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Hong S, Mahajan A, Shinya Y, Laack NN, Link MJ, O'Brien EK, Stokken JK, Janus JR, Ho TP, Choby G, Van Gompel JJ. Longitudinal treatment outcomes of recurrent clival chordomas: a single-center retrospective study. J Neurosurg 2024; 140:920-928. [PMID: 37856417 DOI: 10.3171/2023.7.jns231196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/28/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE The objective of this study was to clarify the detailed clinical course of recurrent clival chordoma and the outcomes of each treatment modality. METHODS A single-center retrospective analysis was conducted on patients seen for recurrent clival chordoma. The cohort was identified from those who underwent surgery, stereotactic radiosurgery, or proton therapy at the authors' institution between 1990 and 2022. RESULTS A total of 95 recurrences in 40 patients with a median (interquartile range [IQR]) follow-up of 43 (18-79) months were identified. The median (IQR) age at the time of diagnosis was 48 (36-62) years, and 55% of patients were male. Twenty-three patients were treated with surgery followed by adjuvant radiation before the first recurrence. The median (range) number of recurrences per patient was 2 (1-8), and the median (IQR) time to the first recurrence was 29 (9-51) months. The recurrences were treated with one or more of the following therapies: surgery, radiation, systemic therapy, and laser interstitial thermal therapy (LITT). Surgery was performed for 44 recurrences in 25 patients. Radiation was used to treat 42 recurrences in 28 patients. Patients with recurrences treated with surgery plus radiation had the longest progression-free survival (PFS) (median [95% CI] overall survival [OS] 120 [0-245] months, p < 0.01, log-rank test). Patients with recurrences but without prior radiation had longer PFS than those patients with prior radiation. The median (95% CI) OS after the first recurrence was 68 (54-82) months, 5-year OS after the first recurrence was 48%, and 10-year OS was 27%. Multivariate Cox regression analysis showed that mortality after the first recurrence was significantly associated with no adjuvant radiation (HR 0.149, 95% CI 0.038-0.59, p = 0.0067), older age at the time of the first recurrence (HR 1.04, 95% CI 1.01-1.08, p = 0.021), and total number of recurrences (p = 0.032). Seven patients received systemic therapy, and the median (95% CI) OS of these patients since initiation of systemic therapy was 31 (11-51) months. Imatinib and/or nivolumab were used in 6 patients (15%). One patient (3%) was treated with LITT for his fourth recurrence. CONCLUSIONS Despite the aggressive nature of recurrent chordoma, 14 of 29 patients (48%) survived for more than 5 years after the initial recurrence using combined therapies. Multiple treatment options may contribute to the long-term survival of patients with this intractable tumor.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Thanh P Ho
- 4Medical Oncology, Mayo Clinic, Rochester, Minnesota
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Pellerano FM, Messilaty MS, Chin SS, Parnes GJ, Akbar NA, Agarwal V, Mbekeani JN. Isolated Third Nerve Palsy as the Initial Manifestation of a Large Clival Chordoma. J Neuroophthalmol 2024; 44:e117-e119. [PMID: 36562553 DOI: 10.1097/wno.0000000000001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Fernando M Pellerano
- Department of Ophthalmology (FMP), Indiana University School of Medicine, Indianapolis, Indiana; Departments of Surgery (Ophthalmology) (MSM, JNM), and Radiology (GJP), Jacobi Medical Center, Bronx, New York; Department of Pathology (SSC), Montefiore Medical Center, Bronx, New York; Departments of Otorhinolaryngology (NAA, VA) and Neurosurgery (VA), Montefiore Medical Center, Bronx, New York; and Department of Ophthalmology and Visual Sciences (JNM), Albert Einstein College of Medicine, Bronx, New York
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Ali AA, Dashti F, Behbehani RS. Skull-Base Chordoma Mimicking Optic Neuritis. J Neuroophthalmol 2023; 43:e219-e220. [PMID: 36728058 DOI: 10.1097/wno.0000000000001575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Abdullah A Ali
- Al-Bahar Ophthalmology Center (AAA, RSB), Ibn Sina Hospital, Kuwait City, Kuwait; and Department of Radiology (FD), Ibn Sina Hospital, Kuwait City, Kuwait
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Forst DA, Jones PS. Skull Base Tumors. Continuum (Minneap Minn) 2023; 29:1752-1778. [PMID: 38085897 DOI: 10.1212/con.0000000000001361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE This article reviews the presenting features, molecular characteristics, diagnosis, and management of selected skull base tumors, including meningiomas, vestibular schwannomas, pituitary neuroendocrine tumors, craniopharyngiomas, chordomas, ecchordosis physaliphora, chondrosarcomas, esthesioneuroblastomas, and paragangliomas. LATEST DEVELOPMENTS Skull base tumors pose a management challenge given their complex location and, as a result, the tumors and treatment can result in significant morbidity. In most cases, surgery, radiation therapy, or both yield high rates of disease control, but the use of these therapies may be limited by the surgical accessibility of these tumors and their proximity to critical structures. The World Health Organization classification of pituitary neuroendocrine tumors was updated in 2022. Scientific advances have led to an enhanced understanding of the genetic drivers of many types of skull base tumors and have revealed several potentially targetable genetic alterations. This information is being leveraged in the design of ongoing clinical trials, with the hope of rendering these challenging tumors treatable through less invasive and morbid measures. ESSENTIAL POINTS Tumors involving the skull base are heterogeneous and may arise from bony structures, cranial nerves, the meninges, the sinonasal tract, the pituitary gland, or embryonic tissues. Treatment often requires a multidisciplinary approach, with participation from radiation oncologists, medical oncologists, neuro-oncologists, and surgical specialists, including neurosurgeons, otolaryngologists, and head and neck surgeons. Treatment has largely centered around surgical resection, when feasible, and the use of first-line or salvage radiation therapy, with chemotherapy, targeted therapy, or both considered in selected settings. Our growing understanding of the molecular drivers of these diseases may facilitate future expansion of pharmacologic options to treat skull base tumors.
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Nsom J, Khettab M, Molho M, Bintner M, Freppel S, Ah-Pine F. [An unusual skull base tumor]. Ann Pathol 2023; 43:499-503. [PMID: 36933974 DOI: 10.1016/j.annpat.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Jacqueline Nsom
- Service oncologie, CHU de La Réunion, 97410, Saint-Pierre, France
| | - Mohamed Khettab
- Service oncologie, CHU de La Réunion, 97410, Saint-Pierre, France; Unité de recherche en pharmaco-immunologie (UR-EPI), université de La Réunion, 97400, Saint-Pierre, France; U1191, IGF, université de Montpellier, Montpellier, France
| | - Marc Molho
- Service de neuroradiologie, CHU de La Réunion, 97410, Saint-Pierre, France
| | - Marc Bintner
- Service de neuroradiologie, CHU de La Réunion, 97410, Saint-Pierre, France
| | - Sébastien Freppel
- Service de neurochirurgie, CHU de La Réunion, 97410, Saint-Pierre, France
| | - Franck Ah-Pine
- Unité de recherche en pharmaco-immunologie (UR-EPI), université de La Réunion, 97400, Saint-Pierre, France; Service d'anatomie et cytologie pathologiques, CHU de La Réunion, 97410, Saint-Pierre, France.
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Fitzgerald C, Dogan S, Bou-Nassif R, Mclean T, Woods R, Cracchiolo JR, Ganly I, Tabar V, Cohen MA. Stimulated Raman Histology for Rapid Intra-Operative Diagnosis of Sinonasal and Skull Base Tumors. Laryngoscope 2022; 132:2142-2147. [PMID: 35634892 PMCID: PMC10291728 DOI: 10.1002/lary.30233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/07/2022] [Accepted: 05/06/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Intra-operative stimulated Raman histology (SRH) is a novel technology that uses laser spectroscopy and color-matching algorithms to create images similar to the formalin-fixed paraffin-embedded (FFPE) section. We aim to assess the accuracy of SRH in a novel range of sinonasal and skull base tumors. METHODS Select patients undergoing sinonasal and skull base surgery using the Invenio Imaging™ Nio™ Laser Imaging SRH system between June 2020 and September 2021 were assessed. The SRH images were reviewed for pathologic features similar to frozen section (FS) and FFPE. Time taken for results and diagnostic concordance was assessed. RESULTS Sixty-seven SRH images from 7 tumor types in 12 patients were assessed. Pathologies included squamous cell carcinoma, rhabdomyosarcoma, inverted papilloma, adenoid cystic carcinoma, SMARCB1-deficient sinonasal carcinoma, mucosal melanoma, metastatic colonic adenocarcinoma, and meningioma. Tumor was identified in 100% of lesional specimens, with characteristic diagnostic features readily appreciable on SRH. Median time for diagnosis was significantly faster for SRH (4.3 min) versus FS (44.5 min; p = <.0001). Where SRH sample site matched precisely to FS (n = 32/67, 47.8%), the same diagnosis was confirmed in 93.8%. Sensitivity, specificity, precision, and overall accuracy of SRH were 93.3%, 94.1%, 93.8%, and 93.3%, respectively. Near-perfect concordance was seen between SRH and FS (Cohen's kappa [κ] = 0.89). CONCLUSION Stimulated Raman histology can rapidly produce images similar to FFPE H&E in sinonasal and skull base tumors. This technology has the potential to act as an adjunct or alternative to standard FS. LEVEL OF EVIDENCE 4 Laryngoscope, 132:2142-2147, 2022.
