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Anterior Skull Base

Daniel H Coelho, Taylor S Pence, Mostafa Abdel-Hamid, Richard M Costanzo
OBJECTIVE: All successful endonasal surgery, including functional endoscopic sinus surgery (FESS), depends on knowledge of both anatomy and the specific variations that can occur between and within patients. Familiarity with these structures is a critical component in preventing complications from these procedures, and failure to understand subtle variation can have disastrous results. The aim of this study was to characterize the anatomical variations (if any) of the cribriform plate using a large cadaveric sample set...
February 13, 2018: Auris, Nasus, Larynx
Neil Majmundar, Naveed Kamal, Renuka Reddy, Jean A Eloy, James K Liu
The endoscopic endonasal transcribriform approach (EETA) has become a useful strategy in the treatment of various anterior skull base pathology, including meningoencephaloceles, olfactory groove meningiomas, schwannomas, esthesioneuroblastomas, and other sinonasal malignancies. However, not all pathologies are optimally treated through this approach due to tumor size, extent of the lesion, vascular involvement, and the presence of intact olfaction. One must be prepared to use a transcranial approach if the EETA is not favorable...
February 13, 2018: Journal of Neurosurgical Sciences
Verena Gellner, Peter V Tomazic
INTRODUCTION: The endoscopic transnasal transsphenoidal transtubercular approach has become a standard alternative approach to neurosurgical transcranial routes for lesions of the anterior skull base in particular pathologies of the anterior tubercle, sphenoid plane, and midline lesions up to the interpeduncular cistern. For both the endoscopic and the transcranial approach indications must strictly be evaluated and tailored to the patients' morphology and condition. The purpose of this review is to evaluate the evidence in literature of the limitations of the endoscopic transtubercular approach...
February 13, 2018: Journal of Neurosurgical Sciences
James K Liu, Zachary S Mendelson, Gurkirat Kohli, Jean Anderson Eloy
BACKGROUND: Reconstruction of large anterior skull base (ASB) defects after an endoscopic endonasal transcribriform approach (EEA-TC) remains a challenge despite the advent of the vascularized pedicled nasoseptal flap (PNSF). OBJECTIVE: We describe a relaxing PNSF slit incision that extends the anterior and posterior reach of the PNSF to maximize tensionless flap coverage of transcribriform ASB defects. METHODS: A retrospective chart review was conducted on 20 consecutive patients who underwent EEA-TC and subsequent PNSF reconstruction with a relaxing slit incision...
February 5, 2018: World Neurosurgery
Nuthan Kumar, Narendra Chaudhary, Anne Jennifer Prabhu, Leena Robinson Vimala, Deepthi Boddu, Leni Grace Mathew
Thymic carcinoma with central nervous system involvement is very rare in children. A 27-month-old girl presented with a unilateral squint, vomiting, and behavioral changes. Imaging studies showed a silent anterior mediastinal mass and a large metastatic mass at the base of the skull. Biopsy of the anterior mediastinal mass confirmed an undifferentiated tumor consistent with thymic carcinoma. The child died within 3 months of the onset of symptoms, due to progression of the disease. These lethal tumors of unknown histogeneses and etiology are aggressive in nature, resistant to therapy, and have a rapidly fatal course...
January 1, 2018: Asian Cardiovascular & Thoracic Annals
Stephen Y Kang, Antoine Eskander, Ralph Abi Hachem, Enver Ozer, Theodoros N Teknos, Matthew O Old, Daniel M Prevedello, Ricardo L Carrau
BACKGROUND: When locoregional flaps fail to reconstruct the skull base, the microvascular surgeon faces several reconstructive challenges. We present our technique and results of salvage anterior skull base reconstruction utilizing the vastus lateralis free tissue transfer (VLFTT). METHODS: Four patients with anterior skull base defects after previous locoregional flap failure underwent free tissue transfer reconstruction with VLFTT. RESULTS: The success rate of free tissue transfer was 100%...
February 6, 2018: Head & Neck
Priyesh N Patel, Asitha D L Jayawardena, Rachel L Walden, Edward B Penn, David O Francis
Objective To identify and clarify current evidence supporting and disputing the effectiveness of perioperative antibiotic use for common otolaryngology procedures. Data Sources PubMed, Embase (OVID), and CINAHL (EBSCO). Review Methods English-language, original research (systematic reviews/meta-analyses, randomized control trials, prospective or retrospective cohort studies, case-control studies, or case series) studies that evaluated the role of perioperative antibiotic use in common otolaryngology surgeries were systematically extracted using standardized search criteria by 2 investigators independently...
