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Gerlach R, Modesti CL, Rampinelli V. Interdisciplinary Management of Skull Base Tumors. Laryngorhinootologie 2024; 103:S28-S42. [PMID: 38697142 DOI: 10.1055/a-2196-8984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
OBJECTIVE Endoscopic endonasal skull base surgery has gained acceptance worldwide. Comparative analysis has demonstrated that endoscopic skull base surgery may have advantages for many pathologies of the anterior skull base, e. g., sinonasal malignant tumors; pathologies of the central skull base, e. g., pituitary adenomas, craniopharyngiomas; well-selected cases of planum sphenoidale and tuberculum sellae meningiomas; or for clival lesions, e. g., chordomas, chondrosarcomas, or selected meningiomas. Over the past three decades, interdisciplinary surgical teams, consisting of otolaryngologists and neurosurgeons, have provided detailed anatomical knowledge, suggested new approaches or modifications of established surgical techniques, and offered continued surgical education. METHOD A review of pertinent literature was conducted with an emphasis on interdisciplinary endoscopic surgery of skull base lesions. RESULTS Based on the authors̓ surgical experience in two different interdisciplinary endoscopic skull base centers, the authors classify approaches for endoscopic endonasal skull base surgery, describe indications, and key anatomic landmarks for common pathologies, and highlight surgical techniques to avoid complications. CONCLUSION Interdisciplinary endonasal endoscopic surgery combines surgical expertise, improves resection rates for many pathologies, and minimizes morbidity by reducing the incidence of surgical complications.
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Affiliation(s)
| | - Claudia Lodovica Modesti
- Unit of Otolaryngology and Head and Surgery, ASST Spedali Civili di Brescia, University of Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otolaryngology and Head and Surgery, ASST Spedali Civili di Brescia, University of Brescia, Italy
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Sfeir M, Romanos B. Non-serous cyst of the Eustachian tube: A case report, pathology and management. OTOLARYNGOLOGY CASE REPORTS 2023. [DOI: 10.1016/j.xocr.2023.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Yu S, Karsy M, Prashant GN, Barton B, Rosen MR, Parkes W, Evans JJ. Minimally invasive endoscopic approaches to pediatric skull base pathologies. Int J Pediatr Otorhinolaryngol 2022; 162:111332. [PMID: 36206699 DOI: 10.1016/j.ijporl.2022.111332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/21/2022] [Accepted: 09/28/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Endoscopic endonasal approaches to pediatric skull base lesions are rare, challenging, and present distinct considerations from adult pathology. In this study, we describe our endoscopic technical approach to various skull base lesions demonstrating the efficacy and nuances of these approaches in pediatric patients. METHODS Pediatric patients underwent endoscopic approach for skull base lesions from January of 2015 to April of 2021 were included in the study. Presenting symptoms, indications for surgery, surgical outcomes, intraoperative and postoperative complications, length of hospital stay, and length of follow-up were documented. RESULTS A total of 18 patients (median age 12, age-range 1-15, 53% male) underwent 19 endoscopic transsphenoidal procedures. The pathologies included craniopharyngioma (N = 5), biopsy for an unknown disease (n = 2; orbital meningioma and pituitary lymphocytic hypophysitis), pituitary adenoma (N = 2; ACTH-secreting and non-functional), Rathke's cleft cyst (n = 2), CSF leak repairs (n = 2; post-traumatic and spontaneous meningocele), juvenile nasopharyngeal angiofibroma (n = 3, 1 patient had 2 procedures) and rhabdomyosarcoma (n = 1). GTR was achieved in 11 out of 15 procedures (73.3%). Out of 10 patients with a sellar lesion, 6 patients had intraoperative CSF leak (60%). No patients experienced post-operative CSF leak. The median follow-up for all patients was 14 months (1-36 months). CONCLUSION Anterior and middle skull base pathology in pediatric patients can be effectively operated via an endoscopic approach across a wide variety of patient ages and conditions. Minimally invasive techniques with middle turbinate and nasal septum preservation can be achieved without compromising outcomes. A wide variety of surgical repair strategies can be successfully utilized.
