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Skull base tumor

Alexandre Bossi Todeschini, Alaa S Montaser, Douglas A Hardesty, Ricardo L Carrau, Daniel M Prevedello
Endoscopic endonasal approaches (EEA) have gained popularity and acceptance in skull base surgery over the last two decades. So-called expanded EEA allow access in the sagittal plane from the frontal sinus to the odontoid process. The endoscopic endonasal transclival approach allows a unique trajectory into the midline clivus and skull base that is unachievable from traditional craniotomy approaches to lesions such as chondrosarcomas, chordomas, and posterior fossa meningiomas. In this review, we will assess the benefits and drawbacks to using an endoscopic endonasal approach versus transcranial approach to these challenging lesions, assess the anatomical limits of endoscopic endonasal transclival surgery, and discuss the published literature on the topic...
March 8, 2018: Journal of Neurosurgical Sciences
Long Wang, Li Cai, Shuaibin Lu, Hai Qian, Michael T Lawton, Xiang'en Shi
Internal maxillary artery (IMA) bypass has gain momentum in the last 5 years for the treatment of complex cerebrovascular disorders and skull base tumors. However, some issues regarding this treatment modality have been proposed. As one of the most experienced neurosurgical team to perform internal maxillary artery bypass in the world (>100 clinical cases), we reviewed literature in aspects of basic anatomy of maxillary artery with its variations to the lateral pterygoid muscle, initial anastomosis modalities and subsequent exposure techniques in cadaver studies, pre-operative arterial evaluation methods, optimal interposed graft selections and surgical outcome in the management of complex aneurysms, skull base tumors and steno-occlusive disorders...
March 7, 2018: World Neurosurgery
Daniele Marchioni, Angelo Musumeci, Cristoforo Fabbris, Stefano De Rossi, Davide Soloperto
BACKGROUND: The clivus is a region characterized by complex anatomy, with vascular and neural structures that are located in close proximity. Different pathologies can affect this area, and traditional surgical approaches were open approaches. Recently, the endoscopic transnasal technique has been introduced, and currently represents a good alternative for the surgical management of these lesions. This is a preliminary report on patients treated endoscopically for clival lesions by the authors' Skull Base Team...
March 8, 2018: European Archives of Oto-rhino-laryngology
Haitham Odat, Khaled Alawneh, Mohannad Al-Qudah
Jugular paragangliomas are slow growing highly vascular tumors arising from jugular paraganglia. The gold standard of treatment is complete surgical resection. Pre-operative embolization of these highly vascular tumors is essential to reduce intra-operative bleeding, allow safe dissection, and decrease operative time and post-operative complications. Onyx (ethylene-vinyl alcohol copolymer) has been widely used as permanent occluding material for vascular tumors of skull base because of its unique physical properties...
March 7, 2018: Journal of Clinical Medicine
Leslee N Matheny, Sudipa Sarkar, Hanyuan Shi, Jiun-Ruey Hu, Hannah Harmsen, Ty W Abel, Shubhada M Jagasia, Shichun Bao
We present a case of a 52-year-old male who developed Cushing's Syndrome due to ectopic adrenocorticotrophic hormone (ACTH) secretion from a large esthesioneuroblastoma (ENB) of the nasal sinuses. The patient initially presented with polyuria, polydipsia, weakness, and confusion. Computed tomography scan of the head and magnetic resonance imaging showed a 7 cm skull base mass centered in the right cribriform plate without sella involvement. Work-up revealed ACTH-dependent hypercortisolemia, which did not suppress appropriately after high-dose dexamethasone...
2018: Case Reports in Endocrinology
Satoshi Fukai, Naoyuki Okabe, Hayato Mine, Hironori Takagi, Hiroyuki Suzuki
BACKGROUND: Garcin syndrome, which consists of unilateral palsies of almost all cranial nerves without either sensory or motor long-tract disturbances or intracranial hypertension, can be caused by malignant tumors at the skull base. The case of a patient with lung cancer that metastasized to the sphenoid bone and resulted in Garcin syndrome is presented. CASE PRESENTATION: A 76-year-old woman was diagnosed as having non-small cell lung cancer with pericardial and diaphragmatic infiltration, cT4N1M0, stage 3A...
March 6, 2018: World Journal of Surgical Oncology
Ramesh Sharanappa Doddamani, Rajesh Kumar Meena, Selvam Murali Mohan, Neelam Krishnan Venkatramanaa
Trigeminal schwannomas (TSs) are extremely rare tumors in childhood, particularly in the absence of neurofibromatosis. Although multi-staged surgical strategies have been reported in the literature, safe and single stage microsurgical removal is possible. We report a rare case of dumbbell TS, in a 9-year-old girl in whom single stage complete removal was done using fronto-temporo-orbito-zygomatic craniotomy and sub temporal approach.
