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Skullbase surgery

Vinayak Narayan, Shyamal C Bir, Nasser Mohammed, Amey R Savardekar, Devi Prasad Patra, Anil Nanda
BACKGROUND: The giant intracranial meningioma (GIM) constitutes a different spectrum of brain tumors that invade the vital neurovascular structures, which makes the primary mode of treatment, surgery, a technically challenging one. The surgery for GIM is unique because of the large size of the tumor, prominent vascularity, entangling and limited visualization of various neurovascular structures, and severe cerebral edema. This study reports the authors surgical experience of 80 GIM cases, the operative challenges and surgical outcome...
February 2018: World Neurosurgery
Mazda K Turel, Christopher J Chin, Allan D Vescan, Fred Gentili
Chronic rhinosinusitis (CRS) is a common health problem in the Western world. CRS is classified as CRS with (CRSwNP) and without (CRSsNP) nasal polyps. A less common third type is allergic fungal sinusitis, which often presents with polyps and, not infrequently, skull base erosion. Most patients are successfully managed with maximal medical therapy or endoscopic approaches. There are currently no reports of CRSwNPs resulting in fibro-osseous thickening and proptosis in the English literature. As such, the authors report a case of a 33-year-old man who underwent a craniofacial resection with drilling of the hyperostosed bone, which led to resolution of the proptosis and nasal symptoms...
June 2016: Journal of Craniofacial Surgery
Tristan Klosterman, Sherard Tatum
The authors present a patient of a neonate with a skull base extragonadal germ cell tumor requiring a modified facial translocation approach for resection. A 1-week-old female presented with right proptosis, eyelid edema, and nasal obstruction. Imaging revealed a 3-cm right-sided skull base mass involving the right maxillary, ethmoid, sphenoid sinuses, orbit, infratemporal fossa, and cavernous sinus via skull base erosion. The lesion was refractory to chemotherapy and required surgical excision. A modified facial translocation approach with preservation of anterior maxillary bone vascularization was used to remove the tumor, which was found to be teratoma with yolk-sac features...
May 2016: Journal of Craniofacial Surgery
Ramandeep Singh, Britty Baby, Natesan Damodaran, Vinkle Srivastav, Ashish Suri, Subhashis Banerjee, Subodh Kumar, Prem Kalra, Sanjiva Prasad, Kolin Paul, Sneh Anand, Sanjeev Kumar, Varun Dhiman, David Ben-Israel, Kulwant Singh Kapoor
BACKGROUND: Box trainers are ideal simulators, given they are inexpensive, accessible, and use appropriate fidelity. OBJECTIVE: The development and validation of an open-source, partial task simulator that teaches the fundamental skills necessary for endonasal skull-base neuro-endoscopic surgery. METHODS: We defined the Neuro-Endo-Trainer (NET) SkullBase-Task-GraspPickPlace with an activity area by analyzing the computed tomography scans of 15 adult patients with sellar suprasellar parasellar tumors...
February 2016: World Neurosurgery
M Májovský, D Netuka, V Masopust, V Beneš
INTRODUCTION: Clivus is a central structure of the skull base located in the vicinity of the brainstem and vital brain vessels. Clival fractures are usually caused by a high-energy trauma. Cerebrospinal fluid leak is one of the most common complications. CASE REPORT: A middle-aged male sustained a mild head trauma, followed by a nasal cerebrospinal fluid leak. CT scan revealed the massive pneumocephalus and the fracture of the clivus in the posterior wall of the sphenoidal sinus...
July 2015: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Henry W S Schroeder
OBJECTIVE: To describe the decision-making and the surgical strategy in the resection of anterior skullbase meningiomas. METHODS: Details of the microsurgical and endoscopic approach to anterior skullbase meningiomas are presented. RESULTS: Small and midsize olfactory groove, planum sphenoidale, and tuberculum sellae meningiomas can be removed via an endonasal endoscopic approach, an alternative option to the transcranial microsurgical approach...
December 2014: World Neurosurgery
Abdul Rahman Al-Shudifat, Babar Kahlon, Peter Höglund, Ahmed Y Soliman, Kristoffer Lindskog, Peter Siesjo
AIMS: The aim of the present study was to identify predictive factors for outcome after surgery of vestibular schwannomas. DESIGN: This is a retrospective study with partially collected prospective data of patients who were surgically treated for vestibular schwannomas at a single institution from 1979 to 2000. Patients with recurrent tumours, NF2 and those incapable of answering questionnaires were excluded from the study. The short form 36 (SF36) questionnaire and a specific questionnaire regarding neurological status, work status and independent life (IL) status were sent to all eligible patients...
January 2014: Journal of Neurology, Neurosurgery, and Psychiatry
S A R Nouraei, A Hudovsky, J S Virk, P Chatrath, G S Sandhu
OBJECTIVES: To audit the accuracy of clinical coding in otolaryngology, assess the effectiveness of previously implemented interventions, and determine ways in which it can be further improved. DESIGN: Prospective clinician-auditor multidisciplinary audit of clinical coding accuracy. PARTICIPANTS: Elective and emergency ENT admissions and day-case activity. MAIN OUTCOME MEASURES: Concordance between initial coding and the clinician-auditor multi-disciplinary teams (MDT) coding in respect of primary and secondary diagnoses and procedures, health resource groupings health resource groupings (HRGs) and tariffs...
