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Journal of Neurological Surgery. Part B, Skull Base

Manish Kolakshyapati, Fusao Ikawa, Masaru Abiko, Takafumi Mitsuhara, Masaaki Takeda, Tejashwi Shrestha, Kaoru Kurisu
Skull base approach is a neurosurgical challenge requiring dexterity of the operating surgeon for good postoperative outcome. In addition to the experience of the operating surgeon, adequate preoperative information of the tumor is necessary to ensure better outcome. In clinoid meningioma, it is sometimes difficult to determine its relationship with the surrounding structure and the feeding artery. Previously, preoperative simulation has been utilized to determine the intracranial course of the compressed nerves in relation to the petroclival meningioma...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Shunya Hanakita, Moujahed Labidi, Kentaro Watanabe, Sebastien Froelich
Objective  While the endoscopic endonasal approach (EEA) has gained widespread acceptance for the resection of clivus chordomas, conventional transcranial approaches still have a crucial role in craniocervical junction (CCJ) chordoma surgery. In repeat surgery, a carefully planned treatment strategy is needed. We present a surgical treatment plan combining an EEA and a far-lateral craniotomy with endoscopic assistance (EA) in the salvage surgery of a recurrent CCJ chordoma. Case Presentation  A 37-year-old woman who had undergone partial resection of a chordoma extending from the mid-clivus to the CCJ...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Roy Thomas Daniel, Constantin Tuleasca, Alda Rocca, Mercy George, Etienne Pralong, Luis Schiappacasse, Michele Zeverino, Raphael Maire, Mahmoud Messerer, Marc Levivier
Objective  Planned subtotal resection followed by Gamma Knife surgery (GKS) in patients with large vestibular schwannoma (VS) has emerged during the past decade, with the aim of a better functional outcome for facial and cochlear function. Methods  We prospectively collected patient data, surgical, and dosimetric parameters of a consecutive series of patients treated by this method at Lausanne University Hospital during the past 8 years. Results  A consecutive series of 47 patients were treated between July 2010 and January 2018...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Akihito Sato, Sakyo Hirai, Yoshiki Obata, Taketoshi Maehara, Masaru Aoyagi
Background  The far lateral approach includes exposure of the C1 transverse process, vertebral artery, posterior arch of the atlas, and occipital condyle. We designed a method for systematic muscular-stage dissection and present our experience with this approach. Operative Methods  We used a horseshoe scalp flap that was reflected downward and medially. The lateral muscle layers were separated layer to layer to expose the suboccipital triangle. The medial muscle layers were separated in the midline and reflected in a single layer...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Naoki Otani, Terushige Toyooka, Satoru Takeuchi, Arata Tomiyama, Yasuaki Nakao, Takuji Yamamoto, Kojiro Wada, Kentaro Mori
Background  Extradural temporopolar approach for paraclinoid lesions can provide extensive and early exposure of the anterior clinoid process, and complete mobilization and decompression of the optic nerve and internal carotid artery, which can prevent intraoperative neurovascular injury. The present study investigated the usefulness of our less invasive modified technique and discussed its operative nuances. Methods  We retrospectively reviewed medical charts of 80 consecutive patients with neoplastic (21 patients) and vascular lesions (59 patients) who underwent the modified extradural temporopolar approach between September 2009 and March 2014...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Zhan Xue, Lu Kong, Chang-Cun Pan, Zhen Wu, Jun-Ting Zhang, Li-Wei Zhang
Introduction  Brainstem gliomas (BsG) account for 10 to 15% of pediatric brain tumors. Surgery is the preferred treatment for focal and exophytic lesions. Sodium fluorescein has been proven safe and effective in resection of malignant brain tumors. Objective  The objective was to o analyze the safety and effectiveness of this approach, to evaluate intraoperative fluorescein imaging, and to measure the safety of chosen dose for pediatric patients. Methods  Twelve cases were enrolled between March 2014 and September 2016 in Beijing Tiantan Hospital...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Toshihiro Ogiwara, Tetsuya Goto, Yosuke Hara, Kazuhiro Hongo
Objective  The usefulness of the bony surface registration method for navigation system image-guided surgery in the lateral or prone position has been reported. This study was performed to evaluate the efficacy of our new real-time navigation-guided drilling technique with bony surface registration for skull base surgery in the middle and posterior fossae. Methods  The study included 29 surgeries for skull base tumors that required drilling of the petrous bone between January 2015 and December 2017 in Shinshu University Hospital...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Hiroshi Manaka, Katsumi Sakata, Junya Tatezuki, Tadao Shinohara, Wataru Shimohigoshi, Tetsuya Yamamoto
