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Sun L, Qi M, Shao X, Chen S, Fang X, Zhou W, Zhou W, Chen H, He G, Fan X, Sun Y, Di G, Jiang X. Modified Skin Incision and Location of Burr-Hole Surgery via a Retrosigmoid Approach: An Anatomical Study. Skull Base Surg 2022; 84:98-104. [PMID: 36743712 PMCID: PMC9897899 DOI: 10.1055/s-0041-1740971] [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: 10/22/2020] [Accepted: 11/12/2021] [Indexed: 02/07/2023]
Abstract
Objective This study aims to reduce the tissue damage during craniotomy with retrosigmoid approach. A modified sickle-shaped skin incision was developed, and a new burr-hole positioning method was proposed. Methods Five adult cadaveric heads (10 sides) were used in this study. The sickle-shaped skin incision was performed during craniotomy. The nerves, blood vessels, and muscles were observed and measured under a microscope. Additionally, 62 dry adult skull specimens (left sided, n = 35; right sided, n = 27) were used to measure the distance between the most commonly used locating point (asterion [Ast] point) and the posteroinferior point of the transverse sigmoid sinus junction (PSTS) (Ast-PSTS), as well as the distance between the new locating O point and the PSTS (O-PSTS). Then, the reliability of the new locating O point was validated on the same five adult cadaveric heads (10 sides) used for the sickle-shaped skin incision. Results The sickle-shaped skin incision reduced the damage to the occipital nerves, blood vessels, and muscles during the surgery via a retrosigmoid approach. The dispersion and variability of O-PSTS were smaller than those of Ast-PSTS. Conclusion The sickle-shaped skin incision of the retrosigmoid approach can reduce the tissue damage and can completely expose the structures in the cerebellopontine angle. The modified O point is a more reliable locating point for a burr-hole surgery than the Ast point.
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Affiliation(s)
- Lean Sun
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Min Qi
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xuefei Shao
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Sansong Chen
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xinyun Fang
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Wei Zhou
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Wei Zhou
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Hao Chen
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Guoyuan He
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xiran Fan
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Yongkang Sun
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Guangfu Di
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xiaochun Jiang
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China,Address for correspondence Xiaochun Jiang Department of Neurosurgery, Yijishan Hospital, Wannan Medical College2 Wast Zheshan Road, Wuhu, Anhui 241001China
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King AT, Rutherford SA, Hammerbeck-Ward C, Lloyd SK, Freeman SR, Pathmanaban ON, Kellett M, Obholzer R, Afridi S, Axon P, Halliday D, Parry A, Thomas OM, Laitt RD, McCabe MG, Stivaros S, Erridge S, Evans DG. Malignant Peripheral Nerve Sheath Tumors are not a Feature of Neurofibromatosis Type 2 in the Unirradiated Patient. Neurosurgery 2019; 83:38-42. [PMID: 28973692 DOI: 10.1093/neuros/nyx368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 06/25/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The published literature suggests that malignant peripheral nerve sheath tumors (MPNST) occur at increased frequency in neurofibromatosis type 2 (NF2). A recent review based on incidence data in North America showed that 1 per 1000 cerebellopontine angle nerve sheath tumors were malignant. OBJECTIVE To determine whether MPNST occurred spontaneously in NF2 by reviewing our NF2 database. METHODS The prospective database consists of 1253 patients with NF2. One thousand and nine are known to be alive at last follow-up. The presence and laterality/pathology of vestibular schwannoma at diagnosis and last follow-up was sought. RESULTS There were no cases of spontaneous MPNST with 2114 proven (n = 1150) and presumed benign (n = 964) vestibular schwannomas found. Two patients had developed MPNST (1 presumed) after having previously undergone stereotactic radiosurgery for a vestibular schwannoma. CONCLUSION In this series, and from the literature, malignant transformation of a vestibular schwannoma was not a feature of NF2 in the unirradiated patient. NF2 patients should not be told that they have an increased risk of malignant change in a vestibular schwannoma unless they undergo radiation treatment. However, very much larger datasets are required before it can be determined whether there is any association between NF2 and MPNST in the unirradiated patient.
