; P = .012). CONCLUSION: Aggressive surgical resection implementing contemporary skull base approaches can be performed with an acceptable complication profile with preservation of functional status, while conferring a similar OS and RFS.
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Bindal, Ajay K., Rajesh K. Bindal, Harry van Loveren, and Raymond Sawaya. "Management of intracranial plasmacytoma." Journal of Neurosurgery 83, no. 2 (August 1995): 218–21. http://dx.doi.org/10.3171/jns.1995.83.2.0218.
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✓ The authors report on a study of eight cases of intracranial plasmacytoma to identify the risk of progression to multiple myeloma and suggest the treatment required for cure of solitary lesions. The diagnosis of multiple myeloma or myelomatous changes was made in the immediate postoperative period in four patients (50%), two of whom had skull base lesions. Of the four remaining patients, three were treated with complete surgical resection and radiation therapy and had no recurrence of plasmacytoma or progression to multiple myeloma during mean follow up of 12 years (range 2–25 years); one patient underwent subtotal surgical resection and had recurrence of the tumor despite radiation therapy. It is concluded that multiple myeloma is unlikely to develop during the long term in patients with intracranial plasmacytoma who do not develop multiple myeloma or myelomatous changes in the early postoperative period. However, lesions that infiltrate the skull base are not likely to be solitary, and patients who harbor these neoplasms should undergo complete evaluation and close follow-up review to exclude multiple myeloma. A recurrence of solitary intracranial plasmacytoma is possible with subtotal surgical resection despite radiation therapy. Definitive treatment should consist of complete surgical resection with adjuvant radiation therapy.
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Chawdhary, G., S. Hussain, and R. Corbridge. "Delayed diagnosis of central skull-base osteomyelitis with abscess: case report and learning points." Annals of The Royal College of Surgeons of England 99, no. 1 (January 2017): e24-e27. http://dx.doi.org/10.1308/rcsann.2016.0283.
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Central skull-base osteomyelitis (CSBO) is a rare life-threatening infection, usually resulting from medial spread of necrotising otitis externa. Here, we describe a case with no identifiable source of infection, causing a delay in diagnosis. An 80-year-old man with Crohn’s disease treated with mesalazine presented with collapse and tonic–clonic seizure. Computed tomography and magnetic resonance imaging showed a nasopharyngeal mass that was initially thought to be a neoplasm. Awaiting formal biopsy, he represented with collapse and repeat imaging showed features of abscess formation. Review of previous scans revealed skull-base erosion and the diagnosis was revised to skull-base osteomyelitis. This is the first reported case of CSBO associated with mesalazine use, an aminosalicylate used in Crohn’s disease. It is only the second reported case with abscess formation. We discuss the learning points in making a timely diagnosis and examine the potential association of factors such as mesalazine use and abscess formation in this case.
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Yumoto, Eiji, Hiroshi Okamura, and Naoaki Yanagihara. "Transmandibular Transpterygoid Approach to the Nasopharynx, Parapharyngeal Space, and Skull Base." Annals of Otology, Rhinology & Laryngology 101, no. 5 (May 1992): 383–89. http://dx.doi.org/10.1177/000348949210100502.
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The nasopharynx, upper part of the parapharyngeal space, and skull base are relatively inaccessible to the surgeon without major postoperative complications. Operative fields reached by conventional approaches through the palate and maxillary sinus are too limited and narrow to remove extensive tumors. The authors applied a transmandibular transpterygoid approach for the removal of five residual nasopharyngeal carcinomas (NPCs) after full doses of irradiation, one pleomorphic adenoma of the nasopharynx, and one large parapharyngeal schwannoma extending into the jugular foramen. This approach offers a wide operative field so that large blood vessels and cranial nerves can be managed easily. All tumors were successfully resected. Two patients with benign neoplasms had uneventful recoveries after treatment. Of five patients with NPC, two are alive with no evidence of disease for 68 months and 50 months, respectively, while two died of metastases to the liver and bones. The other patient is alive with metastases in the lungs. No tumor recurred in the local primary site, however. Since the number of NPC cases is small, the usefulness of surgical removal of the postirradiation residual NPC is not clear. Our experience proved that the transmandibular transpterygoid approach is a practical method in the treatment of neoplastic lesions in the nasopharynx, parapharyngeal space, and skull base.
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Sen, Chandranath, Aymara I. Triana, Niklas Berglind, James Godbold, and Raj K. Shrivastava. "Clival chordomas: clinical management, results, and complications in 71 patients." Journal of Neurosurgery 113, no. 5 (November 2010): 1059–71. http://dx.doi.org/10.3171/2009.9.jns08596.