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Affiliation(s)
- Conall Fitzgerald
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rabih Bou-Nassif
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tim Mclean
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robbie Woods
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer R. Cracchiolo
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc A. Cohen
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Hall MN, Raviskanthan S, Mortensen PW, Lee AG. Isolated Fourth Nerve Palsy as the Presenting Sign of Clival Chordoma. J Neuroophthalmol 2022; 42:e391-e393. [PMID: 33449491 DOI: 10.1097/wno.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- MacGregor N Hall
- McGovern Medical School at the University of Texas Health Science Center at Houston (MNH), Houston, Texas ; Department of Ophthalmology (SR, PM, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medicine, New York, New York; Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas; University of Texas MD Anderson Cancer Center (AGL), Houston, Texas; Texas A and M College of Medicine (AGL), Bryan, Texas; and Department of Ophthalmology (AGL), the University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Gupta S, Iorgulescu JB, Hoffman S, Catalino M, Bernstock JD, Chua M, Segar DJ, Fandino LB, Laws ER, Smith TR. The diagnosis and management of primary and iatrogenic soft tissue sarcomas of the sella. Pituitary 2020; 23:558-572. [PMID: 32613388 DOI: 10.1007/s11102-020-01062-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Soft tissue sarcoma (STS) of the sella is exceptionally rare. We conducted a case series, literature review, and nationwide analysis of primary and iatrogenic (radiation-associated) STS of the sella to define the clinical course of this entity. METHODS This study employed a multi-institutional retrospective case review, literature review, and nationwide analysis using the National Cancer Database (NCDB). RESULTS We report five patients who were diagnosed at three institutions with malignant STS of the sella. All patients presented with symptoms related to mass effect in the sellar region. All tumors extended to the suprasellar space, with the majority displaying extension into the cavernous sinus. All patients underwent an operation via a transsphenoidal approach with a goal of maximal safe tumor resection in four patients and biopsy for 1 patient. Histopathologic evaluation demonstrated STS in all patients. Post-operative adjuvant radiotherapy and chemotherapy were given to 2 and 1 out of 4 patients with known post-operative clinical course, respectively. The 1-year and 5-year overall survival rates were 100% (5/5) and 25% (1/4). Twenty-two additional reports of primary, non-iatrogenic STS of the sella were identified in the literature. Including the three cases from our series, treatment included resection in all cases, and adjuvant radiotherapy and chemotherapy were utilized in 50% (12/24) and 17% (4/24) of cases, respectively. The national prevalence of malignant STS is estimated to be 0.01% among all pituitary and sellar tumors within the NCDB. CONCLUSIONS We report the prevalence and survival rates of STS of the sella. Multimodal therapy, including maximal safe resection, chemotherapy, and radiotherapy are necessary to optimize outcomes for this uncommon pathology.
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Affiliation(s)
- Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Computational Neurosciences Outcome Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - J Bryan Iorgulescu
- Computational Neurosciences Outcome Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02115, USA
| | - Samantha Hoffman
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael Catalino
- Department of Neurosurgery, University of North Carolina Medical Center, Chapel Hill, NC, 27599, USA
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Melissa Chua
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - David J Segar
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Luis Bradley Fandino
- Department of Orthopedic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Edward R Laws
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
- Computational Neurosciences Outcome Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, 02115, USA.
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Abramson DH, Haque S, Francis JH. Unilateral Retinoblastoma Metastatic to the Skull and Both Orbits. Ophthalmol Retina 2020; 4:1021. [PMID: 33019985 DOI: 10.1016/j.oret.2020.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Affiliation(s)
- David H Abramson
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sofia Haque
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jasmine H Francis
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Yoon J, Barton MJ, St John JA, Ekberg JAK, Khan A, Redmond M. Anterior skull base olfactory tumours, which is what? A case report and review. J Clin Neurosci 2020; 81:1-5. [PMID: 33222894 DOI: 10.1016/j.jocn.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 07/29/2020] [Accepted: 09/06/2020] [Indexed: 11/17/2022]
Abstract
Intracranial schwannomas not originating from cranial nerves are rare. In this paper, we report a case of a 50-year-old male who presented with worsening headaches, diplopia and nausea over two years. Radiological imaging revealed a large tumour arising from the olfactory groove region with a preoperative diagnosis of olfactory groove meningioma (OGM). Intraoperatively, the tumour originated from the region of the attachment of the falx to the crista galli. The patient recovered without complication and histopathology reported an unexpected diagnosis of WHO Grade 1 schwannoma. However, as olfactory groove schwannomas (OGSs) cannot be distinguished from olfactory ensheathing cell tumours (OECTs), it is possible that the tumour could have been either an OGS or an OECT. Distinguishing between OGSs, OECTs and OGMs preoperatively is difficult. OGMs exhibit distinct histopathological features from OGSs/OECTs, however, OGSs and OECTs currently cannot be distinguished from each other. Here, we review the literature to discuss the differentiating features and cellular origins of these three tumours.
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Affiliation(s)
- J Yoon
- Neurosurgery Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - M J Barton
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - J A St John
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Griffith Institute for Drug Discovery, Griffith University, Nathan, Queensland, Australia
| | - J A K Ekberg
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Griffith Institute for Drug Discovery, Griffith University, Nathan, Queensland, Australia
| | - A Khan
- Anatomical Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - M Redmond
- Neurosurgery Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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Abstract
PURPOSE Acromegaly is usually due to growth hormone (GH)-secreting pituitary adenomas, but it may be exceptionally caused by GH-secreting ectopic pituitary adenomas (EPA). EPA are defined as extra-sellar pituitary tumours, extra- or intra-cranially sited, entirely separated from the pituitary stalk and gland. The aim of the study is to address the challenges in the management of clival GHEPA. METHODS We reported a case of a 53-year-old acromegalic patient with a primary clival GHEPA and reviewed systematically the relevant English literature between 1975 and 2019, in keeping with the PRISMA guidelines. RESULTS Four cases of primary clival GHEPA have been described in literature apart from ours. All patients presented with acromegalic features, elevated circulating GH and/or insulin-like growth factor-1 levels. Hyperprolactinemia and empty sella were described in two cases, respectively. These tumours show the typical imaging characteristics of pituitary adenomas, but their neuroradiological diagnosis may be challenging due to their sizes and the difficulty in defining the absence of connections with the pituitary fossa. CONCLUSION Although primary clival GHEPA are exceedingly rare, even if likely under-reported in literature, they should be considered in the differential diagnosis of clival tumours because of their specific management. Surgery represents the first-line treatment option, while medical and radiation therapies can be adopted as neo-adjuvant, adjuvant or primary treatments according to tumour and patient characteristics.
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Affiliation(s)
- Lucia Riccio
- Department of Neurosurgery, Ospedale "Vito Fazzi", Piazza F. Muratore, 1, 73100, Lecce, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Carmine Antonio Donofrio
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | | | - Roberto De Blasi
- Department of Radiology, Azienda Ospedaliera "Cardinale Giovanni Panico", Tricase, Italy
| | - Alessandro Melatini
- Department of Neurosurgery, Ospedale "Vito Fazzi", Piazza F. Muratore, 1, 73100, Lecce, Italy
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Abstract
Parasellar spaces remain particularly singular, comprising the most important neurovascular structures such as the internal carotid artery and optic, oculomotor, and trigeminal nerves. Meningiomas are one of the most frequent tumors arising from parasellar spaces. In this location, meningiomas remain mostly benign tumors with WHO grade I and a meningothelial subtype. Progestin intake should be investigated and leads mostly to conservative strategies. In the case of benign nonsymptomatic tumors, observation should be proposed. Tumor growth will lead to the proposition of surgery or radiosurgery. In the case of an uncertain diagnosis and an aggressive pattern, a precise diagnosis is required. For cavernous sinus and Meckel's cave lesions, complete removal is rarely considered, leading to the proposition of an endoscopic endonasal or transcranial biopsy. Optic nerve decompression could also be proposed via these approaches. A case-by-case discussion about the best approach is recommended. A transcranial approach remains necessary for tumor removal in most cases. Vascular injury could lead to severe complications. Cerebrospinal fluid leakage, meningitis, venous sacrifice, visual impairment, and cranial nerve palsies are more frequent complications. Pituitary dysfunctions are rare in preoperative assessment and in postoperative follow-up but should be assessed in the case of meningiomas located close to the pituitary axis. Long-term follow-up is required given the frequent incomplete tumor removal and the risk of delayed recurrence. Radiosurgery is relevant for small and well-limited meningiomas or intra-cavernous sinus postoperative residue, whereas radiation therapy and proton beam therapy are indicated for large, extended, nonoperable meningiomas. The place of the peptide receptor radionuclide therapyneeds to be defined. Targeted therapy should be considered in rare, recurrent, and aggressive parasellar meningiomas.