December 2013: Clinical Otolaryngology
Scharukh Jalisi, Brian O'Gara, Gentian Toshkezi, Lawrence Chin
OBJECTIVE: The purpose of this study was to describe the effectiveness of local vascularized flaps for the repair of various skull base defects. METHODS: We analyzed a cohort of 138 patients undergoing skull base surgery in a retrospective review of all head and neck surgical oncology cases done at a major tertiary care center between 2005 and 2008. RESULTS: Eighteen patients met our inclusion criteria, requiring local vascularized flap or free graft reconstruction...
January 2015: World Neurosurgery
Christopher R Grindle, Joseph M Curry, Melissa D Kang, James J Evans, Marc R Rosen
OBJECTIVE: Despite the increasing utilization of image-guided surgery, no radiology protocols for obtaining magnetic resonance (MR) imaging of adequate quality are available in the current literature. At our institution, more than 300 endonasal cranial base procedures including pituitary, extended pituitary, and other anterior skullbase procedures have been performed in the past 3 years. To facilitate and optimize preoperative evaluation and assessment, there was a need to develop a magnetic resonance protocol...
November 2011: American Journal of Otolaryngology
Takeshi Okuda, Masahiko Kitano, Mamoru Taneda
A transcranial approach is frequently employed for the closure of cerebrospinal fluid (CSF) rhinorrhea, occurring after skullbase surgery or associated with anterior skull base fracture. However, the site of CSF rhinorrhea is usually most distant from the site of craniotomy and, because securing of an adequate operative field is difficult, elimination of this type of CSF rhinorrhea tends to be insufficient. We have attempted to reconstruct the anatomical structures with an extended transsphenoidal approach for a case with CSF rhinorrhea from the planum sphenoidale, and have succeeded in achieving a more physiological and reliable elimination of CSF rhinorrhea...
November 2006: No Shinkei Geka. Neurological Surgery
Franco DeMonte
Malignancy involving the skull base remains a formidable management challenge. Advances and refinements in diagnostic imaging, instrumentation, microvascular reconstruction, and an improved overall appreciation of the anatomy of the skullbase have extended the boundaries of tumor resectability and in some cases, obviated the need for adjuvant therapies. Successful management of high-grade malignancy however, requires a carefully constructed multi-modal treatment plan to maximize patient outcome. Over the course of an 11-year period, 259 patients with skullbase malignancies were treated by the author in the setting of a tertiary care comprehensive cancer center...
August 2004: Journal of Neuro-oncology
P Yugueros, S J Finical, C H Johnson
The purpose of this study was to validate the use of free flaps in reconstruction of skullbase defects after extensive resection of advanced tumors, and to justify microvascular reconstruction to improve the quality of life and survival in this population. The treatment outcome after ablative resection of skullbase tumors with free flap reconstruction over a 7-year period (1988 to 1995) was studied. Complete removal of the tumor was originally attempted in all patients. All cases had immediate reconstruction...
January 2000: Journal of Reconstructive Microsurgery
F S De Ponte, D J Bottini, P P Sassano, G Iannetti
In the framework of malformations that concerns the craniofacial area, the orbit is often involved because it represents the border structure between the neurocranium and the splanchnocranium. In these malformations it is very easy to find hypertelorism. Tessier classified clefts rising from the anterior skullbase and involving the maxilla and the alveolar process, as medial or 0 = 14 clefts. We report on a 2-year-old patient, treated with cranial decompression at an early age, suffering from this kind of malformation...
July 1997: Journal of Craniofacial Surgery
A Mäkitie, K Aitasalo, J Pukander, J Virtaniemi, K Hyrynkangas, E Suominen, J Vuola, R Kontio, M Markkanen-Leppänen, H Lehtonen, S Asko-Seljavaara, R Grénman
Microvascular free tissue transfer has in many cases replaced classic flap techniques and is now an established workhorse for head and neck reconstructions. In this retrospective study the over 300 patients, who had microvascular free flap reconstructions in head and neck cancer surgery in Finland during a 10-year period (1986-1995) were reviewed. The operations were performed in the University Hospitals by plastic surgeons, ENT specialists or maxillofacial surgeons. The cases consisted of defects resulting from resection of oral cavity tumors (63%), mid- or upper-face and skullbase tumors (20%) and hypopharyngo-esophageal tumors (17%)...
1997: Acta Oto-laryngologica. Supplementum
M K Schwaber, J L Netterville, R Maciunas
Knowledge of the microsurgical anatomy of the lower skullbase is needed in order to resect tumors involving this region. We have dissected 10 formalin-preserved skullbase specimens and identified the structures that would be encountered during the course of surgery using the lateral approach. A morphometric analysis was performed on the jugular foramen, the hypoglossal canal, the condylar emissary vein, and the foramen magnum. By identifying the relationships of the lower skull base, we hope to minimize the morbidity associated with removing lesions in the region...
November 1990: American Journal of Otology
M Tokitsu, M Nakamura, H Yokoyama, H Watanabe, M Hara, K Takeuchi
Two cases of skullbase-penetrating injuries caused by umbrella tips are reported. Case 1: 24-year-old male. Admitted with disturbance of consciousness, left hemiparesis, nasal bleeding, and laceration of left lower eyelid because of having been stabbed by an umbrella tip. Pupils and fundi revealed no definite findings. Plain skull X-ray showed turbid ethmoid sinus and fracture of planum sphenoidale. Cranial CT showed right putaminal hematoma with intraventricular hemorrhage and pneumocephalus. Increased ICP necessitated surgery two days after the injury...
February 1990: No Shinkei Geka. Neurological Surgery
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