January 2018: Asian Journal of Neurosurgery
Silky Chotai, Yi Liu, Songtao Qi
The lesions involving cavernous sinus (CS) and lateral sellar region includes tumors, vascular lesions, infection, inflammation, and trauma. Tumors associated with CS cause significant distortion of the microanatomy posing an additional surgical challenge to the neurosurgeons. The surgical approach and microsurgical anatomy with respect to the origin and growth of the tumor within the CS region have not been comprehensively described in recent years. We conducted a review of literature concerning CS and associated tumors, complied through MEDLINE/OVID and using cross-references of articles on PubMed with the keywords cavernous sinus, CS tumors, pituitary adenoma, meningioma, schwannoma, chordoma, CS hemangiomas, extradural, interdural, intradural, skull base, gamma knife radiosurgery, endoscopic endonasal approach...
January 2018: Asian Journal of Neurosurgery
T L Yogesh, Akshay Shetty, Hema Keswani, Diljith Rishi
Ewing's sarcoma (ES) is an uncommon malignancy of childhood and adults that constitutes 6%-8% of all primary malignant tumors and the third-most common tumor after osteosarcoma and chondrosarcoma, frequently involves the mandible among jaw bones. This article presents a rare case of ES of maxilla in a 22-year-old male patient showing extensive lesion into skull base which was confirmed with computed tomography, dilemmatic histopathologic features in H and E which is not a frequent presentation. Histopathologic features showed monotonous round cells with hypo- and hyper-cellular areas, intralesional hemorrhage and necrosis with lesional cells positive for CD99...
January 2018: Journal of Oral and Maxillofacial Pathology: JOMFP
Asha Karadwal, Shailja Chatterjee
Chondrosarcoma is a rare malignant cartilaginous tumor of the head and neck region. It is a slow-growing tumor and is mostly detected in the anterior maxilla and the base of the skull. We report a case of "Grade II Chondrosarcoma" of the posterior right side of the palate invading maxillary sinus and perforating the floor of the orbit.
January 2018: Journal of Oral and Maxillofacial Pathology: JOMFP
Marc S Schwartz, Gregory P Lekovic
OBJECTIVE The CO2 laser has been used on an intermittent basis in the microsurgical resection of brain tumors for decades. These lasers were typically cumbersome to use due to the need for a large, bulky design since infrared light cannot be transmitted via fiber-optic cables. Development of the OmniGuide cable, which is hollow and lined with an omnidirectional dielectric mirror, has facilitated the reintroduction of the CO2 laser in surgical use in a number of fields. This device allows for handheld use of the CO2 laser in a much more ergonomically favorable configuration, holding promise for microneurosurgical applications...
March 2018: Neurosurgical Focus
Scott L Zuckerman, Mark H Bilsky, Ilya Laufer
BACKGROUND: Chordomas are rare, primary bone tumors that arise from the axial skeleton. Our objective was to analyze trends in radiation and surgery over time and determine location-based survival predictors for chordomas of the skull base, mobile spine, and sacrum. METHODS: A retrospective cohort study of the Surveillance Epidemiology and End Results (SEER) database from 1973-2013 was conducted. All patients had histologically confirmed chordomas. The principal outcome measure was overall survival (OS)...
February 24, 2018: World Neurosurgery
Angela R Shih, Gregory M Cote, Ivan Chebib, Edwin Choy, Thomas DeLaney, Vikram Deshpande, Francis J Hornicek, Ruoyu Miao, Joseph H Schwab, G Petur Nielsen, Yen-Lin Chen
Chordoma is a rare malignant tumor of bone with high morbidity and mortality. Recently, aggressive pediatric poorly differentiated chordoma with SMARCB1 loss has been described. This study summarizes the clinicopathologic features of poorly differentiated chordoma with SMARCB1 loss in the largest series to date. A search of records between 1990-2017 at MGH identified 19 patients with poorly differentiated chordoma. Immunohistochemical stains were evaluated. Kaplan-Meier survival statistics and log-rank (Mantel Cox) tests compared survival with other subtypes...
February 26, 2018: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
Pengfei Wu, Roberto Colasanti, Jungshun Lee, Alba Scerrati, Serdar Ercan, Jun Zhang, Mario Ammirati
BACKGROUND: Several far lateral approaches have been proposed to deal with cranio-vertebral junction (CVJ) tumors including the basic, transcondylar, and supracondylar far lateral approaches (B-FLA, T-FLA, and S-FLA). However, the indications on when to use one versus the other are not well systematized yet. Our purpose is to evaluate in an experimental cadaveric setting which approach is best suited to remove tumors of different sizes. METHODS: We implanted at the CVJ, using a transoral approach, tumor models of different sizes (five 1-cm3 and five 3-cm3 tumors) in ten embalmed cadaveric heads...
