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Méndez Rosito D, Borrayo-Dorado S, Zorrilla-Madera E, Sánchez-Gallardo JF, Gallardo-Ceja D, Ríos FJ, Cárdenas Y, Palmisciano P, Forbes JA, Abdala-Vargas NJ. The M-Point A Novel Landmark in Middle Fossa Surgery: A Cadaveric Morphometric Study. World Neurosurg 2024; 181:e67-e74. [PMID: 37385439 DOI: 10.1016/j.wneu.2023.06.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The arcuate eminence (AE) is an anatomically consistent bony protrusion located on the upper surface of the petrous bone that has been previously studied as a reference for lateral skull base approaches. There is a paucity of information in the neurosurgical literature seeking to improve the safety of the extended middle cranial fossa (MCF) approach using detailed morphometric analysis of the AE. OBJECTIVE To evaluate the use of the AE as an anatomical landmark to help with early identification of the internal acoustic canal (IAC) in MCF approaches by means of a cadaveric study, using a new morphometric reference termed the "M-point." METHODS A total of 40 dry temporal bones and 2 formalin-preserved, latex-injected cadaveric heads were used. The M-point was established as a new anatomic reference by identifying the intersection of a line perpendicular to the alignment of the petrous ridge (PR), originating from the midpoint of the AE, with the PR itself. Subsequent anatomical measurements were performed to measure the distance between M-point and IAC. Additional distances, including PR length and the anteroposterior and lateral AE surfaces, were also measured. RESULTS The mean distance between the M-point and the center of the IAC was 14.9 mm (SD ± 2.09), offering a safe drilling area during an MCF approach. CONCLUSIONS This study provides novel information on identification of a new anatomic reference point known as the M-point that that can be used to improve early surgical identification of the IAC.
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Affiliation(s)
- Diego Méndez Rosito
- Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico.
| | - Sheila Borrayo-Dorado
- Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - Elias Zorrilla-Madera
- Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | | | - David Gallardo-Ceja
- Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - Francisco J Ríos
- Department of Anatomy, Escuela Superior de Medicina, IPN, Mexico City, Mexico
| | - Yolanda Cárdenas
- Department of Anatomy, Escuela Superior de Medicina, IPN, Mexico City, Mexico
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan A Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nadin J Abdala-Vargas
- Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia
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2
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Peng Z, Wang Y, Wang Y, Li Q, Fang Y, Fan R, Zhang H, Jiang W. Hemangiopericytoma/solitary fibrous tumor of the cranial base: a case series and literature review. BMC Surg 2022; 22:289. [PMID: 35897071 PMCID: PMC9327149 DOI: 10.1186/s12893-022-01718-5] [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] [Received: 12/21/2021] [Accepted: 07/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background Hemangiopericytomas (HPCs) are uncommon soft tissue tumors. HPCs that grow in the cranial base are rare. Therefore, skull-base surgeons tend to overlook this disease. This study aimed to increase the awareness of HPCs by summarizing case data from our institution and related publications. We also aimed to contribute to the number of reported cases for future systematic reviews of HPCs. Methods This study included all patients who underwent surgery for HPC/solitary fibrous tumor (SFT) between August 2015 and August 2019. All surgeries were performed at Xiangya Hospital Central South University. We analyzed clinical characteristics, surgical highlights, treatment modalities, and outcomes. Results We included six patients, aged 32–64 years. Lesions were located in the parapharyngeal space in three patients, pterygopalatine fossa in two, and saddle area in one. All patients underwent nasal endoscopic endonasal surgery. In five patients, tumors involved the internal carotid artery (ICA). The exposure and protection of the ICA during surgery are challenging but critical to complete tumor removal. The 3-year overall survival(OS) rate was 66.7%. Conclusions HPC/SFTs are rare tumors of the cranial base that are prone to recurrence. Cranial base HPC/SFTs are often closely associated with the ICA. To our knowledge, this case series reports the largest number of cases of HPCs associated with the ICA. We believe that there is a strong relationship between patient prognosis and whether the tumor encircles the ICA and whether the tumor is completely resected. To confirm this suggestion, more cases are needed for further analysis. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01718-5.