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Affiliation(s)
- Siyuan Yu
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Michael Karsy
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Giyapuram N Prashant
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Blair Barton
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Marc R Rosen
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA; Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - William Parkes
- Division of Otolaryngology, Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - James J Evans
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA; Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Mohd Zulkefli NA, Abdullah A, Hashim ND, Nasseri Z, Kew TY. Mastoid Abscess in a Child With Eustachian Tube Dermoid Cyst. Cureus 2021; 13:e15326. [PMID: 34221773 PMCID: PMC8239477 DOI: 10.7759/cureus.15326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A dermoid cyst (DC) is a benign tumor caused by inclusion errors during embryogenesis. DC of the head and neck is a well-recognized entity both clinically and histologically; however, it rarely occurs in the Eustachian tube (ET). Due to its anatomical position, significant morbidity related to middle ear dysfunction may result from ET obstruction. In this report, we present a rare case of a girl child aged two years and nine months with persistent otorrhea, who was initially diagnosed with acute otitis media with mastoiditis, along with suspicion of congenital cholesteatoma. However, high-resolution CT (HRCT) temporal and MRI of the neck revealed a DC of the ET causing left chronic otitis media (COM) with mastoid abscess. The patient underwent mastoid exploration surgery and myringotomy with grommet insertion. Although complete excision is the standard treatment modality for DC, the treatment of poorly ventilated mastoid and middle ear takes precedence over it. MRI surveillance scan is recommended in such cases.
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Affiliation(s)
| | - Asma Abdullah
- Otorhinolarygology/Otology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Noor Dina Hashim
- Otorhinolarygology/Otology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Zara Nasseri
- Otorhinolarygology/Otology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Thean Yean Kew
- Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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Chen S, Huang Y, Li Y. A case series of dermoids in the middle ear. Int J Pediatr Otorhinolaryngol 2021; 140:110472. [PMID: 33221033 DOI: 10.1016/j.ijporl.2020.110472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/25/2020] [Accepted: 10/25/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Dermoid is a rare disease located in the head and neck and only sporadic cases were previously reported. Surgery with different operational paths is the best solution to the disease. We aimed to analyze the clinical characteristics and outcomes of surgical approach for treating dermoid originated from the middle ear and Eustachian tube. METHODS In this retrospective case series, four cases of dermoids of the middle ear and Eustachian tube, treated by endoscopic-assisted surgical approach were reviewed and analyzed. RESULTS Patients' ages ranged from 7 months to 16 years. All cases involved the middle ear, eustachian tube, and the parapharyngeal space. Postoperative follow-up ranged from 6 months to 11 years. No facial nerve paralysis was observed during or after surgeries. Treatment was efficient in the four cases, with no residual symptoms during post-operative follow-up. CONCLUSIONS Dermoid of the middle ear involving the eustachian tube usually appears in children of early age. Surgical resection with assistance of endoscope has satisfying outcome for these cases.
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Affiliation(s)
- Shubin Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China.