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Object Chordomas are rare malignant neoplasms arising predominantly at the sacrum and skull base. They are uniformly lethal unless treated with aggressive resection and proton beam irradiation. The authors present results of the surgical management of a large number of patients with clivus chordomas. Factors that influence the surgeon's ability to achieve radical tumor resection are also evaluated. Methods Between 1991 and 2005, 71 patients with clivus chordomas underwent surgery. The average follow-up was 66 months (median 60 months, range 3–189 months). Sixty-five patients had complete records that were analyzed in the present report. Thirty-five percent of them had undergone surgery before being treated by the authors. They were evaluated with MR imaging and CT scanning and underwent surgery utilizing a variety of skull base techniques aimed at achieving radical excision. Many also underwent postoperative radiation, usually in the form of proton beam therapy. The patients were followed up with serial imaging at regular intervals as well as with neurological evaluation. Results Radical tumor resection was achieved in 58% of the group. The overall 5-year survival rate was 75%. Radical resection had a positive impact on survival. The ability to achieve radical resection was dependent on the preoperative tumor volume and the number of anatomical areas involved by the tumor. Cranial nerve impairment and CSF leakage were the most frequent postoperative complications. Conclusions Radical excision is the ideal surgical goal in the treatment of clival chordomas and can be achieved with reasonable risks. Several different surgical approaches may be necessary to accomplish this.
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Perry, Avital, Christopher Graffeo, Christopher Marcellino, Bruce Pollock, Nicholas Wetjen, and Fredric Meyer. "Pediatric Pituitary Adenoma: Case Series, Review of the Literature, and a Skull Base Treatment Paradigm." Journal of Neurological Surgery Part B: Skull Base 79, no. 01 (January 24, 2018): 091–114. http://dx.doi.org/10.1055/s-0038-1625984.
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Background Pediatric pituitary adenoma is a rare skull base neoplasm, accounting for 3% of all intracranial neoplasms in children and 5% of pituitary adenomas. Compared with pituitary tumors in adults, secreting tumors predominate and longer disease trajectories are expected due to the patient age resulting in a natural history and treatment paradigm that is complex and controversial. Objectives The aims of this study were to describe a large, single-institution series of pediatric pituitary adenomas with extensive long-term follow-up and to conduct a systematic review examining outcomes after pituitary adenoma surgery in the pediatric population. Methods The study cohort was compiled by searching institutional pathology and operative reports using diagnosis and site codes for pituitary and sellar pathology, from 1956 to 2016. Systematic review of the English language literature since 1970 was conducted using PubMed, MEDLINE, Embase, and Google Scholar. Results Thirty-nine surgically managed pediatric pituitary adenomas were identified, including 15 prolactinomas, 14 corticotrophs, 7 somatotrophs, and 4 non-secreting adenomas. All patients underwent transsphenoidal resection (TSR) as the initial surgical treatment. Surgical cure was achieved in 18 (46%); 21 experienced recurrent/persistent disease, with secondary treatments including repeat surgery in 10, radiation in 14, adjuvant pharmacotherapy in 11, and bilateral adrenalectomy in 3. At the last follow-up (median 87 months, range 3–581), nine remained with recurrent/persistent disease (23%).Thirty-seven publications reporting surgical series of pediatric pituitary adenomas were included, containing 1,284 patients. Adrenocorticotropic hormone (ACTH)-secreting tumors were most prevalent (43%), followed by prolactin (PRL)-secreting (37%), growth hormone (GH)-secreting (12%), and nonsecreting (7%). Surgical cure was reported in 65%. Complications included pituitary insufficiency (23%), permanent visual dysfunction (6%), chronic diabetes insipidus (DI) (3%), and postoperative cerebrospinal fluid (CSF) leak (4%). Mean follow-up was 63 months (range 0–240), with recurrent/persistent disease reported in 18% at the time of last follow-up. Conclusion Pediatric pituitary adenomas are diverse and challenging tumors with complexities far beyond those encountered in the management of routine adult pituitary disease, including nuanced decision-making, a technically demanding operative environment, high propensity for recurrence, and the potentially serious consequences of hypopituitarism with respect to fertility and growth potential in a pediatric population. Optimal treatment requires a high degree of individualization, and patients are most likely to benefit from consolidated, multidisciplinary care in highly experienced centers.