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Affiliation(s)
- Thomas Graillon
- Neurosurgery Department, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, CHU Timone, Marseille, France,
- Aix-Marseille University, INSERM, MMG, Marseille, France,
| | - Jean Regis
- Gamma Knife Unit, Functional and Stereotactic Department, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, CHU Timone, Marseille, France
| | - Anne Barlier
- Aix-Marseille University, INSERM, MMG, Marseille, France
- Molecular Biology Department, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, CHU Timone, Marseille, France
| | - Thierry Brue
- Aix-Marseille University, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, CHU Conception, Marseille, France
| | - Henry Dufour
- Neurosurgery Department, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, CHU Timone, Marseille, France
- Aix-Marseille University, INSERM, MMG, Marseille, France
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital of Erlangen, Erlangen, Germany
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Abstract
RATIONALE Chordomas are rare malignant neoplasms arised from residual embryonic notochordal tissue, mostly located in the axial midline. Tumors along extra-axial locations in the head and neck are rare. Chordomas located in the jugular foramen are extremely rare, with a low incidence of 0.2%. PATIENT CONCERNS A 64-year-old male with 20 years of dizziness history complaining of 6 months of severe dizziness: significant with the changing of the body posture, vertigo which can be self-remissioned within 1 minute and hearing loss of both ears, without headache, nausea, dysphagia, or otalgia. Computed tomography and magnetic resonance imaging (MRI) were performed before surgery which suggests various possibilities. Immunohistochemistry helped to confirm the final diagnosis. DIAGNOSES Immunohistochemistry demonstrated diffuse positivity for S100 (+++), positivity for D2-40 (focal +), EMA (+), and PR (+). Ki-67 labeling index was estimated at 2% focally. The final diagnosis was chordoma. INTERVENTIONS The tumor was excised via retro-sigmoid approach without postoperative radiotherapy. OUTCOMES Facial paralysis occurred in this case. House-Brackmann facial nerve grading system was used to evaluate the facial paralysis of this patient. It is considered as H-B grade IV. The patient was followed up regularly every month after operation, totally for 9 months. An MRI of the brain was performed 6 months after surgery which shows a small range of abnormal signals similar to the previous MRI in the jugular foramen, suggesting that there may be residual or recurrent tumor. And facial paralysis stays at H-B grade IV without any recovery. LESSONS It is a big challenge for us to remove giant tumors located in the jugular foramen because of its unique anatomy. Access should be combined with retro-sigmoid or infra-temporal fossa approach to remove such tumors. Chordomas is a malignant neoplasm which may need radiotherapy after surgery, particularly those with subtotal and partial resection.
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Affiliation(s)
| | - Ya Liu
- Department of Otorhinolaryngology Head and Neck Surgery
| | - Cheng Dong Chang
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ya Ping Xu
- Department of Otorhinolaryngology Head and Neck Surgery
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Wong DKC, Muhamad NS, Sobri SS, Amin WAM, Yusof Z. Metastatic Pleomorphic Adenoma in the infratemporal fossa and neck following total parotidectomy after 30 years. Med J Malaysia 2019; 74:85-86. [PMID: 31079134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Metastasising pleomorphic adenoma is rare and may occur years after surgical excision of a pleomorphic adenoma (PA). We present a 61-year-old woman with a right infratemporal PA with metastases to the cervical lymph nodes after 30 years following a total parotidectomy. She was treated successfully with a resection of the tumour with combined neck and mandibulotomy approach along with postoperative radiotherapy given subsequently.
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Affiliation(s)
- D K C Wong
- KPJ Healthcare University College, Otorhinolaryngology Head & Neck Surgery Department, Negeri Sembilan,Nilai Malaysia.
| | - N S Muhamad
- Hospital Sultanah Bahiyah, Department of Otorhinolaryngology, Alor Setar, Kedah, Malaysia
| | - S S Sobri
- Hospital Sultanah Bahiyah, Department of Pathology, Alor Setar, Kedah, Malaysia
| | - W A M Amin
- Hospital Sultanah Bahiyah, Department of Pathology, Alor Setar, Kedah, Malaysia
| | - Z Yusof
- Hospital Sultanah Bahiyah, Department of Otorhinolaryngology, Alor Setar, Kedah, Malaysia
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15
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Golbin DA, Lasunin NV, Cherekaev VA, Grigorieva NN, Serova NK, Mindlin SN, Kutin MA, Imaev AA. [Biopsy and resection of skull base tumors using transorbital endoscopic approaches: primary results]. Zh Vopr Neirokhir Im N N Burdenko 2019; 83:42-56. [PMID: 31339496 DOI: 10.17116/neiro20198303142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM Transorbital neuroendoscopic surgery is a new skull base surgery technique that uses the orbit as an artificial corridor to the anterior and middle skull base. The space is created between the periorbita and orbital walls by their additional resection and gentle traction of the orbital contents. Skull base structures are reached using cosmetic incisions. The major advantages of transorbital endoscopic approaches include their variety, possibility of their combination, and access to the central and lateral skull base lesions. The aim of this study was to analyze the primary results of transorbital endoscopic biopsy and resection of skull base lesions, which were performed at the N.N. Burdenko National Medical Research Center for Neurosurgery (Moscow, Russia). MATERIAL AND METHODS In 2017-2018, the authors operated on 12 patients with skull base lesions using transorbital endoscopic approaches. The series included ten female and two male patients. The patient's age varied between 24 and 78 years. All patients were admitted for the first time. Half of them underwent biopsy, while the other half underwent tumor resection. The upper-lateral transorbital approach with an eyebrow incision was used in most (8/12) patients; the retrocaruncular approach was used in two cases; the lateral retrocanthal approach was applied in one case; the upper-medial approach with an eyebrow incision was used in one patient. RESULTS The histological diagnosis was established in all six biopsies: 3 pseudotumors, 2 WHO Grade I meningiomas, and 1 clear-cell kidney cancer. Tumor resection was successful in 5 out of 6 patients; repeated surgery was required in one patient. In one case, the transorbital approach was combined with the transnasal one for treatment of supraorbital mucocele. One patient developed a persistent neurological deficit (dysfunction of the fifth and sixth nerves) after upper-lateral transorbital surgery. There were no poor cosmetic results in the series. CONCLUSION Transorbital neuroendoscopic surgery needs an interdisciplinary approach and a sufficient amount of surgical experience. Surgical skills setting includes microsurgical and endoscopic tumor resection, harvesting and positioning of free and vascularized grafts for skull base reconstruction and prevention of postoperative enophthalmos, and facial incisions and their cosmetic closure. Implementation of new local vascularized flaps may significantly improve the results of transorbital endoscopic procedures and extend the spectrum of indications.
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Affiliation(s)
- D A Golbin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - N V Lasunin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | - N K Serova
- Burdenko Neurosurgical Center, Moscow, Russia
| | - S N Mindlin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - M A Kutin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A A Imaev
- Burdenko Neurosurgical Center, Moscow, Russia
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Tan LY, Tan AP. A rare case of paediatric meningioma masquerading as intra-axial lesion. Med J Malaysia 2018; 73:439-440. [PMID: 30647227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Meningiomas are neoplasm arising from meningoepithelial cells, most commonly in the fifth to sixth decade of life. Meningiomas are rare in paediatric population, accounting for 0.4-4.1% of all paediatric tumours and less than 3% of paediatric brain tumours. However, meningiomas represent the most common dural based tumours in children. We describe a rare case of paediatric fibroblastic meningioma within the left middle cranial fossa masquerading as an intra-axial mass lesion. Our discussion will be centred on atypical features of paediatric meningiomas and differential diagnosis of extra-axial mass lesion in the paediatric population.
