Transcervical Approach for Resection of Lateral Skull Base Tumors

Objectives Conventional approaches for removal of lateral skull base tumors, including transmandibular, infratemporal fossa, preauricular transzygmatic subtemporal approaches, are major invasive procedures that often sacrifice hearing and cause abnormal occlusion and cosmetic defects. Reports of the transcervical approach for resection of skull base tumors are rare, although it was described for resection of clival chordomas in as early as 1966. The purpose of this study is to review our experiences in management of lateral skull base tumors using the transcervical approach. Study Design Retrospective chart review. Methods Six lateral skull base tumor cases treated with transcervical approach procedures were reviewed, including the medical records. Results There were 4 males and 2 females. Age ranged from 12 through 52 years. Histopathological diagnoses included malignant schwannoma(n = 1), malignant carotid body tumor(n = 1), heamangioma(n=1), schwannoma (n=2) and pleomorphic adenoma (n = 1). Transcervical techniques were used in all cases with the use of microscope in the lateral skull base area. Complete tumor removal was achieved in all cases. Postoperative radiotherapy was implemented in 1 case of malignant schwannoma and 1 case of malignant carotid body tumor. Jugular foramen syndrome occurred as a surgical complication in 1 case of malignant Schwannoma of the vagus nerve. There was no tumor recurrence during the 10 - 42 month follow-up period. Conclusion Compared with conventional approaches, the transcervical approach provides a easy, safe, minimal invasive and effective procedure for removal of selected lateral skull base tumors.

Recurrent ameloblastoma in the anterior skull base: Report of 3 cases

Recurrent ameloblastoma is common following inadequate excision but rarely presents in the anterior skull base. We presented 3 patients with recurrent ameloblastoma in the anterior skull base including the frontotemporal fossa and the pterygomaxillary fossa that occurred following multiple enucleations, segmental mandibulectomy, or partial maxillectomy for ameloblastoma in the jaws. Attenborough approach was used in the exposure of the frontotemporal fossa. Attenborough plus Barbosa approach was used in the exposure of the pterygomaxillary fossa. The patients were treated by radical dissection. Microscopy confirmed that the histopathologic pattern of one case was fixed follicular and plexiform, two cases were follicular. All patients healed without serious complications. The local recurrences of the patients following the operations were found in 3 to 4 years. The present study showed that the tumors in the regions had a greater recurrence potential even when treated with radical dissection, and the original tumors were the high-risk follicular pattern.

Postoperative mometasone irrigations improve quality of life in skull base tumor patients

Objectives:The use of topical corticosteroids to manage postoperative sinonasal symptoms after endoscopic skull base surgery (ESBS) has not been well studied.We quantified long‐term impact of postoperative steroid irrigations (SIs) on quality of life of patients after ESBS.Methods:Retrospective review of patients at the University of Pennsylvania undergoing ESBS from 2010 to 2019.Data on patient demographics and postoperative treatment with nasal saline irrigation twice daily with and without dissolved steroids (mometasone or budesonide) was collected.Preoperative,and 1‐,3‐,6‐,12‐,18‐,and 24‐month postoperative Sino‐Nasal Outcome Test (SNOT‐22) scores were assessed.Results:A total of 727 patients were assessed (53.4% males),with 479 patients in the no SI group and 248 patients in the SI group.Preoperative SNOT‐22 scores did not differ significantly (P = 0.19).1‐,3‐,6‐,12‐,18‐,and 24‐month post‐op SNOT‐22 scores did not significantly differ between groups.However,mometasone irrigations resulted in significantly lower postoperative 2‐year SNOT‐22 scores compared to budesonide (P < 0.01) and saline (P = 0.03).Conclusions:Though corticosteroid irrigations are routine in managing inflammatory sinus disease,their role in postoperative management after ESBS for tumors is unclear.Our findings suggest that mometasone irrigation may be effective at improving postoperative quality of life in patients after ESBS.