January 1, 2018: Otolaryngology—Head and Neck Surgery
V Hellstern, M Aguilar-Pérez, S Schob, P Bhogal, M AlMatter, P Kurucz, A Grimm, H Henkes
Dural arteriovenous fistulas (DAVF) involving the anterior and posterior condylar vein at the skull base are rare but important to recognize. Due to the highly variable anatomy of the venous system of the skull base, detailed anatomical knowledge is essential for correct diagnosis and appropriate treatment of these lesions. In this report we review the normal anatomy of the condylar veins and describe rare and, to our knowledge, not previously reported anatomical variants. We also highlight the treatment modalities for these lesions with focus on the endovascular transvenous occlusion based on four consecutive cases from our center...
February 5, 2018: Clinical Neuroradiology
Mirza Pojskić, Kenan I Arnautović
In this video clip, the authors present the resection of a tuberculum sellae meningioma with compression of the left optic nerve and a chiasm ( Fig. 1 ) through a standard cranial orbital (CO) skull base approach. 1 2 3 The key step in the tumor resection was microsurgical dissection of left and right A1 segments of the anterior cerebral artery and the anterior communicating artery and the separation of the tumor from these vascular structures. This was followed by careful separation of the meningioma from both optic nerves, the chiasm and the pituitary stalk...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
D Locatelli, F Pozzi, G Agresta, S Padovan, A Karligkiotis, P Castelnuovo
Objectives  We illustrate a suprasellar craniopharyngiomas treated with an extended endoscopic endonasal approach (EEEA). Design  Case report of a 43-year-old male affected by cerebral lesion located in suprasellar region involving the third ventricle and compressing the neurovascular structures, causing an anterosuperior dislocation of the chiasma. There is a complete disruption of the pituitary stalk that can explain the clinical finding of partial anterior hypopituitarism and hyperprolactinemia. The lesion is characterized by a solid and cystic component...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Oshri Wasserzug, Ari DeRowe, Barak Ringel, Gadi Fishman, Dan M Fliss
Introduction  Skull base lesions in children and adolescents are rare, and comprise only 5.6% of all skull base surgery. Anterior skull base lesions dominate, averaging slightly more than 50% of the cases. Until recently, surgery of the anterior skull base was dominated by open procedures and endoscopic skull base surgery was reserved for benign pathologies. Endoscopic skull base surgery is gradually gaining popularity. In spite of that, open skull base surgery is still considered the "gold standard" for the treatment of anterior skull base lesions, and it is the preferred approach in selected cases...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Oded Ben-Ari, Anat Wengier, Barak Ringel, Narin N Carmel Neiderman, Zvi Ram, Nevo Margalit, Dan M Fliss, Avraham Abergel
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...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
H C Patricio, A Felippu, C D Pinheiro-Neto, L U Sennes
BACKGROUND: The aims of this study were to analyze the relationships between the medial orbitofrontal artery (MOFA) and the anterior skull base (ASB) including anatomical endonasal landmarks using computed tomography angiography (CTA). METHODS: We studied 52 CTAs using OsiriX software. All CTAs were placed in the same anatomical position. MOFA was identified in the sagittal and coronal plane and its correlation with ASB was analyzed. The distance between the MOFA and landmarks for endonasal surgery were obtained, determining the high risk areas for its injury...
February 3, 2018: Rhinology
Megumi Sasaki, Toshiaki Ishikawa, Shinichi Yamauchi, Fukuichiro Orita, Tomiyuki Miura, Michiyo Tokura, Marie Hanaoka, Akifumi Kikuchi, Megumi Ishiguro, Masamichi Yasuno, Hiroyuki Uetake
In 2009, A 67-year-old woman underwent high anterior resection for rectal cancer(RS, type 2, pT3, pN1, cM0, pStage III a). U FT/LV was administered for 6 months as adjuvant chemotherapy after the operation. Because peritoneum dissemination and pelvic lymph node metastasis developed 9 months after the operation, CapeOX plus Bmab therapy was started, and we monitored the cancer partial response for the next 6 years. Six years and 9 months after the operation, we detected metastasis to the sacrum; thus, radiotherapy was started...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Abraam Yacoub, Lukas Anschuetz, Daniel Schneider, Wilhelm Wimmer, Marco Caversaccio
OBJECTIVE: Expanded endoscopic endonasal approaches to the infratemporal fossa (ITF) are increasingly performed due to the improved visualization and the less morbidity in comparison to the classic open approaches. However, only a few studies in the literature investigated the lateral endoscopic access to the ITF. The purpose of our study is to examine the ITF with the minimal invasive endoscopically assisted Gillies approach with the trial of its expansion through a double port technique...
