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Base of skull surgery

Brittany N Burton, Jenny Q Hu, Aria Jafari, Richard D Urman, Ian F Dunn, W Linda Bi, Adam S DeConde, Rodney A Gabriel
OBJECTIVES: Updated multi-institutional database studies assessing perioperative risk factors on 30-day morbidity and mortality after skull base surgeries are limited. We aim to identify perioperative risk factors and report the incidence of 30-day morbidity and mortality in adult patients after skull base surgery. PATIENTS AND METHODS: We queried the 2007-2016 American College of Surgeons National Surgical Quality Improvement program database to identify patients who underwent anterior, middle, or posterior skull base surgery...
June 10, 2018: Clinical Neurology and Neurosurgery
Desmond A Brown, Nicholas L Deep, Colin L Driscoll, Michael J Link, Mark E Jentoft, David J Daniels
Epstein-Barr virus-associated smooth-muscle tumors are rare tumors seen in immunocompromised patients. Most cases occur in the context of AIDS and organ transplantation, and very rarely in the setting of congenital immunodeficiency, with only 5 case reports of the latter published so far in the literature. The authors report the case of a previously healthy 8-year-old girl with headaches and precocious puberty who was found to have a large skull base lesion. There was a synchronous left adrenal lesion. She underwent resection of the skull base lesion and a left adrenalectomy...
June 15, 2018: Journal of Neurosurgery. Pediatrics
Alessia Corrado, Monica Battle, Sarah K Wise, F Eun-Hyung Lee, David M Guidot, John M DelGaudio, Samuel A Molina, Joshua M Levy
BACKGROUND: The endocannabinoid system represents a highly conserved, innate signaling network with direct and indirect control of eicosanoid-mediated inflammation. Activation of the type 2 cannabinoid receptor (CB2R) leads to decreased type 2 inflammation and reduced production of arachidonic acid (AA). Given that altered AA metabolism is associated with aspirin-exacerbated respiratory disease (AERD), we hypothesized that expression of the CB2R gene CNR2 is increased in AERD. METHODS: Nasal polyps from consecutive patients undergoing endoscopic sinus surgery for AERD or allergic fungal rhinosinusitis (AFRS) were prospectively evaluated...
June 13, 2018: International Forum of Allergy & Rhinology
Yalcin Alimoglu, Adem Topcu
OBJECTIVE: The aim of this study was to investigate the distances between the anterior nasal spine and basal lamella (BL), skull base, nasofrontal beak (NfB), and the anterior wall of sphenoid sinus on computed tomography (CT) images. METHODS: A total of 160 patients who were seen at the otolaryngology clinic of our institution were evaluated with the help of the image processing software of the radiology department. Cases in which bony structures could not be seen clearly because of previous surgery or trauma were excluded...
June 11, 2018: Journal of Craniofacial Surgery
R Jankowski, C Rumeau, D T Nguyen, P Gallet
Nasalisation is a surgical technique proposed for the treatment of nasal polyposis in 1995. The technique as initially described was based on large opening of the maxillary, sphenoidal and frontal ostia and resection of the middle turbinates, with the aim of resecting the mucosa of the lateral masses of the ethmoid as completely and safely as possible. Recent findings on the evolution and development of the nose and sinuses and sinus physiology allow both the concept and the technique of nasalisation to be updated...
June 7, 2018: European Annals of Otorhinolaryngology, Head and Neck Diseases
Moujahed Labidi, Kentaro Watanabe, Shunya Hanakita, Hun Ho Park, Schahrazed Bouazza, Anne-Laure Bernat, Sébastien Froelich
INTRODUCTION: Variations and additions to the endoscopic endonasal exposure have been proposed around a "modular" strategy. These extensions are often necessary to provide additional working space and reduce conflict between the instruments and the endoscope. Resection of endonasal structures, which affects negatively the sinonasal quality of life (QOL), is thus undertaken not only to obtain tumor exposure but also to improve the maneuverability of the instruments. METHODS: Our objective was to achieve the same skull base exposures and tumor resections while limiting the surgical footprint on sinonasal structures and patients' QOL...
June 7, 2018: World Neurosurgery
Marianne Hollensteiner, Michael Malek, Peter Augat, David Fürst, Falk Schrödl, Stefan Hunger, Benjamin Esterer, Stefan Gabauer, Andreas Schrempf
PURPOSE: Surgical skills can be improved through practical exercise. The use of specimens, human as well as animal, or live animals for surgical training is limited due to ethical concerns. Drawbacks of simulators are costs, fidelity and creditibility. Thus, simulators must be evaluated objectively to determine their validity before they can be used as teaching modalities. The aim of this study was to verify the face content and construct validity of a novel model-based simulator for lifting tabula externa transplants from the parietal skull...