Preoperative embolization for intracranial meningioma has remained controversial for several decades. In this study, we retrospectively reviewed our experience of embolization using particulate embolic material and coil to clarify the therapeutic efficacy, safety, and risk of complication. Methods  We reviewed 69 patients who underwent embolization with particulate embolic material followed by surgical resection. An additional 6 procedures were included for patients in whom recurrence was treated, for a total of 75 procedures of preoperative embolization...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Koji Takeuchi, Shinji Kawabata, Ryo Hiramatsu, Yoko Matsushita, Hiroki Tanaka, Yoshinori Sakurai, Minoru Suzuki, Koji Ono, Shin-Ichi Miyatake, Toshihiko Kuroiwa
Objectives  Boron neutron capture therapy (BNCT) is a nuclear reaction-based tumor cell-selective particle irradiation that occurs when nonradioactive Boron-10 is irradiated with low-energy neutrons to produce high-energy α particles (10B [ n , α] 7Li). Possible complications associated with extended surgical resection render high-grade meningioma (HGM) a challenging pathology and skull-base meningiomas (SBMs) even more challenging. Lately, we have been trying to control HGMs using BNCT. This study aims to elucidate whether the recurrence and outcome of HGMs and SBMs differ based on their location...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Kiyoto Shiga, Katsunori Katagiri, Daisuke Saitoh, Takenori Ogawa, Kenjiro Higashi, Hisanori Ariga
Objectives  This article aims to clarify the long-term outcomes of patients with squamous cell carcinoma of the temporal bone who underwent concomitant chemoradiotherapy (CCRT). Design and Setting  The study design was a retrospective chart review. Patients and Methods  From December 2001 to June 2014, 23 patients with cancer of the temporal bone who were treated by CCRT at the Tohoku University Hospital and the Iwate Medical University Hospital were enrolled in this study. For advanced cancer of the temporal bone, a modified docetaxel, cisplatin, and 5-fluorouracil (TPF) regimen was used for CCRT...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Masahiro Toda, Kenzo Kosugi, Hiroyuki Ozawa, Kaoru Ogawa, Kazunari Yoshida
Objective  The main purpose of this article is to assess the effectiveness and safety of surgery via the endoscopic endonasal approach (EEA) for cavernous sinus (CS) lesion in patients with nonfunctioning pituitary adenomas (NFPA). Design  Retrospective study. Setting  Keio University Hospital. Participants  Thirty patients who underwent CS surgery via the EEA between 2009 and 2017 for Knosp grade 4 NFPA with pre- and postoperative magnetic resonance imaging available for volumetric analysis. Main Outcome Measures  Clinical presentation, extent of resection, and surgical complications...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Matteo Zoli, Federica Guaraldi, Ernesto Pasquini, Giorgio Frank, Diego Mazzatenta
Introduction  The endoscopic endonasal approach (EEA) might seem an "unnatural" route for intradural lesions such as meningiomas. The aim of this study is to critically revise our management of anterior skull base meningiomas to consider, in what cases it may be advantageous. Material and Methods  Each consecutive case of anterior skull base meningioma operated on through an EEA or combined endoscopic-transcranial approach at our institution, between 2003 and 2017, have been included. Tumors were classified on the basis of their location and intra or extracranial extension...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Philippe Lavigne, Daniel L Faden, Eric W Wang, Carl H Snyderman
Objective  The nasoseptal flap (NSF) is considered the primary vascularized flap for reconstruction of dural defects with endoscopic endonasal surgery (EES) of the skull base. However, the complications and morbidities associated with this reconstructive flap are poorly understood. This article presents a systematic review of the complications and morbidities related to the use of the NSF in skull base surgery. Method  A systematic review of the literature based on published guidelines was performed to identify potential complications and morbidities related to the NSF...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Amir Goodarzi, Arjang Ahmadpour, Atrin Toussi, Kiarash Shahlaie