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Affiliation(s)
- Andrew T King
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Scott A Rutherford
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Charlotte Hammerbeck-Ward
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Simon K Lloyd
- Department of Otolaryngology, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Simon R Freeman
- Department of Otolaryngology, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Omar N Pathmanaban
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Mark Kellett
- Department of Neurology, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Rupert Obholzer
- Department of Otolaryngology, Guy's and St. Thomas' Hospital, London, United Kingdom
| | - Shazia Afridi
- Department of Neurology, Guy's and St. Thomas' Hospital, London, United Kingdom
| | - Patrick Axon
- Department of Otolaryngology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Dorothy Halliday
- Department of Clinical Genetics, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Allyson Parry
- Department of Neurology, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Owen M Thomas
- Department of Neuroradiology, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Roger D Laitt
- Department of Neuroradiology, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Martin G McCabe
- Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Stavros Stivaros
- Department of Neuroradiology, Manchester Academic Health Science Centre, Central Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Sara Erridge
- Institute of Cancer Sciences, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Central Manchester NHS Foundation Trust, Manchester, United Kingdom
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Melanoma Mimicking Malignant Peripheral Nerve Sheath Tumor with Spread to the Cerebellopontine Angle: Utility of Next-Generation Sequencing in Diagnosis. Case Rep Pathol 2018; 2018:9410465. [PMID: 30050716 PMCID: PMC6046181 DOI: 10.1155/2018/9410465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 05/28/2018] [Accepted: 06/07/2018] [Indexed: 01/02/2023] Open
Abstract
Cutaneous spindle cell malignancy is associated with a broad differential diagnosis, particularly in the absence of a known primary melanocytic lesion. We present an unusually challenging patient who presented with clinical symptoms involving cranial nerves VII and VIII and a parotid-region mass, which was S100-positive while lacking in melanocytic pigment and markers. Over a year after resection of the parotid mass, both a cutaneous primary lentigo maligna melanoma and a metastatic CP angle melanoma were diagnosed in the same patient, prompting reconsideration of the diagnosis in the original parotid-region mass. Next-generation sequencing of a panel of cancer-associated genes demonstrated 19 identical, clinically significant mutations as well as a high tumor mutation burden in both the parotid-region and CP angle tumors, indicating a metastatic relationship between the two and a melanocytic identity of the parotid-region tumor.
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Conte G, Di Berardino F, Zanetti D, Avignone S, Sina C, Iofrida E, Triulzi F. The 'full-blown' MRI of sudden hearing loss: 3D FLAIR in a patient with bilateral metastases in the internal auditory canals. Neuroradiol J 2017; 31:39-41. [PMID: 29046124 DOI: 10.1177/1971400917736927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a case of a 57-year-old man with bilateral masses in the internal auditory canal. The peculiar findings at magnetic resonance imaging with tridimensional fluid-attenuated inversion recovery sequence combined with clinical data provided new insights into understanding the pathophysiology of the hearing loss.