Treatment of skull base communicating tumor with endoscopeassisted microneurosurgery and diode laser

The skull base communicating tumor is characterized by simultaneous invasion of the intracranial and extracranial structures. The tumor may originate from the intracranial structures and invade extracranially, or vice versa. The total resection of the tumor is difficult, and a lot of complications may occur after the operation.1 From September 1998 to September 2002, 21 patients with skull base communicating tumors were treated in our hospital by endoscope-assisted combined with diode laser through approaches. microneurosurgery different operative

Frontal lobe position after single-layer cadaveric dermal matrix repair of large anterior skull base defects

Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always be available.One alternative option is a flexible single-layer ASB repair.Initial studies indicate low cerebrospinal fluid leak rates with a single-layer repair.However,the level of frontal lobe support,particularly the propensity for a significant inferior displacement of the frontal lobe,is not known.The goal of this study is to determine the frontal lobe position after single-layer acellular dermal allograft repair in large ASB defects.Study Design:Retrospective cohort study.Setting:Tertiary care medical center.Subjects and Methods:This cohort study compares the frontal lobe position in adults who underwent endoscopic endonasal ASB tumor resection and single-layer cadaveric dermal matrix repair(ASB cohort)with control subjects without intracranial abnormalities(control cohort).The ASB cohort includes subjects with an ASB defect of≥5 cm anterior/posterior and≥1.5 cm wide and who had imaging at least 2 months after surgery.The frontal lobe position is measured on sagittal CT/MRI using a reference line from the base of the sella to the nasion.A value of zero indicates that the inferior-most aspect of the frontal lobe is at the level of the nasion-sellar line.A positive value indicates that the frontal lobe is inferior to the nasion-sellar line.The ASB cohort frontal lobe position is compared with the control cohort using the Mann-WhitneyU test.A priori we set an absolute difference of 5 mm as a clinically significant difference.Results:The ASB cohort includes 47 subjects who are 57%male with an average age of 60 years(range:31-89 years).The most common ASB pathology is esthesioneuroblastoma(n=21)and 81%of the ASB cohort had postoperative radiation.The control cohort includes 20 subjects who are 60%male,with a mean age of 45 years(range:19-74 years).The majority of controls underwent imaging for head trauma(n=13).The ASB mean frontal lobe position is-0.2 mm superior to the nasion-sellar line(range:-9.2 to 10.4 mm),while the control’’s mean frontal lobe position is 1.1 mm inferior to the nasion-sellar line.This difference is not statistically significant(P=0.13)and does not reach our a priori definition of clinical significance.The frontal lobe position of ASB subjects who had radiation is closer to the nasion-sellar line as compared with those who did not undergo radiation.Conclusions:Single-layer acellular dermal graft repair maintains frontal lobe support and position in large ASB defects.

Multi-disciplinary surgery for simultaneous resection of multiple tumors in a patient with newly diagnosed metastatic pheochromocytoma/paraganglioma

Metastatic pheochromocytoma/paraganglioma(MPP)is a rare endocrine tumor that originates from extra-adrenal chromaffin cells such as the paraganglia cells of sympathetic and parasympathetic nerves.It usually causes multiple solid tumors and exhibits strong aggressiveness with poor prognosis,with a reported 5-year survival rate of less than 50%.Cases of brain and retroperitoneal metastases at the initial diagnosis have not yet been reported.We report a 41-year-old male patient initially diagnosed with MPP in the brain and retroperitoneum who underwent multi-disciplinary collaborative surgery and simultaneous removal of two tumors at our center.Postoperative pathology revealed infiltrative growth of a skull base tumor.The patient chose to receive the tyrosine kinase inhibitor sunitinib as a targeted treatment.A 3-month follow-up after surgery showed that the patient recovered well without signs of metastasis or recurrence.We present multi-disciplinary surgery under similar circumstances for enhanced treatment and postoperative management.The patient demonstrates a favorable prognosis during postoperative follow-up,indicating that simultaneous multidisciplinary surgery may offer greater benefits for MPP patients.