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Oskouian, Rod J., John A. Jane, Aaron S. Dumont, Jonas M. Sheehan, Jeffrey J. Laurent, and Paul A. Levine. "Esthesioneuroblastoma: clinical presentation, radiological, and pathological features, treatment, review of the literature, and the University of Virginia experience." Neurosurgical Focus 12, no. 5 (May 2002): 1–9. http://dx.doi.org/10.3171/foc.2002.12.5.5.
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Esthesioneuroblastoma is a rare and malignant upper nasal cavity neoplasm involving the anterior skull base. Treatment includes surgery, radiotherapy, chemotherapy, or a combination. The ideal treatment modality has yet to be determined. Esthesioneuroblastoma often lies in proximity to the optic nerves, optic chiasm, and the orbit. Resection risks damaging these critical structures, and radiotherapeutic techniques, similar to those applied for paranasal sinus tumors, may damage these vital structures and result in late sequelae such as blindness and cortical necrosis. Management strategies for this neoplasm lack uniformity, and there is no universally accepted staging system. In this paper the authors discuss the clinical presentation, radiological and pathological features, and treatment of this rare, malignant skull base neoplasm, as well as review the literature. They also present their results and treatment regimen, which includes preoperative radio- and chemotherapy or 1) craniofacial resection if the lesion has a significant intrac-erebral component, or 2) frontal sinus resection if little intracranial extension exists.
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Alturaiki, Sajedh M., Ali Almomen, Ghaleb Al Azzeh, Abdulrahman Al Khatib, and Nada Alshaikh. "Fibro-osseous lesions of the paranasal sinuses and the skull base." International Journal of Otorhinolaryngology and Head and Neck Surgery 4, no. 6 (October 24, 2018): 1324. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20184345.
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<p class="abstract"><strong>Background:</strong> Osteomas, ossifying fibromas, and fibrous dysplasia comprise a set of benign neoplasms known as fibro-osseous lesions (FO), which can arise in the paranasal sinuses. The vast majority of benign FO lesions (BFOL) are incidental findings on radiographs. They tend to be slow-growing tumors, and are infrequently symptomatic. The management strategy can vary significantly for theses lesions. This can range from serial, observations to aggressive surgical resection, based on symptomatology, size, and location of the lesion.</p><p class="abstract"><strong>Methods:</strong> Retrospective analysis of all the data of different symptomatic FO of the paranasal sinuses and the skull base was performed at King Fahad specialist hospital, Dammam, KSA (2006 to 2017). </p><p class="abstract"><strong>Results:</strong> A total of 21 patients were identified; 10 (46.7%) patients were diagnosed with osteoma, 8 (38.1%) with fibrous dysplasia, 2 (9.5%) with ossifying fibroma and one (4.8%) with juvenile active ossifying (JAOF), 17 were adults and 4 were children, the range of f/u (3-60) months. 19 patients were managed by the endonasal endoscopic approach. They continue to be followed with no evidence of recurrence. Two cases required the revision combined endoscopic open approach to ensure adequate removal of the disease (residual and recurrence).</p><p><strong>Conclusions:</strong> Diagnostic dilemma of BFOL can be overcome with a combination of clinical, radiological and pathological criteria. Correct diagnosis of fibro-osseous tumors is crucial for adequate therapy as their treatment, prognosis, clinical aggressiveness and long term complications of individual entities vary significantly. Endoscopic computer-assisted surgery is the treatment of choice. Endoscopic resection remains a technical challenge. </p>
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Lucke-Wold, Brandon, Erik C. Brown, Justin S. Cetas, Aclan Dogan, Sachin Gupta, Timothy E. Hullar, Timothy L. Smith, and Jeremy N. Ciporen. "Minimally invasive endoscopic repair of refractory lateral skull base cerebrospinal fluid rhinorrhea: case report and review of the literature." Neurosurgical Focus 44, no. 3 (March 2018): E8. http://dx.doi.org/10.3171/2017.12.focus17664.