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Affiliation(s)
- L Y Tan
- National University of Singapore, Department of Diagnostic Imaging, Singapore.
| | - A P Tan
- National University of Singapore, Department of Diagnostic Imaging, Singapore
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17
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Abdulkerimov KT, Abdulkerimov ZK, Kartashova KI, Abdulkerimov TK. [The current trends and the tactical-technical approaches to the management of the neoplastic processes in the base of the skull]. Vestn Otorinolaringol 2018; 83:7-10. [PMID: 30412167 DOI: 10.17116/otorino2018830517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The neoplastic processes localized in the base of the skull and the surrounding region have until recently been considered as the inoperable condition. Juvenile angiofibroma of the base of the skull or angiofibroma of the base of the skull (ABS) is most frequently encountered in the otorhinolaryngological practice. In terms of the histological picture, ABS is a benign tumour having a very complicated structure. The multi-disciplinary approach and the application of up-to-date medical technologies made it possible to obtain an insight into the deepest-lying areas of the base of the skull. A total of 69 patients presenting with juvenile angiofibroma of the base of the skull were available for the examination in the present study. In all this cases, the presence of the tumour was confirmed by the histological studies. Apart from the routine medical examination, all the patients underwent X-ray investigations including computed tomography with 3D-reconstruction, angiography subtracted VRT-reconstruction, and magnetic resonance tomography with contrast enhancement. Moreover, the trans-maxillary-buccal approach was applied with the use of the endovideoscopic equipment. All the patients were discharged from the clinic in the satisfactory condition. Recurrent tumours were documented only in three patients, the lethal cases were altogether absent. The length of the period of follow-up observations amounted to five and more years. It is concluded that the application of the modern medical technologies in the combination with the 'teamwork' interdisciplinary approach greatly contributes to the successful surgical treatment of the pathological processes localized at the base of the skull and the surrounding region.
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Affiliation(s)
- Kh T Abdulkerimov
- Department of Otorhinolaryngology, Ural State Medical University, Ministry of Health of the Russian Federation, Ekaterinburg, Russia; Municipal City Hospital No 40, Ekaterinburg, Russia
| | - Z Kh Abdulkerimov
- Department of Otorhinolaryngology, Ural State Medical University, Ministry of Health of the Russian Federation, Ekaterinburg, Russia; Municipal City Hospital No 40, Ekaterinburg, Russia
| | - K I Kartashova
- Department of Otorhinolaryngology, Ural State Medical University, Ministry of Health of the Russian Federation, Ekaterinburg, Russia
| | - T Kh Abdulkerimov
- Department of Otorhinolaryngology, Ural State Medical University, Ministry of Health of the Russian Federation, Ekaterinburg, Russia
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Yang X, Liu J, Ren Y, Richard SA, Zhang Y. Isolated intracranial Rosai-Dorfman disease mimicking petroclival meningioma in a child: Case report and review of the literature. Medicine (Baltimore) 2017; 96:e8754. [PMID: 29381971 PMCID: PMC5708970 DOI: 10.1097/md.0000000000008754] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Rosai -Dorfman disease (RDD) is a rare, idiopathic, and non-neoplastic histioproliferative disease with distinctive entity of unknown etiology. Central nervous system (CNS) RDD is uncommon, hence, isolated intracranial RDD is extremely rare. So far only 6 cases of CNS RDD with the lesions originating from petroclival region have been reported. We present a case of isolated intracranial RDD mimicking petroclival meningioma. PATIENT CONCERNS A 14-year-old girl was admitted at our hospital with a 3-month history of dizziness, slowly progressing headache, and 2-month history of instability in walking. Cranial nerve deficits, including left facial paralysis, left facial numbness and left hearing loss, were evident on examination. DIAGNOSES Initial diagnosis of petroclival meningioma was made according to preoperative magnetic resonance imaging. INTERVENTIONS The lesion was resected subtotally and pathology confirmed RDD. The patient received gamma-knife treatment for the residual lesion. OUTCOMES The patient recovered well and the residual lesion significantly retrogressed on follow-up images. LESSONS Preoperative diagnosis of petroclival RDD is full of challenges. Although surgical resection of lesions is an effective treatment option, total resection is not highly recommended because the surgery-related defect must be minimal. Patient with residual lesion can be put on steroid therapy and/or radiotherapy, especially for IgG4 positive subset of RDD.
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Abstract
The natural history of giant prolactinomas is not known. While it is commonly accepted that the enlargement of microadenoma is rare and more limited than macroadenoma, it is so far uncommon that macroadenoma progress to giant adenoma. Thus, spontaneous enlargement of adenomas is poorly documented. We report the unusual history of undiagnosed microprolactinoma, revealed 12years later at the stage of a giant adenoma presenting as a skull base tumor. This unique observation provides information on the natural history of giant adenomas and arguments for particular attention to microadenomas with signs of invasion. Moreover, this clinical case highlights the need for a prolactin dosage for all midline skull base tumors.
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Affiliation(s)
- C Briet
- Institut Mitovasc, unité CNRS 6214/Inserm1083, université d'Angers, 49100 Angers, France; Service d'endocrinologie diabétologie nutrition, centre de référence des maladies rares de la réceptivité hormonale, CHU d'Angers, Angers, France
| | - F Bernard
- Service de neurochirurgie, CHU d'Angers, 49100 Angers, France
| | - P Rodien
- Institut Mitovasc, unité CNRS 6214/Inserm1083, université d'Angers, 49100 Angers, France; Service d'endocrinologie diabétologie nutrition, centre de référence des maladies rares de la réceptivité hormonale, CHU d'Angers, Angers, France.
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20
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Kim NI, Yang JI, Kim SS, Lee JS, Lim SC, Jung S, Lee JH, Moon KS, Lee KH. Sinonasal renal cell-like adenocarcinoma, a unique variant of primary clear cell carcinoma of the head and neck: The first reported case in Korea. Medicine (Baltimore) 2017; 96:e7711. [PMID: 28767609 PMCID: PMC5626163 DOI: 10.1097/md.0000000000007711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Primary sinonasal renal cell-like adenocarcinoma (SNRCLA) is a rare and unique neoplasm. PATIENT CONCERNS A 63-year-old man presented with repeated epistaxis, nasal obstruction and hyposmia of 2-month duration. Radiological studies revealed a mass of the left ethmoid sinus involving anterior skull base. DIAGNOSIS The patient was treated with craniofacial resection, bifrontal craniotomy combined with an endonasal endoscopic approach. Intraoperatively, a hypervascular paranasal mass invading the dura mater was removed en block. Histologically, the tumor resembled a clear cell renal cell carcinoma, with cuboidal shaped cells having clear cytoplasm. The tumor cells were positive for CK7, S100, vimentin and PAX-8 and negative for CD10 and PAX-2 by immunohistochemistry. No evidence of renal malignancy was found by radiological and clinical examinations. INTERVENTIONS AND OUTCOMES Following local radiation therapy, the patient was in good health without recurrence for 15 months after the operation. LESSONS To the best of the authors' knowledge, this is the first reported case of SNRCLA in Korea. Because of its histological feature of clear cytoplasm, SNRCLA needs to be differentiated from clear cell renal cell carcinoma and other salivary clear cell carcinomas. The prognosis of SNRCLA is generally favorable as shown in the previously reported cases. Considering the limited number and follow-up periods of the cases, however, delayed recurrence should be kept in mind for clinicians.
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Affiliation(s)
| | | | | | | | | | - Shin Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanamdo, South Korea
| | | | - Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanamdo, South Korea
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21
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Chandrasekhar SS. Anterior Skull Base Malignancies-The Otolaryngologist's Contribution. Otolaryngol Clin North Am 2017; 50:xix-xx. [PMID: 28314408 DOI: 10.1016/j.otc.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sujana S Chandrasekhar
- Department of Otolaryngology-, Head and Neck Surgery, Hofstra-Northwell School of Medicine, Icahn School of Medicine at Mount Sinai, 1421 Third Avenue, 4th Floor, New York, NY 10028, USA.
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22
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Williams UU, Zavala AM, Van Meter A, Rebello E, Tan J, Owusu-Agyemang P. Unanticipated Compression of the Trachea in a 5-Month-Old Undergoing an MRI for Evaluation of Neurofibromatosis. A A Case Rep 2017; 8:1-3. [PMID: 28036318 DOI: 10.1213/xaa.0000000000000407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Neurofibromatosis type 1 is an autosomal-dominant disorder with the tendency toward the formation of tumors. Plexiform neurofibromas are the most common type of tumors seen in neurofibromatosis type 1. Approximately 50% occur in the head and neck region with a 5% incidence of airway involvement. We describe the case of a 5 month old with a plexiform neurofibroma of the neck who developed complete airway obstruction on induction of anesthesia. Magnetic resonance imaging revealed a skull base neurofibroma extending to the hypopharynx and resulting in deviation of the airway. Because of the possibility of airway involvement, a careful preanesthetic evaluation as well as a slow induction with the maintenance of spontaneous ventilation should be considered in patients presenting with facial neurofibromas.