Objective  Our primary objective was to retrospectively review our single institution experience using an anatomic multilayered repair of the retrosigmoid suboccipital craniotomy. Our secondary objective was to review the existing body of literature on the repair of this craniotomy and compare our outcomes to previous results. Design  Retrospective review of 25 consecutive patients undergoing repair for the retrosigmoid craniotomy. Setting  University of California Davis Medical Center (2010-2016). Participants  A total of 25 consecutive patients who underwent retrosigmoid craniotomy and repair...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Chelsea S Hamill, Jennifer A Villwock, Kevin J Sykes, Roukoz B Chamoun, D David Beahm
Objectives  The number of transsphenoidal adenohypophysectomies (TSAs) surgeries has grown significantly since 1993. While there has been an overall decreasing trend in length of stay (LOS), socioeconomic factors may impact hospitalization. This study explores the impact of socioeconomic factors on LOS and total charges in uncomplicated patients undergoing TSA. Design  Retrospective cohort. Setting  2009 to 2013 Nationwide Inpatient Sample. Participants  Patients undergoing TSA without medical complications...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
John P Marinelli, Jeffrey R Janus, Jamie J Van Gompel, Michael J Link, Eric J Moore, Kathryn M Van Abel, Brandon W Peck, Christine M Lohse, Daniel L Price
Objectives  Neck metastases in patients with esthesioneuroblastoma (ENB) constitute the most significant predictor of poor long-term survival. Recently, researchers discovered the existence of dural lymphatic channels that drain to the cervical lymph nodes. From this physiologic basis, we hypothesized that patients with ENB who develop dural invasion (DI) would exhibit a proclivity for neck metastases. Design  Retrospective review. Setting  Tertiary referral center. Participants  All patients treated for ENB from January 1, 1994 to December 31, 2015...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Neil S Patel, Matthew L Carlson
Objectives  To describe transnasal Eustachian tube (ET) occlusion with a liquid embolic solution for lateral skull base cerebrospinal fluid (CSF) leaks. Design  A lateral skull base CSF fistula model was developed by the authors using fresh cadaveric heads. Using a transtympanic needle, regulated pressurized pigmented saline was continuously instilled into the middle ear space and visualized endoscopically in the nasopharynx. An angioembolization catheter was then placed through the cartilaginous ET orifice just medial to the bony ET...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Christopher S Graffeo, Avital Perry, Aditya Raghunathan, Trynda N Kroneman, Mark Jentoft, Colin L Driscoll, Brian A Neff, Matthew L Carlson, Jeffrey Jacob, Michael J Link, Jamie J Van Gompel
Introduction  Vestibular schwannoma (VS) behavior following subtotal resection (STR) is highly variable. Overall progression rates have been reported as high as 44%, and optimal treatment is controversial. Correspondingly, identification of a reliable clinical or pathologic marker associated with progression after STR would help guide decision-making. Methods  A prospectively maintained institutional VS registry from 1999 to 2014 was retrospectively reviewed for sporadic VS patients who underwent primary STR without preceding stereotactic radiosurgery (SRS) by a single neurosurgery-neurotology team...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Karl Lindberg, Angelica Kouti, Doerthe Ziegelitz, Tobias Hallén, Thomas Skoglund, Dan Farahmand
Background  The assessment of pituitary tumor (PT) volume is important in the treatment and follow-up of patients with PT. Previously, PT volume estimation has been performed by conventional geometric equations (CGE) such as abc/2 (simplified ellipsoid volume equation) and 4πr 3 /3 (sphere), both presuming a symmetric tumor shape, which occurs uncommonly in patients with PT. In contrast, three-dimensional (3D) voxel-based software segmentation takes the irregular and asymmetric shapes that PTs often possess into account and might be a more accurate method for PT volume segmentation...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Nidal Muhanna, Harley Chan, Jimmy Qiu, Michael Daly, Tahsin Khan, Francesco Doglietto, Walter Kucharczyk, David P Goldstein, Jonathan C Irish, John R de Almeida
Objectives/Hypothesis  The endoscopic endonasal approach (EEA) for nasopharyngectomy is an alternative to the maxillary swing approach (MSA) for selected recurrent nasopharyngeal carcinomas (NPC). We compare the access between these approaches. Methods  Three cadaver specimens were used to compare access volumes of the EEA and MSA. Exposure volumes were calculated using image guidance registration to cone beam computed tomography and tracking of accessible tissue with volumetric quantification. The area of exposure to the carotid artery was measured...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
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