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Cerebrospinal fluid (CSF) leaks occur in approximately 10% of patients undergoing a translabyrinthine, retrosigmoid, or middle fossa approach for vestibular schwannoma resection. Cerebrospinal fluid rhinorrhea also results from trauma, neoplasms, and congenital defects. A high degree of difficulty in repair sometimes requires repetitive microsurgical revisions—a rate of 10% of cases is often cited. This can not only lead to morbidity but is also costly and burdensome to the health care system. In this case-based theoretical analysis, the authors summarize the literature regarding endoscopic endonasal techniques to obliterate the eustachian tube (ET) as well as compare endoscopic endonasal versus open approaches for repair. Given the results of their analysis, they recommend endoscopic endonasal ET obliteration (EEETO) as a first- or second-line technique for the repair of CSF rhinorrhea from a lateral skull base source refractory to spontaneous healing and CSF diversion. They present a case in which EEETO resolved refractory CSF rhinorrhea over a 10-month follow-up after CSF diversions, wound reexploration, revised packing of the ET via a lateral microscopic translabyrinthine approach, and the use of a vascularized flap had failed. They further summarize the literature regarding studies that describe various iterations of EEETO. By its minimally invasive nature, EEETO imposes less morbidity as well as less risk to the patient. It can be readily implemented into algorithms once CSF diversion (for example, lumbar drain) has failed, prior to considering open surgery for repair. Additional studies are warranted to further demonstrate the outcome and cost-saving benefits of EEETO as the data until now have been largely empirical yet very hopeful. The summaries and technical notes described in this paper may serve as a resource for those skull base teams faced with similar challenging and otherwise refractory CSF leaks from a lateral skull base source.
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Taguchi, Yoshio, Katsuyuki Tanaka, Motoshi Matsuzawa, and Hiroaki Sekino. "A surgical technique to avoid postoperative enophthalmos in the cranioorbital approach." Journal of Neurosurgery 85, no. 3 (September 1996): 514–17. http://dx.doi.org/10.3171/jns.1996.85.3.0514.
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✓ The authors describe a surgical technique to avoid postoperative enophthalmos when using the cranioorbital approach. To perform osteotomies with a less demanding technique, two separate bone flaps were created: 1) a free frontotemporal bone flap and 2) en bloc removal of the superior and lateral orbital rims. Because the latter bone flap includes both the orbital roof and the posterolateral wall of the orbit with the greater wing of the sphenoid bone, unnecessary bone defects in the lateral orbital wall are avoided. The technique has been performed in seven patients treated for medially located skull base neoplasms or complex anterior circulation aneurysms without postoperative enophthalmos or other cosmetic problems. The authors believe this cranioorbital approach, with its simpler, less invasive surgical technique, offers a definite advantage by avoiding postoperative enophthalmos.
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Findlay, J. Max, David Chiasson, Alan R. Hudson, and Mario Chui. "Giant-cell tumor of the middle cranial fossa." Journal of Neurosurgery 66, no. 6 (June 1987): 924–28. http://dx.doi.org/10.3171/jns.1987.66.6.0924.
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✓ The authors report the case of a 23-year-old man with a giant-cell tumor of the right middle cranial fossa floor. His presentation and management are described, and some aspects of this rare neoplasm of the skull base are reviewed. The role of adjuvant radiotherapy is discussed.
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Kondziolka, Douglas, L. Dade Lunsford, and John C. Flickinger. "The Role of Radiosurgery in the Management of Chordoma and Chondrosarcoma of the Cranial Base." Neurosurgery 29, no. 1 (July 1, 1991): 38–46. http://dx.doi.org/10.1227/00006123-199107000-00007.
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Abstract Despite conventional multimodality treatment (surgery and fractionated radiation therapy), recurrence and clinical progression of cranial base chordomas and chondrosarcomas are common. The malignant behavior of these tumors is a result of their critical location, locally aggressive nature, and high recurrence rate. To explore the role of radiosurgery in the treatment of these skull base neoplasms, we assessed its use in four patients with chordoma and two with chondrosarcoma. In five of the patients, radiosurgery was used as adjuvant therapy for residual or recurrent tumors after surgical debulking, and in one patient with a chordoma, it was the primary treatment. No patient received fractionated external beam radiotherapy. All tumors were less than 30 mm in diameter and were treated with 20 Gy to the tumor margin. Skull base computed tomography and magnetic resonance images were essential to define the anatomic relationships between tumor and adjacent basal structures. During follow-up (mean, 22 mo; range, 8-36 mo), we found no progression of the treated tumor volume in any patient. Neurological deficits before treatment improved in three patients; the other three patients remained in stable neurological condition. Serial follow-up imaging studies demonstrated that two patients showed reduction in tumor size and four patients had no tumor growth. In one patient, a metastatic parietal lobe chondrosarcoma developed and was treated by microsurgery. Another patient showed tumor progression outside of the radiosurgical trcatment volume. Our results attest to the value of stereotactic radiosurgery as an adjuvant or primary treatment for selected patients with chordoma or chondrosarcoma and demonstrate its potential advantages over standard fractionated irradiation. Analysis of the long-term clinical and imaging effects after radiosurgery is warranted. (Neurosurgery 29:38-46, 1991)
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Langevin, Claude-Jean, Matthew M. Hanasono, Howard A. Riina, Philip E. Stieg, and Henry M. Spinelli. "Lateral Transzygomatic Approach to Sphenoid Wing Meningiomas." Operative Neurosurgery 67, suppl_2 (December 1, 2010): ons377—ons384. http://dx.doi.org/10.1227/neu.0b013e3181f8d3ad.