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Affiliation(s)
- Uduak Ursula Williams
- From the Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, Houston, Texas
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Abstract
Meningiomas originating in Meckel's cave (MC) are uncommon lesions that represent 1% of all intracranial meningiomas. Innovations in skull base surgery have enabled resection of these lesions with less morbidity, but require an intimate knowledge of both lesional pathology and regional microneuroanatomy. To review the surgical and clinical considerations involved in the management of MC meningiomas, we retrospectively reviewed data from patients who underwent transpetrosal resection of primary MC meningiomas between 1984 and 1998. Of 146 patients who underwent transpetrosal removal of meningiomas, 7 were believed to have tumors originating in MC. All 7 patients presented with trigeminal dysfunction, facial pain, and/or headache. Complete tumor removal was achieved in 5 of the 7 patients. Facial hypoesthesia or anesthesia, paralysis of cranial nerve VI, and ophthalmoplegia were among the postoperative complications encountered. Meningiomas of MC represent treatable lesions whose diagnosis requires prompt imaging of patients with trigeminal dysfunction and symptoms of facial pain and headache.
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Affiliation(s)
- Daniel I Choo
- Neuroscience Institute, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, OH 45267-0528, USA
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24
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Leong JL, Batra PS, Citardi MJ. CT-MR Image Fusion for the Management of Skull Base Lesions. Otolaryngol Head Neck Surg 2016; 134:868-76. [PMID: 16647550 DOI: 10.1016/j.otohns.2005.11.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 11/02/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE: Image fusion software creates composite images from computed tomography (CT) and magnetic resonance (MR) images. STUDY DESIGN AND SETTING: CT-MR fusion studies between August 2004 to July 2005 were reviewed. CT scan images (1-mm axial) were obtained on a multi-detector CT scanner. MR images (1-mm axial) were obtained with a T1-weighted, volume acquisition technique. CT-MR fusion images were created on the Instatrak 3500 Plus or CBYON Suite. RESULTS: A total of 25 patients had 27 CT-MR image fusion studies. CT-MR fusion accuracy was 2 mm or better. During preoperative planning and intraoperative navigation, CT-MR fusion facilitated the delineation of the anatomic relationships between the lesion and the skull base. CONCLUSIONS: CT-MR image fusion yields composite images that combine features of each component imaging modality. Image fusion, when combined with surgical navigation, further enhances potential skull base applications for minimally invasive endoscopic surgery.
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Affiliation(s)
- Jern-Lin Leong
- Singapore General Hospital, Department of Otolaryngology, Singapore
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25
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Laccourreye L, Halimi P, Bonfils P, Laccourreye O. Atypical Pseudotumoral Osteomyelitis of the Skull Base. Otolaryngol Head Neck Surg 2016; 137:524-5. [PMID: 17765793 DOI: 10.1016/j.otohns.2007.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 04/24/2007] [Indexed: 11/25/2022]
Affiliation(s)
- Laurent Laccourreye
- Department of Oto-rhino-laryngology-Head and Neck Surgery, Université Paris V - Descartes, HEGP, APHP, Paris, France
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26
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Gui S, Zong X, Wang X, Li C, Zhao P, Cao L, Zhang Y. Classification and surgical approaches for transnasal endoscopic skull base chordoma resection: a 6-year experience with 161 cases. Neurosurg Rev 2016; 39:321-32; discussion 332-3. [PMID: 26846667 DOI: 10.1007/s10143-015-0696-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/29/2015] [Accepted: 10/31/2015] [Indexed: 01/13/2023]
Abstract
The aim of this study is to retrospectively analyze 161 cases of surgically treated skull base chordoma, so as to summarize the clinical classification of this tumor and the surgical approaches for its treatment via transnasal endoscopic surgery. Between August 2007 and October 2013, a total of 161 patients (92 males and 69 females) undergoing surgical treatment of skull base chordoma were evaluated with regard to the clinical classification, surgical approach, and surgical efficacy. The tumor was located in the midline region of the skull base in 134 cases, and in the midline and paramedian regions in 27 cases (extensive type). Resection was performed via the transnasal endoscopic approach in 124 cases (77%), via the open cranial base approach in 11 cases (6.8%), and via staged resection combined with the transnasal endoscopic approach and open cranial base approach in 26 cases (16.2%). Total resection was achieved in 38 cases (23.6%); subtotal resection, 86 cases (53.4%); partial resection of 80-95%, 29 cases (18%); and partial resection <80%, 8 cases (5%). The clinical classification method used in this study seems suitable for selection of transnasal endoscopic surgical approach which may improve the resection degree and surgical efficacy of skull base chordoma. Gross total resection of skull base chordoma via endoscopic endonasal surgery (with addition of an open approach as needed) is a safe and viable alternative to the traditional open approach.
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Affiliation(s)
- Songbai Gui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuyi Zong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinsheng Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuzhong Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Peng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yazhuo Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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27
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Đerić D, Dudvarski Z, Cvorović L. OTOLOGICAL MANIFESTATIONS OF TURNER SYNDROME: CLINICAL AND RADIOLOGICAL FINDINGS. Med Pregl 2016; 69:45-47. [PMID: 27498533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Turner syndrome is a chromosomal abnormality where all or a part of one of the X chromosomes is absent or it has other abnormalities. Besides characteristic abnormalities of short stature and infertility, women with Turner syndrome have increased risks for tumors of the central nervous system, especially meningioma and an otologic disease. Meningioma involving the middle ear is extremely rare, and this condition has never been published in association with Turner syndrome. CASE REPORT We present an otologic manifestation associated with other abnormalities in a patient with Turner syndrome and discuss diagnosis and possible treatment options. CONCLUSION Multidisciplinary team approach is essential in these patients in order to evaluate their vulnerability and define therapeutic priorities.
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Park ES, Lee EJ, Park JB, Cho YH, Hong SH, Kim JH, Kim CJ. A Single-Institution Retrospective Study of Jugular Foramen Schwannoma Management: Radical Resection Versus Subtotal Intracranial Resection Through a Retrosigmoid Suboccipital Approach Followed by Radiosurgery. World Neurosurg 2015; 88:552-562. [PMID: 26520430 DOI: 10.1016/j.wneu.2015.10.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite advances in skull base surgery, achieving effective surgical management of jugular foramen schwannomas (JFSs) that avoids postoperative cranial nerve (CN) deficits remains a challenge. Subtotal resection followed by radiosurgery (rather than radical resection) is increasingly being viewed as a better treatment strategy. Here, an institutional database was retrospectively analyzed for outcomes after surgical treatment of JFSs to evaluate the optimal strategy for managing JFSs. METHODS Twenty-two patients with JFSs were operated on by either radical resection (n = 13) or conservative resection plus radiosurgery (n = 9). These 2 different groups were compared in terms of early (≤4 weeks after surgery) and late postoperative functional outcome and oncologic control. RESULTS No deaths occurred in either group, but there were 3 surgery-related complications in the radical resection group. Postoperative CN deficits and additional procedures related to CN morbidity were generally higher in the radical resection group, but the differences were not statistically significant. The conservative surgery group showed a statistically significant improvement in the level of dysphagia and dysphagia-related functional state in the late postoperative period. There was 1 case of recurrence after radical resection over a mean follow-up period of 73 months. All tumors in the conservative surgery group were controlled over a mean period of 34 months. CONCLUSIONS Our results suggest that conservative resection of JFSs via a familiar intracranial approach plus radiosurgery may be an effective surgical alternative for improving functional outcome with adequate oncologic control.
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Affiliation(s)
- Eun Suk Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun Jung Lee
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young Hyun Cho
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Seok Ho Hong
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Jin Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Xie XZ, Huo XK. Diagnostic accuracy of three-dimensional CT reconstruction and cephalometry for lateral skull base tumors. Eur Rev Med Pharmacol Sci 2015; 19:3574-3578. [PMID: 26502846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the diagnostic accuracy of three-dimensional CT reconstruction and cephalometry in lateral skull base tumors. PATIENTS AND METHODS Fifty-eight patients with lateral skull base tumors were randomly divided into control group (n = 29, examined with conventional diagnostic technique) or study group (n = 29, examined with three-dimensional CT reconstruction and cephalometry). The diagnostic accuracy, tumor distribution and image characteristics were compared between both patient groups. RESULTS In control group, preoperative tumor diagnosis was consistent with intraoperative diagnosis in 20 patients, similar in 7 patients and discrepant in 2 patients. In study group, there were 24 consistent, 4 similar, and 1 discrepant diagnoses (p < 0.05 vs. control group). Frequency of individual tumor types, as revealed by either diagnostic method, was comparable. The images obtained with three-dimensional CT reconstruction were clearer, facilitating an accurate demonstration of the tumor, including tumor size and location. CONCLUSIONS Three-dimensional CT reconstruction and cephalometry provides accurate diagnosis of lateral skull base tumors, which is helpful for subsequent surgical treatment.
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Affiliation(s)
- X Z Xie
- CT and Ultrasound Departments, Liaocheng Second People's Hospital, Linqing, Liaocheng, Shandong Province, China.