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Affiliation(s)
- Giorgio Conte
- 1 Neuroradiology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Italy
| | | | - Diego Zanetti
- 2 Audiology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Italy
| | - Sabrina Avignone
- 1 Neuroradiology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Italy
| | - Clara Sina
- 1 Neuroradiology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Italy
| | - Elisabetta Iofrida
- 3 Otolaryngology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Italy
| | - Fabio Triulzi
- 1 Neuroradiology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Italy.,4 Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy
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Ropero Carmona MF, Cabrera Rodríguez JJ, Quirós Rivero J, Muñoz García JL. Bilateral Metastasis in the Internal Auditory Canal of Malignant Melanoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017. [DOI: 10.1016/j.otoeng.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Watanabe K, Cobb MIPH, Zomorodi AR, Cunningham CD, Nonaka Y, Satoh S, Friedman AH, Fukushima T. Rare Lesions of the Internal Auditory Canal. World Neurosurg 2017; 99:200-209. [DOI: 10.1016/j.wneu.2016.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
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Ropero Carmona MF, Cabrera Rodríguez JJ, Quirós Rivero J, Muñoz García JL. Bilateral metastasis in the internal auditory canal of malignant melanoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 68:181-182. [PMID: 27515766 DOI: 10.1016/j.otorri.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 05/23/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Juan Quirós Rivero
- Servicio de Oncología Radioterápica, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - Julia L Muñoz García
- Servicio de Oncología Radioterápica, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
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Hooten KG, Oliveria SF, Sadrameli SS, Gandhi S, Yachnis AT, Lewis SB. Bilateral internal auditory canal gangliogliomas mimicking neurofibromatosis Type II. Surg Neurol Int 2016; 7:39. [PMID: 27127704 PMCID: PMC4838925 DOI: 10.4103/2152-7806.180300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 02/16/2016] [Indexed: 11/20/2022] Open
Abstract
Background: Gangliogliomas are rare low grade, typically well-differentiated, tumors that are composed of mature ganglion cells and neoplastic glial cells. These tumors can appear at virtually any location along the neuroaxis but classically occur in the temporal lobe of young patients. In a small number of cases, gangliogliomas have presented as masses in the brainstem or involving cranial nerves. With the exception of vestibular schwannomas, bilateral tumors in the region of the internal auditory canal (IAC) or cerebellopontine angle (CPA) are exceedingly rare. Case Description: We report a case of a 58-year-old male who presented with hearing loss, tinnitus, and vertigo. Initial magnetic resonance imaging revealed bilateral nonenhancing IAC/CPA tumors. Based on this finding, a presumptive diagnosis of neurofibromatosis Type II was made, which was initially managed conservatively with close observation. He returned for follow-up with worsening vertigo and tinnitus, thus prompting the decision to proceed with surgical resection of the symptomatic mass. Intriguingly, pathological study demonstrated a WHO Grade I ganglioglioma. Description: We report a case of a 58-year-old male who presented with hearing loss, tinnitus, and vertigo. Initial magnetic resonance imaging revealed bilateral nonenhancing IAC/CPA tumors. Based on this finding, a presumptive diagnosis of neurofibromatosis Type II was made, which was initially managed conservatively with close observation. He returned for follow-up with worsening vertigo and tinnitus, thus prompting the decision to proceed with surgical resection of the symptomatic mass. Intriguingly, pathological study demonstrated a WHO Grade I ganglioglioma. Conclusion: This is the first reported case of bilateral IAC/CPA gangliogliomas. When evaluating bilateral IAC/CPA lesions with unusual imaging characteristics, ganglioglioma should be included in the differential diagnosis.
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Affiliation(s)
- Kristopher G Hooten
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - Seth F Oliveria
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - Saeed S Sadrameli
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - Shashank Gandhi
- Department of Neurosurgery, North Shore Long Island Jewish, Manhasset, NY, USA
| | - Anthony T Yachnis
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Stephen B Lewis
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
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Chang MT, Michaelides EM. High rate of bilaterality in internal auditory canal metastases. Am J Otolaryngol 2015; 36:798-804. [PMID: 26545474 DOI: 10.1016/j.amjoto.2015.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 06/04/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Presentation of three cases of metastatic carcinoma to the internal auditory canal bilaterally, as well as a systematic review of the literature regarding the characteristics of these lesions. MATERIALS AND METHODS Using a MEDLINE Ovid search (1946-2015), we identified and reviewed 102 cases of metastatic carcinoma to the internal auditory canal. Metrics recorded include: patient age, sex, tumor type, laterality, past oncologic history, co-occurring metastatic sites, clinical findings, radiographic findings, therapy received, and outcome. Cases of unilateral versus bilateral IAC were compared. RESULTS Remarkably, 52.9% reported cases of internal auditory canal metastases have bilateral occurrence. The most common primary tumor sites for internal auditory canal metastases were lung (21.2%), skin (18.6%), and breast (16.7%), with lung and skin cancers having the highest rates of bilateral metastasis. Meningeal metastasis occurred at a much higher rate in bilateral cases (47.2%) versus unilateral cases (8.5%). Brain parenchymal metastasis also occurred at a higher rate in bilateral cases (38.2%) versus unilateral cases (19.2%). Outcomes for cases of internal auditory canal metastases are generally poor, with 56.3% of unilateral cases and 86.1% of bilateral cases reporting patient death within 5 years from diagnosis. CONCLUSIONS In cases of internal auditory canal metastasis, clinicians should carefully assess for not only contralateral disease but also additional metastatic disease of the central nervous system. Rapid-onset hearing loss, tinnitus, vertigo, or facial palsy should raise suspicion for internal auditory canal metastasis, particularly in patients with a known oncologic history.