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ABSTRACT BACKGROUND: Sphenoid wing meningiomas are slow-growing, well-circumscribed, and histologically benign lesions. The recurrence rate is low if removed completely at the time of surgery. Adequate surgical exposure with minimal morbidity is a challenge for those treating these lateral skull base lesions. OBJECTIVE: To describe our experience with the lateral tranzygomatic approach for resection of sphenoid wing meningioms in which the entire zygoma is mobilized and remains vascularized by masseter muscle attachments. METHODS: A retrospective review of the records of 19 patients who underwent sphenoid wing meningioma resection via a lateral transzygomatic approach between 1997 and 2007 was performed. A confirmatory cadaver dissection was performed to illustrate the anatomic nature of the technique. To achieve maximal exposure and minimal brain retraction, a lateral transzygomatic approach with osteotomies of the entire zygoma, which remains pedicled on the masseter muscle, was used. RESULTS: Nineteen patients with sphenoid wing meningioma underwent resection via a lateral transzygomatic approach. Complete resection of the meningioma was achieved in 17 cases. Morbidity consisted of temporary frontal nerve weakness (57.9%), mild to moderate temporalis atrophy (36.8%), and diplopia (15.8%). There were no cases of wound infection, bone malunion, or resorption. A mean follow-up period of 33.1 months (range, 2-71 months) revealed no recurrences after surgery as demonstrated by computed tomography or magnetic resonance imaging. CONCLUSION: The lateral transzygomatic approach to the sphenoid wing can be performed safely with minimal morbidity and facilitates complete resection of the tumor. Complete removal at an early stage is the best prognostic factor in treating sphenoid wing meningioma. This approach belongs in the armamentarium of surgeons who are involved in the resection of skull base neoplasms.
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Nussbaum, Eric S. "Cerebral Revascularization." Neurosurgical Focus 14, no. 3 (March 2003): 1–2. http://dx.doi.org/10.3171/foc.2003.14.3.1.
Full textAbstract:
Despite decades of critical analysis, the precise indications for cerebral revascularization remain poorly defined. It is clear that some patients undergoing therapeutic carotid artery (CA) sacrifice for the management of unclippable intracranial aneurysms or skull base neoplasms will require revascularization to prevent or reduce the risk of cerebral infarction.4,11 Nevertheless, the decisions of when to perform this procedure and what type of bypass to undertake in these cases remain debated. The question of whether revascularization should be conducted in cases involving ischemic disease is even more controversial.1–3,5,8 This issue of Neurosurgical Focus is devoted to the topic of cerebral revascularization, assembling a collection of articles from noted experts in this field. The papers address many of the challenging and important issues yet to be defined in this controversial area.
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Boedeker, Carsten Christof, Hartmut P. H. Neumann, Gerd Jürgen Ridder, Wolfgang Maier, and Jörg Schipper. "Paragangliomas in patients with mutations of the SDHD gene." Otolaryngology–Head and Neck Surgery 132, no. 3 (March 2005): 467–70. http://dx.doi.org/10.1016/j.otohns.2004.09.024.
Full textAbstract:
OBJECTIVE: Paragangliomas represent neoplasms of neural crest origin that arise from paraganglia. Mutations in the gene encoding succinate dehydrogenase subunit D (SDHD) are responsible for a percentage of hereditary paragangliomas. We previously described a group of 271 pheochromocytoma patients, 11 of whom had mutations of the SDHD gene. The objective of this study was to find out whether those 11 patients had additional paragangliomas. STUDY DESIGN: Ten patients participated in our clinical screening program that included MRI of the skull base and neck, thorax, and abdomen, as well as an 18Fluoro-DOPA positron emission tomography (DOPA-PET). RESULTS: Five patients presented with head and neck paragangliomas, 1 patient with a thoracic paraganglioma, and 2 patients with intraabdominal paragangliomas. CONCLUSIONS: The screening for paragangliomas in patients with mutations of the SDHD gene offers the chance to diagnose those tumors in an early stage. SIGNIFICANCE: Because morbidity after surgical resection increases with tumor size, early surgery will minimize the potential risks.