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30
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Rastatter JC, Snyderman CH, Gardner PA, Alden TD, Tyler-Kabara E. Endoscopic endonasal surgery for sinonasal and skull base lesions in the pediatric population. Otolaryngol Clin North Am 2015; 48:79-99. [PMID: 25439550 DOI: 10.1016/j.otc.2014.09.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Endoscopic endonasal skull base surgical techniques, initially developed in adult patients, are being utilized with increasing frequency in pediatric patients to treat sinonasal and skull base lesions. This article reviews the current state of endoscopic endonasal approaches to the skull base to both treat disease and reconstruct the skull base in pediatric patients. Sinonasal and skull base embryology and anatomy are reviewed as a foundation for understanding the disease processes and surgical techniques. Selected skull base pathologies and conditions that involve the pediatric skull base are also reviewed.
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Affiliation(s)
- Jeffrey C Rastatter
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 25, Chicago, IL 60611, USA; Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, NMH/Galter Room 15-200, 675 N Saint Clair, Chicago, IL 60611, USA.
| | - Carl H Snyderman
- Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh School of Medicine, 200 Lothrop Street, Suite 500, Pittsburgh, PA 15213, USA; Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH B-400, Pittsburgh, PA, 15213, USA.
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH B-400, Pittsburgh, PA, 15213, USA
| | - Tord D Alden
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 28, Chicago, IL 60611, USA; Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, NMH/Arkes Family Pavilion Suite 2210, 676 N Saint Clair, Chicago, IL 60611, USA
| | - Elizabeth Tyler-Kabara
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH B-400, Pittsburgh, PA, 15213, USA; Division of Pediatric Neurosurgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA
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Tatagiba M, Rigante L, Mesquita Filho P, Ebner FH, Roser F. Endoscopic-Assisted Posterior Intradural Petrous Apicectomy in Petroclival Meningiomas: A Clinical Series and Assessment of Perioperative Morbidity. World Neurosurg 2015. [PMID: 26210709 DOI: 10.1016/j.wneu.2015.07.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the clinical feasibility and outcome of the endoscopic-assisted posterior intradural petrous apicectomy approach (PIPA) for petroclival meningiomas extending into the supratentorial space. METHODS From 2005-2013, 29 patients with a petroclival meningioma underwent tumor removal through a PIPA approach. The approach consists of a retrosigmoid approach, intradural anterior resection of the petrous apex and microsurgical removal of the tumor, followed by endoscopic-assisted visualization and removal of tumor parts in the middle fossa or anterior to the brainstem. RESULTS Patients consisted of 7 men and 22 women; the mean age of patients was 52.7 years. In 24 patients, surgery was performed with the patient in a semisitting position; in 5 patients, surgery was performed with the patient in a supine position. A total resection was achieved in 19 patients (66%). A Karnofsky performance scale score >60% was recorded in 27 patients (93%), with surgical complications that involved a cerebrospinal fluid leak in 3 patients, bleeding in the surgical cavity in 2 patients, and pneumocephalus in 1 patient. The most frequent postoperative neurologic deficit was facial palsy (34%), which disappeared or improved consistently in all but 1 patient, who required a cranial nerve VII-cranial nerve XII anastomosis. CONCLUSIONS For petroclival meningiomas extending into the middle fossa, the endoscopic-assisted PIPA approach is safe and straightforward. The principal advantages of the PIPA approach are familiarity with the retrosigmoid route; the absence of temporal lobe retraction; and early control of the cranial nerves, vessels, and brainstem. However, careful patient selection regarding tumor extension is fundamental to obtaining optimal outcomes.
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Affiliation(s)
- Marcos Tatagiba
- Department of Neurosurgery, Eberhard-Karls-Universität Tübingen, Tubingen, Germany
| | - Luigi Rigante
- Department of Neurosurgery, Eberhard-Karls-Universität Tübingen, Tubingen, Germany
| | - Paulo Mesquita Filho
- Department of Neurosurgery, Eberhard-Karls-Universität Tübingen, Tubingen, Germany
| | - Florian H Ebner
- Department of Neurosurgery, Eberhard-Karls-Universität Tübingen, Tubingen, Germany
| | - Florian Roser
- Department of Neurosurgery, Eberhard-Karls-Universität Tübingen, Tubingen, Germany; Department of Neurosurgery, Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates.
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Wu Z, Wang L, Guo Z, Wang K, Zhang Y, Tian K, Zhang J, Sun W, Yu C. Experimental study on differences in clivus chordoma bone invasion: an iTRAQ-based quantitative proteomic analysis. PLoS One 2015; 10:e0119523. [PMID: 25793716 PMCID: PMC4368785 DOI: 10.1371/journal.pone.0119523] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/13/2015] [Indexed: 11/18/2022] Open
Abstract
Although a bone tumor, significant differences in the extent of bone invasion exist in skull base chordoma, which directly affect the extent of surgical resection, and have an impact on its prognosis. However, the underlying mechanism of the phenomenon is not clearly understood. Therefore, we used an iTRAQ-based quantitative proteomics strategy to identify potential molecular signatures, and to find predictive markers of discrepancy in bone invasion of clivus chordoma. According to bone invasive classification criteria, 35 specimens of clivus chordoma were calssified to be either endophytic type (Type I) or exophytic type (Type II). An initial screening of six specimens of endophytic type and six of exophytic was performed, and 250 differentially expressed proteins were identified. Through the GO and IPA analysis, we found evidence that the expression of inflammatory activity-associated proteins up-regulated in endophytic type, whereas the expression of cell motility-associated proteins up-regulated in exophytic ones. Moreover, TGFβ1 and mTOR signal pathway seemed to be related with bone invasion. Thus, TGFβ1, PI3K, Akt, mTOR, and PTEN were validated in the following 23 samples by immune histochemistry and Western blot. The expression levels of TGFβ1 and PTEN were significantly lower in the endophytic type than in the exophytic ones. It was found that TGFβ1 may play an important role in its bone invasion. The mechanisms may be related with conducting an increased inflammatory cell response and a decline in cytoskeletal protein expression. PTEN is confirmed to be associated with the degree of bone invasion. The PI3K/AKT/mTOR signaling pathway might be associated with the bone invasion, but still needs a larger sample size to be verified These results, for the first time, not only demonstrate the biological changes that occur in different growth patterns from the perspective of proteomics, but also provide novel markers that may help to reveal the mechanisms behind clivus chordomas.
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Affiliation(s)
- Zhen Wu
- Dept Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, PR China
| | - Liang Wang
- Dept Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, PR China
| | - Zhengguang Guo
- Core Facility of Instruments, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences Peking Union Medical College, Beijing, PR China
| | - Ke Wang
- Dept Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, PR China
| | - Yang Zhang
- Dept Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, PR China
| | - Kaibing Tian
- Dept Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, PR China
| | - Junting Zhang
- Dept Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, PR China
| | - Wei Sun
- Core Facility of Instruments, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences Peking Union Medical College, Beijing, PR China
| | - Chunjiang Yu
- Dept Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, PR China
- * E-mail: (CJY); (WS)
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Chen Z, Ye Y, Qiu Q, Zhang S, Liu Y. [A case report: myofibroblastic sarcoma of the nasal cavity and skull base have survived 9 years after endoscopic surgery]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 50:73-74. [PMID: 25764937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Ahmed R, Sheybani A, Menezes AH, Buatti JM, Hitchon PW. Disease outcomes for skull base and spinal chordomas: a single center experience. Clin Neurol Neurosurg 2014; 130:67-73. [PMID: 25590662 DOI: 10.1016/j.clineuro.2014.12.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/11/2014] [Accepted: 12/20/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Chordomas carry significant morbidity due to their growth patterns and surgical constraints in resection. En bloc resection, when feasible, is the ideal treatment goal, but is associated with significant morbidity. We sought to elucidate the relationship between extent of surgery, location and radiotherapy in relation to overall disease and progression free survival (PFS). METHODS We reviewed case records for all patients with a primary histopathological diagnosis of clival and spinal chordomas that was presented to our institution between 1978 and 2010. RESULTS A total of 49 patients (location: n=30, skull base/clival; n=12 vertebral column; n=7 sacrum) were identified with mean follow-up period of 6.3 years (range 0.25 months-33 years). Improved 5 year and 10 year survival rates were noted following gross total resection (n=8, 5 year and 10 year survival=88%) as compared to patients that underwent subtotal resection (n=41, 55% and 31%, respectively), (p-value>0.05, GTR versus STR). Adjuvant high-dose stereotactic fractionated radiotherapy (HS-FSRT) significantly improved 5 year PFS in craniocervical chordoma patients (70%, n=13) as compared to standard dose radiation therapy (20%, n=16; p-value=0.03). Overall 10 year survival for craniocervical patients undergoing HD-FSRT (40%) was however not significantly different in comparison with conventional radiotherapy (45%). Sacral chordomas had the worst prognosis with 3 year survival of 28.6%. CONCLUSIONS GTR offers the best prognosis for improved long-term survival. Adjuvant HD FSRT for cranio-cervical/clival chordomas significantly improves disease free survival though the long-term benefits on survival have yet to be established. Sacral chordomas are associated with a worse prognosis and poor long-term survival.