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Affiliation(s)
- Zhouying Peng
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yumin Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yaxuan Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Qinxuan Li
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yan Fang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Ruohao Fan
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Hua Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Weihong Jiang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. .,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, 410008, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. .,Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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3
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Corniola MV, Roche PH, Bruneau M, Cavallo LM, Daniel RT, Messerer M, Froelich S, Gardner PA, Gentili F, Kawase T, Paraskevopoulos D, Régis J, Schroeder HW, Schwartz TH, Sindou M, Cornelius JF, Tatagiba M, Meling TR. Management of cavernous sinus meningiomas: Consensus statement on behalf of the EANS skull base section. BRAIN AND SPINE 2022; 2:100864. [PMID: 36248124 PMCID: PMC9560706 DOI: 10.1016/j.bas.2022.100864] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/08/2022] [Accepted: 01/16/2022] [Indexed: 01/04/2023]
Abstract
Introduction The evolution of cavernous sinus meningiomas (CSMs) might be unpredictable and the efficacy of their treatments is challenging due to their indolent evolution, variations and fluctuations of symptoms, heterogeneity of classifications and lack of randomized controlled trials. Here, a dedicated task force provides a consensus statement on the overall management of CSMs. Research question To determine the best overall management of CSMs, depending on their clinical presentation, size, and evolution as well as patient characteristics. Material and methods Using the PRISMA 2020 guidelines, we included literature from January 2000 to December 2020. A total of 400 abstracts and 77 titles were kept for full-paper screening. Results The task force formulated 8 recommendations (Level C evidence). CSMs should be managed by a highly specialized multidisciplinary team. The initial evaluation of patients includes clinical, ophthalmological, endocrinological and radiological assessment. Treatment of CSM should involve experienced skull-base neurosurgeons or neuro-radiosurgeons, radiation oncologists, radiologists, ophthalmologists, and endocrinologists. Discussion and conclusion Radiosurgery is preferred as first-line treatment in small, enclosed, pauci-symptomatic lesions/in elderly patients, while large CSMs not amenable to resection or WHO grade II-III are candidates for radiotherapy. Microsurgery is an option in aggressive/rapidly progressing lesions in young patients presenting with oculomotor/visual/endocrinological impairment. Whenever surgery is offered, open cranial approaches are the current standard. There is limited experience reported about endoscopic endonasal approach for CSMs and the main indication is decompression of the cavernous sinus to improve symptoms. Whenever surgery is indicated, the current trend is to offer decompression followed by radiosurgery. A thorough evaluation of cavernous sinus meningiomas by a multidisciplinary team is mandatory. Microsurgery should be considered for aggressive lesions in young patients. Extended endoscopic approaches can be effective when combined with radiotherapy. Stereotaxic radiotherapy and stereotaxic radiosurgery offer excellent tumour control in small/asymptomatic lesions .
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Kim JG, Lee DH, Kim YI, Kim IS, Sung JH, Yang SH. Modified Orbitozygomatic Approach for Resecting a Parasellar Tumor in a Single Institution. Brain Tumor Res Treat 2021; 9:58-62. [PMID: 34725985 PMCID: PMC8561225 DOI: 10.14791/btrt.2021.9.e24] [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] [Received: 05/10/2021] [Revised: 07/16/2021] [Accepted: 09/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background Modified orbitozygomatic craniotomy is characterized by simplicity and wide exposure. The purpose of the present study was to describe a modified orbitozygomatic approach without resecting the zygomatic arch for large parasellar tumor surgeries. Methods Between April 2016 and December 2019, seven patients with parasellar tumor underwent surgiest with a modified orbitozygomatic approach. Surgical procedures, clinical outcomes, and complications were analyzed. Results This study included 3 meningiomas, 2 pituitary adenomas, 1 chondrosarcoma, and 1 schwannoma. Modified orbitozygomatic craniotomy provides a wider surgical freedom in the opticocarotid and prechiasmatic cistern than frontotemporal craniotomy without orbitotomy, Total, subtotal, and partial resections were achieved for 3, 2, and 2 patients, respectively. Reasons for partial resections were tight adhesion to the carotid artery and encasing of the carotid artery. Permanent morbidities developed in one patient with 3rd nerve palsy and one patient with hemiparesis. Conclusion Modified orbitozygomatic approach can provide the shortest access to the interpeduncular cistern with a minimum brain retraction. Surgeons who experience surgical challenge during the conventional approach for parasellar tumor resection are recommended to learn the modified orbitozygomatic approach.