January 29, 2018: World Neurosurgery
Vural Hamzaoglu, Mustafa Aktekin, Onur Ismi, Hakan Ozalp, Dilan Karşiyaka, Fuat Cem Baskan, Yusuf Vayisoglu, Rabia Bozdogan Arpaci, Filiz Cayan, Can Mehmet Eti, Emine Ecem Cakir, Perihan Gocer, Merve Turkegun, Arzu Kanik, Celal Bagdatoglu, Derya Umit Talas
BACKGROUND: As the skull base has a complex anatomy, we underline the importance of anomalies for side asymmetry. It is useful to investigate relationship between anatomical structures for the surgical procedure orientations. Dural adherence, enlarged superior petrosal sinus, influence of neural crest cells, and cranial base ossification are among the factors in morphometric growth on skull base. MATERIAL AND METHODS: Twenty-five fetuses of an estimated gestational age ranging from 17 to 34 weeks were studied in the Anatomy Laboratory of Mersin University Medical Faculty...
January 19, 2018: Journal of Craniofacial Surgery
Arsheed H Hakeem, Imtiyaz H Hakeem, Abhishek Budharapu, Fozia Jeelani Wani
Although lipoma is frequently seen in the head and neck region, but occurrence of the lipoma in the parapharyngeal space is rare. It is extremely rare for a parapharyngeal lipoma to extent to the pterygoid region (ie, anterior skull base). Management of giant parapharyngeal space lipoma with skull base extension and proximity to the vital neurovascular structures poses a challenge to surgeon. The authors report a patient with giant lipoma extending from the upper border of the clavicle to the pterygoid region...
January 19, 2018: Journal of Craniofacial Surgery
Rodrigo Mologni Gonçalves Dos Santos, José Mario De Martino, Francisco Haiter Neto, Luis Augusto Passeri
This article introduces a method that extends the McNamara cephalometric analysis to produce 3-dimensional (3D) measurement values from cone-beam computed tomography images. In the extended method, the cephalometric landmarks are represented by 3D points; the bilateral cephalometric landmarks are identified on both sides of the skull; the cephalometric lines, with the exception of the facial axis, are represented by 3D lines; the cephalometric planes, with the exception of the facial plane, are represented by planes; the effective mandibular length, the effective midfacial length, and the lower anterior facial height are measured as 3D point-to-point distances; the nasion perpendicular to point A, the pogonion to nasion perpendicular, the upper incisor to point A vertical, and the lower incisor to point A-pogonion line are measured each as components of a vector; the facial axis angle is measured as a line-to-plane angle; and the mandibular plane angle is measured as a plane-to-plane angle...
January 19, 2018: Journal of Craniofacial Surgery
Hamid Borghei-Razavi, Huy Q Truong, David T Fernandes-Cabral, Emrah Celtikci, Joseph D Chabot, S Tonya Stefko, Eric W Wang, Carl H Snyderman, Aaron Cohen-Gadol, Paul A Gardner, Juan C Fernández-Miranda
BACKGROUND: Minimally invasive accesses to the anterior skull base include endoscopic endonasal approach (EEA) and supraorbital eyebrow approach. The two are often seen as competing and not alternative or combinatory approaches. In this study, we evaluated the anatomical limitations of each approach and the combined approach for accessing the anterior skull base. METHODS: Ten neurovascular injected cadaver heads were used for the study. Supraorbital approach to the anterior skull base was performed on five heads, and EEA was done on the other five...
January 25, 2018: World Neurosurgery
Kaisorn L Chaichana, Tito Vivas-Buitrago, Christina Jackson, Jeffrey Ehresman, Alessandro Olivi, Chetan Bettegowda, Alfredo Quinones-Hinojosa
OBJECTIVE: There is a growing trend towards skull base (SB) approaches and retractorless surgery to minimize brain manipulation during surgery. We evaluated the radiographic changes over time after surgical resection of anterior cranial fossa meningiomas with and without both SB approaches and/or fixed retractor systems. METHODS: All adults undergoing primary resection of an anterior cranial fossa WHO grade I meningioma through a craniotomy at a single academic tertiary-care institution from 2010-2015 were retrospectively reviewed...
January 20, 2018: World Neurosurgery
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