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Affiliation(s)
- Raheel Ahmed
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City 52246, USA.
| | - Arshin Sheybani
- Radiation Oncology; University of Iowa Hospitals and Clinics, Iowa City 52246, USA
| | - Arnold H Menezes
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City 52246, USA
| | - John M Buatti
- Radiation Oncology; University of Iowa Hospitals and Clinics, Iowa City 52246, USA
| | - Patrick W Hitchon
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City 52246, USA
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Li D, Hao SY, Wang L, Tang J, Xiao XR, Jia GJ, Wu Z, Zhang LW, Zhang JT. Recurrent petroclival meningiomas: clinical characteristics, management, and outcomes. Neurosurg Rev 2014; 38:71-86; discussion 86-7. [PMID: 25319087 DOI: 10.1007/s10143-014-0575-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 03/22/2014] [Accepted: 05/18/2014] [Indexed: 11/25/2022]
Abstract
This study seeks to elucidate the prognostic predictors and outcomes of recurrent/progressive petroclival meningiomas (PCMs). We reviewed our cohort of 39 recurrent/progressive PCMs (27 females, 69.2%) and analyzed the results from the literature. Twenty-three patients underwent reoperations, 2 received radiotherapy alone, and 14 declined any treatment. During a follow-up of 70.4 months, 7 patients experienced a 2nd recurrence/progression (R/P) and 18 patients died. In the 23 patients, gross total resection (GTR), subtotal resection (STR), and partial resection (PR) were achieved in 8, 8, and 7 patients, respectively. The percentage of the 2nd R/P-free survival of GTR, STR, and PR was 88%, 67%, and 40%, respectively. The overall survival following the 1st R/P of GTR, STR, and PR was 88%, 63%, and 33%, respectively. Patients rejecting treatment suffered from significantly poor overall survival (7%; p = 0.001) and short survival duration (42.0 months; p = 0.016) compared with that of the patients receiving treatment (67% and 86.9 months). The GTR was the only independent favorable predictor. In the 21 included studies with 98 recurrent/progressive PCM patients, 17 patients presented with a 2nd R/P and 10 died of a 2nd R/P; patients undergoing observation had a significantly poor tumor regrowth control rate compared with patients undergoing surgery (p = 0.004) or radiotherapy alone (p < 0.001). Proactive treatment should be performed for patients with recurrent/progressive PCMs. Observation can lead to relentless outcome. GTR as a preferential therapeutic strategy should be pursued as far as possible on the condition of minimal functional impairment.
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Affiliation(s)
- Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6,, Chongwen District, Beijing, 100050, People's Republic of China
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36
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Della Puppa A, Rustemi O, Gioffrè G. Response. J Neurosurg 2014; 121:766-768. [PMID: 25317438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Santana EFM, Helfer TM, Piassi Passos J, Araujo Júnior E. Prenatal diagnosis of a giant epignathus teratoma in the third trimester of pregnancy using three-dimensional ultrasound and magnetic resonance imaging. Case report. Med Ultrason 2014; 16:168-171. [PMID: 24791849 DOI: 10.11152/mu.201.3.2066.162.efms1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 20-year-old nulliparous woman was referred due a cervical mass in the fetus in an ultrasound examination performed in the 25th week of pregnancy. The exam revealed an irregular, solid-cystic heterogeneous mass measuring 75x54 mm that came to the exterior through the mouth of the fetus. Three-dimensional ultrasound and magnetic resonance imaging confirmed the diagnosis of epignathus teratoma and the normal finding of the central nervous system. The patient was admitted at 28 weeks, in premature labor. Tocolysis, corticosteroid and amniotic fluid drainage were programmed to be performed before conducting ex utero intrapartum treatment (EXIT). However, there was premature rupture of membranes and the EXIT procedure was brought forward. After premature placental abruption, the newborn's birth was concluded. Tracheostomy was performed, but the newborn's condition progressed to bradycardia and death in a few minutes.
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Affiliation(s)
| | | | - Jurandir Piassi Passos
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo-SP, Brazil
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38
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Gousias K, Niehusmann P, Gielen GH, Simon M. Karyopherin a2 and chromosome region maintenance protein 1 expression in meningiomas: novel biomarkers for recurrence and malignant progression. J Neurooncol 2014; 118:289-296. [PMID: 24664371 DOI: 10.1007/s11060-014-1423-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 03/11/2014] [Indexed: 11/28/2022]
Abstract
The karyopherin protein family comprises importins and exportins which are nucleocytoplasmic shuttling receptors. Increased levels of karyopherin a2 and chromosome region maintenance protein 1 correlate with a higher WHO grade and a poorer prognosis in patients with infiltrative astrocytomas. The aim of this study was to evaluate representative members of importins and exportins (i.e. karyopherin a2 and chromosome region maintenance protein 1) as novel biomarkers for meningiomas of WHO grades I-III. We semiquantitatively analyzed nuclear expression of karyopherin a2, chromosome region maintenance protein 1 and the MIB1 labeling index using immunohistochemistry in 108 primary (44 meningiomas WHO grade I, 48 meningiomas WHO grade II, 16 meningiomas WHO grade III) and 13 recurrent meningiomas. Statistical analysis was performed using standard techniques. Karyopherin a2 (p < 0.001) and chromosome region maintenance protein 1 (p = 0.002) expression correlated significantly with the histological grade. Karyopherin a2 expression correlated with proliferative activity as assessed by the MIB1 index (p < 0.001). Recurrent tumors expressed significantly higher levels of karyopherin a2 (p = 0.045) when compared to primary growths. Multivariate analysis of the overall series as well as of patients with atypical meningiomas identified higher karyopherin a2 (≥ 5 vs. <5%) and chromosome region maintenance protein 1 (≥ 60 vs. 60%) expression as independent predictors of tumor recurrence. Karyopherin a2 and chromosome region maintenance protein 1 expression may have potential as novel biomarkers for meningiomas.
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Affiliation(s)
- Konstantinos Gousias
- Department of Neurosurgery, University Hospital of Bonn, Sigmund Freud Strasse 25, 53105, Bonn, Germany.
| | - Pitt Niehusmann
- Department of Neuropathology, University Hospital of Bonn, Sigmund Freud Strasse 25, 53105, Bonn, Germany
| | - Gerrit H Gielen
- Department of Neuropathology, University Hospital of Bonn, Sigmund Freud Strasse 25, 53105, Bonn, Germany
| | - Matthias Simon
- Department of Neurosurgery, University Hospital of Bonn, Sigmund Freud Strasse 25, 53105, Bonn, Germany
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Sari-Rieger A, Hassfeld S, Junker K, Rustemeyer J. Adenoid cystic carcinoma of the skull base mimicking temporomandibular disorder. Oral Maxillofac Surg 2014; 18:115-118. [PMID: 23636713 DOI: 10.1007/s10006-013-0414-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 04/15/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Temporomandibular disorder (TMD) involves problems of the temporomandibular joint and its adjacent muscular system. Because TMD prevalence is high among Western populations, complaints in these regions are generally attributed to TMD. However, in rare cases, TMD symptoms are mimicked by malignant tumors of the head. CASE REPORT Upon first presentation, an 18-year-old female complained about typical symptoms of TMD. After an initial splint therapy and physiotherapy, painful symptoms increased significantly. Twelve weeks after initial diagnosis, further diagnostic imaging revealed a tumor formation at the skull base with infiltration of the infratemporal fossa. Histological evaluation confirmed the diagnosis of adenoid cystic carcinoma. Two years after resection of the tumor, lung metastases were detected with no option of curative treatment. CONCLUSION TMD symptoms, which are refractory to treatment or exhibit significant worsening during therapy, should be regarded as warning signals and as an indication that early further diagnostic imaging is warranted.
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Affiliation(s)
- Aynur Sari-Rieger
- Department of Oral and Maxillofacial Surgery, Plastic Operations, Klinikum Bremen-Mitte, School of Medicine of the University of Göttingen, Bremen, Germany
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40
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Pasche P, Broome M, Daniel RT. [Skin cancers infiltrating the skull base]. Rev Med Suisse 2013; 9:1758-1764. [PMID: 24187748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Squamous cell and basocellular carcinoma of the face have an excellent prognosis. Nevertherless, a small proportion therefore of these cancers differs by a much more aggressive behavior, caracterised by a tendency to infiltrate the deep facial soft tissues and facial bones. The invasion of the craniofacial skeleton and the intracranial structures follows the embryonic fusion lines or the facial sensitive or motor nerves, sometimes years after the initial treatment. The development of craniofacial surgery, reconstruction techniques and conformational radiotherapy allows us now to offer curative guided treatments, for these advanced staged tumors with a remaining limited prognosis. A therapeutic benefit implies a rigorous selection of these patients.