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Affiliation(s)
- Jin Gu Kim
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Hoon Lee
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Il Kim
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Ho Yang
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Manzoor NF, Morone P, Kelly PD, Chotai S, Yawn RJ, Chambless LB, Thompson RC, Rivas A. Outcomes of Transzygomatic Middle Cranial Fossa Approach for Skull Base Tumors-A Single Institutional Experience. J Neurol Surg B Skull Base 2020; 82:e205-e210. [PMID: 34306939 DOI: 10.1055/s-0040-1708881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 02/14/2020] [Indexed: 10/24/2022] Open
Abstract
Objective This study aimed to evaluate surgical outcomes after transzygomatic middle cranial fossa (MCF) (TZ-MCF) approach for tumor control in patients with large skull base lesions involving the MCF and adjacent sites. Setting This study was done at the tertiary skull base center. Design This is a retrospective case series. Main Outcome Measures The main outcome measures were tumor control (recurrence), new-onset cranial neuropathies, facial nerve and audiometric outcomes, cerebrospinal fluid (CSF) leak, and wound complications. Results Sixteen patients were identified with a median age of 45 years (range: 20-72). The mean maximum tumor dimension was 5.49 cm (standard deviation [SD]: 1.2, range: 3.1-7.3) and the mean tumor volume was 28.5 cm 3 (SD: 18.8, range: 2.9-63.8). Ten (62.5%) tumors were left sided. The most common pathology encountered was meningioma ( n = 7) followed by chondrosarcoma ( n = 4). Mean follow-up was 36.3 (SD: 26.9) months. Gross total resection or near total resection was achieved in nine (56.2%) and planned subtotal resection was used in seven (43.7%). Postoperative additional new cranial nerve (CN) deficits included CN V ( n = 1), CN III ( n = 2), CN VI ( n = 1), and CN X ( n = 1). Major neurological morbidity (hemiplegia) was encountered in two patients with resolution. There were no cases of CSF leak, meningitis, hemorrhage, seizures, aphasia, or death. There was no recurrence or regrowth of residual tumor. Facial nerve function was preserved in all but one patient (House-Brackmann grade 2). Conclusion Various skull base tumors involving MCF with extension to adjacent sites can be successfully resected using the TZ-MCF approach in a multidisciplinary fashion. This approach yields optimal exposure and permits excellent tumor control with acceptable CN and neurological morbidity.
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Affiliation(s)
- Nauman F Manzoor
- Department of Otolaryngology, The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Peter Morone
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Patrick D Kelly
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Silky Chotai
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Robert J Yawn
- Department of Otolaryngology, The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Lola B Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Reid C Thompson
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Alejandro Rivas
- Department of Otolaryngology, The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Lee JJ, Kim YI, Hong JT, Sung JH, Lee SW, Yang SH. Intraoperative monitoring of motor-evoked potentials for supratentorial tumor surgery. J Korean Neurosurg Soc 2014; 56:98-102. [PMID: 25328645 PMCID: PMC4200373 DOI: 10.3340/jkns.2014.56.2.98] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/17/2014] [Accepted: 08/16/2014] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this study was to assess the feasibility and clinical efficacy of motor evoked potential (MEP) monitoring for supratentorial tumor surgery. Methods Between 2010 and 2012, to prevent postoperative motor deterioration, MEP recording after transcranial stimulation was performed in 84 patients with supratentorial brain tumors (45 males, 39 females; age range, 24-80 years; median age, 58 years). MEP monitoring results were correlated with postoperative motor outcome compared to preoperative motor status. Results MEP recordings were stable in amplitude (<50% reduction in amplitude) during surgery in 77 patients (91.7%). No postoperative motor deficit was found in 66 out of 77 patients with stable MEP amplitudes. However, postoperative paresis developed in 11 patients. False negative findings were associated with edema in peri-resectional regions and postoperative bleeding in the tumor bed. MEP decrease in amplitude (>50%) occurred in seven patients (8.3%). However, no deficit occurred postoperatively in four patients following preventive management during the operation. Three patients had permanent paresis, which could have been associated with vascular injury during tumor resection. Conclusions MEP monitoring during supratentorial tumor surgery is feasible and safe. However, false negative MEP results associated with postoperative events may occur in some patients. To achieve successful monitoring, collaboration between surgeon, anesthesiologist and an experienced technician is mandatory.
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Affiliation(s)
- Jung Jae Lee
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Young Il Kim
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Sang Won Lee
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Seung Ho Yang
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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