May 21, 2018: Journal of Cranio-maxillo-facial Surgery
Chan-Jung Chang, Chuan-Hung Sun, Tzu-Sheng Chen, Hung-Pin Wu
A glomangiopericytoma, or sinonasal type hemangiopericytoma, is a rare lesion which accounts for <0.5% of all sinonasal tumors. The mainstay treatment is wide excision. Instead of traditional open surgical approaches, such as midfacial degloving or lateral rhinotomy, we offer a case of 21-year-old male with diagnosis of glomangiopericytoma with skull base and intraorbital invasion and received navigation-assisted endoscopic excision of a glomangiopericytoma.
April 2018: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
Simone Peraio, Paul Chumas, Paul Nix, Nick Phillips, Atul Tyagi
BACKGROUND: Nowadays the endoscopic endonasal approach is increasingly being used to remove craniopharyngiomas, tuberculum sellae meningiomas and other presellar and parasellar lesions and its value in anterior skull base surgery is undisputed. Herein, we assess the relative advantages, disadvantages and feasibility of the keyhole eyebrow approach and the endonasal endoscopic approach in four cadaveric heads for the removal of presellar and parasellar lesions. METHODS: We used four cadaveric heads for 12 surgical dissections...
June 6, 2018: British Journal of Neurosurgery
Tom Theys, Anais Van Hoylandt, Charlotte-Elise Broeckx, Laura Van Gerven, Joyce Jonkergouw, Marc Quirynen, Johannes van Loon
BACKGROUND: Cerebrospinal fluid (CSF) leakage represents an important and sometimes challenging complication in both cranial and spinal surgery. Current available options for dural closure pose inherent problems regarding safety, efficacy, immunogenicity, cost, and invasiveness. In this article, the use of leukocyte- and platelet-rich fibrin (L-PRF) derived from the patient's own blood is proposed to facilitate dural closure. We aim to describe the safety, feasibility, and applicability of L-PRF membranes and plugs in cranial and spinal neurosurgery...
June 6, 2018: Acta Neurochirurgica
Martina Perwög, Zoltan Bardosi, Georgi Diakov, Olivia Jeleff, Florian Kral, Wolfgang Freysinger
PURPOSE: Computer-aided navigation is widely used in ENT surgery. The position of a surgical instrument is shown in the CT/MR images of the patient and can thus be a good support for the surgeon. The accuracy is highly dependent on the registration done prior to surgery. A microscope and a probe can both be used for registration and navigation, depending on the surgical intervention. A navigation system typically only reports the fiducial registration error after paired-point registration...
June 5, 2018: International Journal of Computer Assisted Radiology and Surgery
Ashish Jung Thapa, Bing-Xi Lei, Mei-Guang Zheng, Zhong-Jun Li, Zheng-Hao Liu, Yue-Fei Deng
Objectives  The objective was to explore further the surgical treatment of posttraumatic skull base defects with cerebrospinal fluid (CSF) leak and to identify the most common factors affecting the surgical treatment of posttraumatic skull base defect with CSF leak retrospectively. Materials and Methods  This study included 144 patients with head trauma having skull base defect with CSF leak who had been surgically treated at Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from 1998 to June 2016...
April 2018: Journal of Neurological Surgery. Part B, Skull Base
Tao Xie, Xiaobiao Zhang, Ye Gu, Chongjing Sun, Tengfei Liu
PURPOSE: Cerebrospinal fluid leakage is always the primary complication during the endoscopic endonasal skull base surgery. Dural suturing technique may supply a rescue method. However, suturing and knotting in such a deep and narrow space are difficult. Training in the model can improve skills and setting a stepwise curriculum can increase trainers' interest and confidence. METHODS: We constructed an easy model using silicone and acrylic as sphenoid sinus and using the egg-shell membrane as skull base dura...
June 1, 2018: European Archives of Oto-rhino-laryngology
Nathan T Zwagerman, Mathew N Geltzeiler, Eric W Wang, Juan C Fernandez-Miranda, Carl H Snyderman, Paul A Gardner
We present a case of cerebrospinal fluid (CSF) leak after endoscopic endonasal resection of a large clival chordoma in an obese patient. The leak was at the lower reconstruction at the craniocervical junction and had failed repositioning. Using the V-Loc™ wound closure device (Covidien, New Haven, Connecticut) to suture the nasoseptal flap to the nasopharyngeal fascia, a water-tight seal was created and, along with a lumbar drain, the patient healed successfully.CSF leak after an endoscopic endonasal approach (EEA) to intradural pathologies remains one of the more common complications...