February 26, 2018: Acta Neurochirurgica
Giandomenico Maggiore, Maria Silvia Lazio, Oreste Gallo
Olfactory neuroblastoma is a rare malignant tumor of neuroectodermal origin and represents the most common cancer of the nasal cavity in pediatric age. The gold standard of treatment consists of en bloc resection, numerous studies have shown as the endoscopic approaches permit good control of the disease improving the quality of life after the treatment. Herein we describe the case of a 13-year-old patient referred to our outpatient clinic with a polypoid multi-lobed lesion occupying the left nasal cavity and imaging that confirmed a left-sided nasal mass without cribriform plate involvement (Kadish B)...
February 20, 2018: Auris, Nasus, Larynx
Anasuya Guha, Libor Hart, Helena Polachova, Martin Chovanec, Petr Schalek
BACKGROUND: Ameloblastoma represents the most common epithelial odontogenic tumor. Because of the proximity of the maxillary tumors to the orbit and skull base, it should be managed as radically as possible. Maxillectomy mainly via the transfacial or transoral approach represents the most common type of surgical procedure. Drawback of these approaches is limited control of the superiomedial extent of the tumour in the paranasal area. We report the use of a combined endoscopic endonasal and transoral approach to manage maxillary plexiform ameloblastoma in a 48 year old male patient...
February 20, 2018: Journal of Stomatology, Oral and Maxillofacial Surgery
Matthias Mattke, Kira Vogt, Nina Bougatf, Thomas Welzel, Jan Oelmann-Avendano, Henrik Hauswald, Alexandra Jensen, Malte Ellerbrock, Oliver Jäkel, Thomas Haberer, Klaus Herfarth, Jürgen Debus, Matthias Uhl
BACKGROUND: The current study compares the results of irradiation with protons and irradiation with carbon ions via a raster scan technique in patients with G1 and G2 skull base chondrosarcomas. METHODS: Between 2009 and 2014, a total of 101 patients (40 men and 61 women) with a median age of 44 years (range, 19-77 years) were irradiated with carbon ions (79 patients) or protons (22 patients) via a raster scan technique at the Heidelberg Ion Beam Therapy Center...
February 22, 2018: Cancer
Clarissa Gillmann, Antony J Lomax, Damien C Weber, Oliver Jäkel, Christian P Karger
PURPOSE: To derive the dose-response curve for temporal lobe reactions (TLRs) after proton therapy and to compare the resulting relative biological effectiveness (RBE)-weighted tolerance doses based on an RBE of 1.1 with published values for carbon ions, which were calculated by the two versions of the local effect model (LEM I or IV). METHODS AND MATERIALS: 62 patients treated with protons for skull base tumors were analyzed for TLRs using magnetic resonance imaging...
February 16, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Blake H Priddy, Bradley A Otto, Ricardo L Carrau, Daniel M Prevedello
BACKGROUND: Neoplasms rarely present during pregnancy. However, increase in plasma volume, hormone release induced growth, and tumor hypervascularity, can cause rapid symptoms. These range from not requiring intervention to necessitating emergent operations. OBJECTIVE: We describe an algorithm for the management of symptomatic neoplasm in the obstetric population, and provide recommendations regarding surgical indications and timing. METHODS: Patients who presented to a skull base clinic from 2010-2016 at large tertiary care hospital were reviewed to identify patients who presented with a skull base tumor during pregnancy...
February 14, 2018: World Neurosurgery
Stephen J Johans, Kevin N Swong, Daniel J Burkett, Michael P Wemhoff, Sean M Lew, Chirag R Patel, Anand V Germanwala
Superficial siderosis (SS) of the CNS is a rare and often unrecognized condition. Caused by hemosiderin deposition from chronic, repetitive hemorrhage in the subarachnoid space, it results in parenchymal damage in the subpial layers of the brain and spinal cord. T2-weighted MRI shows the characteristic hypointensity of hemosiderin deposition, classically occurring around the cerebellum, brainstem, and spinal cord. Patients present with progressive gait ataxia and sensorineural hearing impairment. Although there have been several studies, case reports, and review articles over the years, the clear pathophysiology of subarachnoid space hemorrhage remains to be elucidated...
February 16, 2018: Journal of Neurosurgery. Pediatrics
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