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Affiliation(s)
- P Pasche
- Service d'ORL et de chirurgie cervico-faciale, CHUV, 1011 Lausanne.
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41
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Zhang FP, She CP, Bing J, Zhang QF. [One case of meningioma of middle and posterior fossae and skull base: as monaural secretory otitis media for the first performance]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 48:842-843. [PMID: 24406183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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42
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Bekelis K, Roberts DW. Response. Neurosurg Focus 2013; 35:E6. [PMID: 24205519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Moiyadi AV, Pai P, Nair D, Pal P, Shetty P. Dural involvement in skull base tumors--accuracy of preoperative radiological evaluation and intraoperative assessment. J Craniofac Surg 2013; 24:1268-1272. [PMID: 24015414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Dural involvement is an important consideration in assessment of cranial base tumors dictating resectability and prognosis. Preoperative as well as intraoperative clues are valuable but not always correct. We evaluated a consecutive series of craniofacial resections at our center to correlate radiologically suspected dural involvement vis-à-vis intraoperative assessment and eventual pathology. METHODS We conducted a retrospective analysis of cases of skull base tumors where potential dural involvement was considered. We recorded the preoperative radiological impression (contrast-enhanced magnetic resonance imaging) regarding dural involvement (normal, extradural, intradural, parenchymal disease), intraoperative impression (normal, adherent, subdural, parenchymal disease), and final histology (normal, reactive, tumor). We also recorded instances where the dura was resected and/or inadvertently breached and the incidence of postoperative cerebrospinal fluid leak and meningitis. RESULTS One hundred twenty-seven cases were evaluated. Transcranial approaches were performed in 68 cases. Nineteen percent (24 cases) were endoscopic procedures. Dural resection was performed in 38 cases (30 being proven pathologically). The incidence of cerebrospinal fluid leak was 4.7%. The sensitivity, specificity, positive predictive value, and negative predictive value of magnetic resonance assessment were 34.5%, 97.9%, 83.3%, and 83.2%, respectively, providing an overall accuracy of 84%, and those for intraoperative dural adherence were 84.6%, 85.6%, 44%, 97.6%, and 85.5.%, respectively. CONCLUSIONS Preoperative magnetic resonance imaging, although a good modality for imaging the disease extent, may not always identify the extent of dural involvement. Intraoperative assessment therefore becomes very important especially when it is unequivocally normal. Both should be used to ensure accurate treatment strategies and tailor the need for dural resection.
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Affiliation(s)
- Aliasgar V Moiyadi
- Departments of Neurosurgery, Tata Memorial Centre, Parel, Mumbai, India.
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Dash S, Annamalai AK, Simpson HL, Sarkies N, Antoun NM, Mannion R. Acute shrinkage of a giant prolactinoma, masquerading as an erosive skull base tumour, with cabergoline. QJM 2013; 106:85. [PMID: 22075008 DOI: 10.1093/qjmed/hcr221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S Dash
- Institute of Metabolic Science, Wolfson Diabetes and Endocrine Clinic, Addenbrooke's Hospital, Cambridge University NHS Trust, Cambridge, UK
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45
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Zielinski G, Grala B, Koziarski A, Kozlowski W. Skull base secretory meningioma. Value of histological and immunohistochemical findings for peritumoral brain edema formation. Neuro Endocrinol Lett 2013; 34:111-117. [PMID: 23645307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 02/18/2013] [Indexed: 06/02/2023]
Abstract
Meningiomas are very common neurosurgical problem. Their histological appearance, different size and localization, adherence to vital neural and vascular structures or extensive peritumoral brain edema (PTBE), especially in deep seated tumors, may lead to severe, life-threatening complications. We report a case of tuberculum sellae meningioma (TSM). A 48-year old female presented with 7-month history of blurred vision and progressive visual impairment. Intracranial tumor was confirmed by magnetic resonance imaging (MRI). After ophtalmological and endocrinological evaluation, the patient underwent surgical removal of the tumor. She immediately recovered from her visual disturbances and no tumor recurrences were seen during follow-up. Pathological diagnosis showed a meningioma of the secretory subtype (MS). We discuss the role of immunohistochemical staining in the diagnosis and the role of different factors in the PTBE formation. Selection of surgical route to the TSM is discussed, as well. Review of the literature is presented.
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Affiliation(s)
- Grzegorz Zielinski
- Department of Neurosurgery, Military Institute of Medicine, Warsaw, Poland.
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46
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Amiraraghi N, Syed MI, Syed S, Williams AT. Paraganglioma of the skull base presenting as nasal polyps. Laryngoscope 2012; 123:577-80. [PMID: 23027682 DOI: 10.1002/lary.23645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/27/2012] [Accepted: 07/09/2012] [Indexed: 11/07/2022]
Abstract
The authors report a case of paraganglioma of the skull base presenting as nasal polyps. A 29-year-old patient presented with epistaxis and was found to have nasal polyps. The patient underwent a nasal polypectomy. After pathology showed an unusual appearance, the mass was subsequently excised endoscopically using radiofrequency coblation, and it was found to be originating from the skull base. The diagnosis was made using a combination of clinical findings, radiology, and histopathology examination. It is important to consider paraganglioma in the differential diagnosis of unusual tumors of the nose and skull base.
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Affiliation(s)
- Natasha Amiraraghi
- Department of Otolaryngology, The Royal Infirmary, Edinburgh, United Kingdom
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47
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Friedrich RE. Transoral or parapharyngeal approach to remove sporadic skull base schwannoma. Anticancer Res 2012; 32:4557-4559. [PMID: 23060586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Sporadic schwannomas of the skull base are rare. We present two cases with sporadic schwannoma of this region that pose diagnostic and therapeutic problems. The first patient (female, 40 years of age) developed an extensive vagal schwannoma with deviation of the internal carotid to the medial side. A transoral extirpation of the tumour was chosen to allow for surgery without visible scars. A second patient (female, 63 years of age) developed a skull base tumour some months after resection of oral squamous cell carcinoma from the floor of the mouth. This tumour was not visible on computed-tomographic scans taken prior to ablative surgery for oral cancer. A lateral pharyngotomy was chosen in order to allow for extension of the resection in case of carcinoma spread. Healing was uneventful in both patients. Both patients developed solitary schwannomas-only, without any hint of type 2 neurofibromatosis or schwannomatosis during a follow-up of several years. Exclusion of a tumour predisposition syndrome is recommended in patients with peripheral nerve sheath tumours.
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Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany.
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Guinto-Balanzar G, Abdo-Toro M, Aréchiga-Ramos N, Leal-Ortega R, Zepeda-Fernández E, Nambo-Lucio MDJ. Plasma cell tumor of the clivus: report of two cases. CIR CIR 2012; 80:171-176. [PMID: 22644013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Plasma cell tumor only rarely affects the cranium and may be found as an isolated lesion or as a part of multiple myeloma. In this review we present the clinical and radiological characteristics and analyze the evolution of two cases of this tumor located at the skull base, specifically in the clivus and sellar region. We also present a brief review of the literature. CLINICAL CASES Case #1: The patient was a 66-year-old female with a solitary plasmacytoma of the bone (the isolated form of plasma cell tumor) that was totally removed. Case #2: The patient was a 61-year-old male with the diffuse form of this disease who was submitted to subtotal removal. In both patients, adjuvant treatment based on radiotherapy and chemotherapy was proposed; however, only one patient (Case #2) accepted adjuvant treatment and had a very favorable result. Most clinical symptoms disappeared and the patient is currently alive and with a very good quality of life (>3-year follow-up). The other patient (Case #1), despite the presence of the localized form of the disease, died 3 months after diagnosis. CONCLUSION Early diagnosis and removal of as much of the tumor as possible, but mainly the opportune indication of adjuvant treatment with radiotherapy and chemotherapy, are the keys to management of these cases.
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Affiliation(s)
- Gerardo Guinto-Balanzar
- Neurocirugía del Hospital de Especialidades del Centro Médico Nacional Siglo XXI, México, Distrito Federal, Mexico.
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Klimenko KÉ. [The recent news in endoscopic surgery: a review of the literature and meta-analysis]. Vestn Otorinolaringol 2012:98-104. [PMID: 23304718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
During a few recent years, endonasal surgery has become the principal tool for the operative treatment of many pathologies affecting the base of the skull. The present work was designed to estimate the possibilities of using endoscopic endonasal surgery to treat sinus and skull base lesions and illustrate the recent progress in the development of endoscopic equipment and instrumentation. The meta-analysis of the results of on-going research on the application of the endonasal endoscopic technology is described with the special emphasis on the plastic treatment of liquor fistulas, removal of juvenile nasopharyngeal angiofibromas, treatment of pathological changes in the clivial region and odontoid cervicomedullary junction.
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Affiliation(s)
- Albert H Kim
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
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