May 30, 2018: Operative Neurosurgery (Hagerstown, Md.)
Katsunori Shijo, Nobuhiro Moro, Mari Sasano, Mitsuru Watanabe, Hiroshi Yagasaki, Shori Takahashi, Taku Homma, Atsuo Yoshino
BACKGROUND: Sarcoidosis is a multi-organ disease of unknown etiology characterised by the presence of epithelioid granulomas, without caseous necrosis. Systemic sarcoidosis is rare among children, while neurosarcoidosis in children is even rarer whether it is systemic or not. CASE PRESENTATION: We described the case of a 12-year-old boy who presented with monocular vision loss accompanied by unusual MRI features of an extensive meningeal infiltrating mass lesion...
May 29, 2018: BMC Neurology
Alexander Verhaeghe, Stijn De Muynck, Jan W Casselman, Nikolaas Vantomme
BACKGROUND: Pneumocephalus is usually seen in trauma or cranial surgery. It is rarely reported as a delayed complication of ventriculoperitoneal (VP) shunt placement for hydrocephalus secondary to trauma, tumor or aqueduct stenosis. In this paper, we describe a case of intraventricular pneumocephalus (NPH) presenting 10 months after placement of a shunt for normal pressure hydrocephalus. CASE DESCRIPTION: Following the diagnosis of normal pressure hydrocephalus, a pressure-regulated VP shunt was implanted in an 81-year old patient...
May 24, 2018: World Neurosurgery
Shivani D Rangwala, Ben A Strickland, Robert C Rennert, Kristine Ravina, Joshua Bakhsheshian, Kyle Hurth, Steven L Giannotta, Jonathan J Russin
BACKGROUND AND IMPORTANCE: Infectious intracranial aneurysms are a rare subset of intracranial aneurysms caused by bacterial, fungal, or viral sources. Intracranial aneurysms of fungal etiology carry a high mortality risk and typically occur in immunocompromised patients via direct extension of skull base infections, or more rarely, after intracranial surgery. CLINICAL PRESENTATION: We present the case of a 27-yr-old female with systemic lupus erythematous and primary pulmonary mucormycosis, who suffered a subarachnoid hemorrhage from a ruptured fusiform distal middle cerebral artery aneurysm...
May 24, 2018: Operative Neurosurgery (Hagerstown, Md.)
Tsung-Yen Hsieh, Brian Cervenka, Raj Dedhia, Edward Bradley Strong, Toby Steele
Importance: Three-dimensional (3D) printing is an emerging tool in the creation of anatomical models for simulation and preoperative planning. Its use in sinus and skull base surgery has been limited because of difficulty in replicating the details of sinus anatomy. Objective: To describe the development of 3D-printed sinus and skull base models for use in endoscopic skull base surgery. Design, Setting, and Participants: In this single-center study performed from April 1, 2017, through June 1, 2017, a total of 7 otolaryngology residents and 2 attending physicians at a tertiary academic center were recruited to evaluate the procedural anatomical accuracy and haptic feedback of the printed model...
May 17, 2018: JAMA Otolaryngology—Head & Neck Surgery
Paul Nix, Seyed A Alavi, Atul Tyagi, Nick Phillips
INTRODUCTION: Endoscopic anterior skull base surgery is now established practice. For skull base teams to manage complex pathology a variety of good dural repair techniques are required. However repairing certain skull base defects can be challenging. We look to see if a learning curve is associated with different types of CSF leaks in the anterior skull base Methods: Analysis of a prospectively collected database, contain 383 cases, on all endoscopic anterior skull base operations at one UK institution looking at CSF repair...
May 25, 2018: British Journal of Neurosurgery
C L Xu, J P Liang, Q T Lu, S J Zhang
Objective: This paper is intend to observe the feasibility of surgical approach with which communicating neoplasm outside cerebral dura mater and orbital fasciae was removed by transnasal endoscopic surgery. Method: Nine patients suffered from communicating neoplasm in the area of naso-orbital-cranio complex were treated with transnasal endoscopic surgery. The size of skull base bone defect was from 1.25 cm×1.13 cm to 3.25 cm×2.69 cm. No eye enucleation was done. No reconstructions of skull base and medial wall of orbital cavity were done...
August 20, 2017: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
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