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Affiliation(s)
- Michael T Chang
- Yale University School of Medicine, Section of Otolaryngology, 800 Howard Ave, 4th Fl, New Haven, CT.
| | - Elias M Michaelides
- Yale University School of Medicine, Section of Otolaryngology, 800 Howard Ave, 4th Fl, New Haven, CT.
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Non-schwannomatosis lesions of the internal acoustic meatus-a diagnostic challenge and management: a series report of nine cases. Neurosurg Rev 2015; 38:641-8. [PMID: 25957055 DOI: 10.1007/s10143-015-0638-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/09/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
Vestibular schwannomas (VS) are the most common lesions of cerebellopontine angle (CPA) corresponding to 76-91 % of the cases. Usually, these lesions present typical CT and MRI findings. Non-schwannomatous tumors restricted to the internal auditory meatus (IAM) are rare and their preoperative radiological diagnosis may be difficult. This article describes nine surgically treated intrameatal non-schwannomatous lesions (NSL) and reviews the literature. In the last 16 years, a total of 471 patients with diagnosis of VS were operated on in our department. Preoperatively, 42 patients had diagnosis of intrameatal schwannomas, but surgery revealed in nine cases NSL (3 meningiomas, 3 arachnoiditis/neuritis, 1 cavernoma, 1 vascular loop, and 1 arachnoid cyst). Most frequent symptoms presented by patients with NSL were hearing loss 89 % (8/9) of patients, tinnitus 78 % (7/9), and vertigo 33 % (3/9). Almost all lesions (8/9) presented MRI findings of isointense signal in T1W with contrast enhancement. The only exception was the arachnoid cyst with intracystic bleeding, which was hyperintense in T1W that is not enhanced with contrast. This series shows an occurrence of 21.4 % of non-schwannomatous tumors in 42 cases of lesions restricted to the IAM. Whenever a solely intrameatal enhanced tumor is detected, it is necessary to think about other diagnostic possibilities rather than VS. Therapeutic management may be changed, specially if radiosurgical treatment is considered.
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Göbel A, Kenny K, Atlas S. Rare Bilateral Lipoma of the Internal Auditory Canals. Neuroradiol J 2010; 23:501-5. [DOI: 10.1177/197140091002300423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 06/27/2010] [Indexed: 11/17/2022] Open
Abstract
About 10% of all intracranial tumors are localized in the cerebellopontine angle and in the internal auditory canal. Less than 2% of these are lipomas. Furthermore, it can be expected that lipomas in this position with a bilateral localization are exceedingly rare. We describe a 70-year-old-woman with lipomas in both internal auditory canals presented in the literature for the first time and include a detailed literature research.
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Affiliation(s)
- A.B. Göbel
- Department of Radiology, Stanford University School of Medicine; Stanford, California, USA
| | - K. Kenny
- Department of Internal Medicine, Stanford University School of Medicine; Stanford, California, USA
| | - S.W. Atlas
- Department of Radiology, Stanford University School of Medicine; Stanford, California, USA
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