| | - Yanran Huang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
| | - Yongxin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
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Bell R, Marston AP, Discolo CM. Eustachian Tube Rhabdomyomatous Mesenchymal Hamartoma in a Pediatric Patient. JAMA Otolaryngol Head Neck Surg 2020; 146:968-970. [DOI: 10.1001/jamaoto.2020.1801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kobets A, Ammar A, Dowling K, Cohen A, Goodrich J. The limits of endoscopic endonasal approaches in young children: a review. Childs Nerv Syst 2020; 36:263-271. [PMID: 31845030 DOI: 10.1007/s00381-019-04455-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/27/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The endoscopic endonasal approach (EEA) provides visualization of four deep surgical corridors (transcribiform, transtubercular, transsellar, and transclival) with superior illumination and specialized deep-reaching instruments, as compared to microscopic techniques. Several studies have evaluated EEAs in children but do not stratify for the very young of age, whose particularly small nares and developmental anatomy may limit endonasal instrumentation. METHODOLOGY A comprehensive review of EEAs in infants and children to age 4 was performed to determine the limitations in this age group. RESULTS Eighteen studies were identified describing this approach for pediatric patients and the surgical caveats and limitations were reviewed. In very small children, CSF leaks, meningioencephaloceles, tumors of the anterior skull base, and lesions at the rostral cervical spine have been successfully treated endonasally. While newer studies advocate using 2.7-mm diameter (18-cm length) lenses, 4-mm diameter rigid lenses have been used without technical difficulty. The youngest patient in whom an EEA was used was a 6-week-old for a dermoid resection. Some have advocated that due to the small nares, approaches via bilateral entry are optimal for multiple instruments, however, others, including authors of a series of 28 repaired CSF leaks demonstrate successful single nare access. DISCUSSION EEAs are associated with less blood loss, are less likely to hinder normal growth of the skull and midface, and allow for the resection of even malignant lesions. Despite the limitations of the frontal, ethmoid, and sphenoid sinuses before age 3, reports have not documented insurmountable difficulty with EEAs even in infants. 2.7-mm diameter endoscopes are favored unilaterally or bilaterally to treat both benign and malignant lesions and preserve the young patient's facial anatomy better than older methods. Ever improving technology has facilitated the use of this approach in patients it would otherwise be infeasible for in the past, but it still cannot overcome the anatomical constraints of certain young patients in which this approach remains unindicated. Patient selection is therefore of utmost importance and the risks and benefits of more extensive approaches in these cases must be considered.
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Affiliation(s)
- Andrew Kobets
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe St, 5th Floor, Baltimore, MD, 21287, USA.
| | - Adam Ammar
- Leo Davidoff Department of Neurological Surgery, Division of Pediatric Neurosurgery, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave, The Bronx, NY, 10467, USA
| | - Kamilah Dowling
- Leo Davidoff Department of Neurological Surgery, Division of Pediatric Neurosurgery, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave, The Bronx, NY, 10467, USA
| | - Alan Cohen
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe St, 5th Floor, Baltimore, MD, 21287, USA
| | - James Goodrich
- Leo Davidoff Department of Neurological Surgery, Division of Pediatric Neurosurgery, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Ave, The Bronx, NY, 10467, USA
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Campbell BR, Yawn RJ, O'Connell BP, Rivas A. Dermoid tumor of the middle ear: A case report and review of the literature. OTOLARYNGOLOGY CASE REPORTS 2017. [DOI: 10.1016/j.xocr.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wu J, Schulte J, Yang C, Baroody F, Ginat DT. Hairy Polyp of the Nasopharynx Arising from the Eustachian Tube. Head Neck Pathol 2015; 10:213-6. [PMID: 25939422 PMCID: PMC4838952 DOI: 10.1007/s12105-015-0632-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/29/2015] [Indexed: 11/26/2022]
Abstract
Hairy polyps of the nasopharynx display characteristic radiological imaging findings, including the presence of fat in the polypoid mass. Furthermore, diagnostic imaging is useful for delineating the site of origin of these lesions, which can facilitate surgical planning. For instance hairy polyps that arise from the right Eustachian tube can be amputated via a trans-nasal approach with endoscopy, but may necessitate a two stage approach in order to avoid injury to critical structures, such as the internal carotid artery. On histology, hairy polyps comprise an outer keratinizing squamous epithelium with adnexal tissue, including hair follicles, and central fibroadipose and cartilaginous tissue. These features are exemplified in this sine qua non radiology-pathology correlation article.
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Affiliation(s)
- Judy Wu
- Department of Radiology, Pritzker School of Medicine, University of Chicago, 5841 S Maryland Avenue, Chicago, IL, 60637, USA
| | - Jefree Schulte
- Department of Pathology, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Carina Yang
- Department of Radiology, Pritzker School of Medicine, University of Chicago, 5841 S Maryland Avenue, Chicago, IL, 60637, USA
| | - Fuad Baroody
- Departments of Surgery, Section of Otolaryngology-Head and Neck Surgery, and Pediatrics, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Daniel Thomas Ginat
- Department of Radiology, Pritzker School of Medicine, University of Chicago, 5841 S Maryland Avenue, Chicago, IL, 60637, USA.
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