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Yang R, Li QX, Mao C, Peng X, Wang Y, Guo YX, Guo CB. [Multimodal image fusion technology for diagnosis and treatment of the skull base-infratemporal tumors]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:53-58. [PMID: 30773544 DOI: 10.19723/j.issn.1671-167x.2019.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To explore the value of incorporated multimodal image fusion technology with computer-aided design of the skull base-infratemporal tumor treatment. METHODS A retrospective study was carried out to enroll seventeen patients with skull base-infratemporal tumors treated at Peking University Hospital of Stomatology from February 2011 to September 2018. Plain CT, enhanced CT and MRI data were imported into the iPlan 3.0 software (BrainLab navigation system), and the image fusion was performed for each patient preoperatively. Then the three-dimensional images of the tumor, vital vessels and craniofacial bones were reconstructed to prepare virtual operation design. We evaluated the application of multimodal image fusion technology that had been incorporated with computer-aided planning during the navigation-guided biopsy or surgery, through the analysis of the biopsy and operation data and regular follow-up postoperatively. RESULTS The mean age of 17 patients (7 males and 10 females) was 46 years. Primary tumors occurred in 11 cases, and recurrent tumors in 6 cases. The size of the 17 tumors ranged from 2.9 cm to 9 cm, and the mean size was 4.35 cm. There were 7 cases with skull base bone destruction and/or intracranial extension, and 10 cases with tumors adjacent to the skull base. High-quality multimodal fused images were obtained in all the 17 cases. The spatial-position relationships of the tumors, adjacent craniomaxillofacial bones and vital vessels labeled with different colors were displayed well on the generated fusion images. The multimodal image fusion technology that incorporated with computer-aided three-dimensional reconstruction and then applied in navigation-guided biopsy or surgery showed that, preoperative analysis and virtual operation design functioned with good results, especially in cases with small tumor size, recurrence or illdefined borders in the skull base-infratemporal region. Operation was carried out in 16 cases after preoperative diagnosis and assessment, and 1 case was performed by navigation-guided biopsy only. The proportions of navigation-guided surgery and biopsy were 70.6% (12/17) and 17.6% (3/17) individually. The positive rate of pathologic diagnosis using navigation-guided biopsy was 100% (3/3). All the navigation-guided biopsies or operations were carried out successfully. Complications included 1 case of cerebrospinal fluid leak from a recurred meningioma patient postoperatively, and 1 case of facial paralysis resulting from parotid-gland deep lobe tumor. Most (14/15) tumors got complete removal with safe boundary through intra-operative navigation verification and post-operative imaging confirmation, except for one case of subtotal resection to avoid the injury of cavernous sinus. The pathological results of the tumors could be classified to mesenchymal (10), adenogenous (3), neurogenic (3) or epithelial (1) resources. The follow-up time ranged from 3 to 94 months, with the median follow-up time of 9 months. CONCLUSION Taking full advantages of individualized multimodal images, could help analyze the three-dimensional spatial position relationship of tumors, vital vessels and craniofacial bones properly, and then complete the virtual operation design well. The incorporated multimodal image fusion technology with navigation technology may improve the accuracy and safety of core needle biopsy and surgical treatment of skull base-infratemporal tumors.
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Affiliation(s)
- R Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Q X Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - C Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - X Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Y Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Y X Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - C B Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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Conde-Díaz C, Llenas-García J, Parra Grande M, Terol Esclapez G, Masiá M, Gutiérrez F. Severe skull base osteomyelitis caused by Pseudomonas aeruginosa with successful outcome after prolonged outpatient therapy with continuous infusion of ceftazidime and oral ciprofloxacin: a case report. J Med Case Rep 2017; 11:48. [PMID: 28219414 PMCID: PMC5319094 DOI: 10.1186/s13256-017-1221-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/24/2017] [Indexed: 11/16/2022] Open
Abstract
Background Skull base osteomyelitis is an uncommon disease that usually complicates a malignant external otitis with temporal bone involvement. It affects predominantly diabetic and immunocompromised males and has a high mortality rate. Pseudomonas aeruginosa is the most common causative organism. Currently, there is no consensus about the best therapeutic option. Here we describe a case of severe skull base osteomyelitis caused by Pseudomonas aeruginosa with progressive palsy of cranial nerves that was successfully managed with prolonged outpatient continuous infusion of ceftazidime plus oral ciprofloxacin. Case presentation A 69-year-old Caucasian man presented with dysphagia, headache, and weight loss. He complained of left earache and purulent otorrhea. Over the following weeks he developed progressive palsy of IX, X, VI, and XII cranial nerves and papilledema. A petrous bone computed tomography scan showed a mass in the left jugular foramen with a strong lytic component that expanded to the cavum. A biopsy was then performed and microbiological cultures grew Pseudomonas aeruginosa. After 6 weeks of parenteral antibiotic treatment, our patient was discharged and treatment was continued with a domiciliary continuous infusion of a beta-lactam through a peripherally inserted central catheter, along with an oral fluoroquinolone for 10 months. Both radiological and clinical responses were excellent. Conclusions Skull base osteomyelitis is a life-threating condition; clinical suspicion and correct microbiological identification are key to achieve an accurate and timely diagnosis. Due to the poor outcome of Pseudomonas aeruginosa skull base osteomyelitis, prolonged outpatient parenteral antibiotic therapy administered by continuous infusion could be a valuable option for these patients.
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Affiliation(s)
- Cristina Conde-Díaz
- Infectious Diseases Unit, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03203, Elche, Alicante, Spain.
| | - Jara Llenas-García
- Infectious Diseases Unit, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03203, Elche, Alicante, Spain.,Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Mónica Parra Grande
- Departement of Microbiology, Hospital General Universitario de Elche, Alicante, Spain
| | - Gertrudis Terol Esclapez
- Infectious Diseases Unit, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03203, Elche, Alicante, Spain
| | - Mar Masiá
- Infectious Diseases Unit, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03203, Elche, Alicante, Spain.,Universidad Miguel Hernández, Alicante, Spain
| | - Félix Gutiérrez
- Infectious Diseases Unit, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03203, Elche, Alicante, Spain.,Universidad Miguel Hernández, Alicante, Spain
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Elkhatib AH, Soldatova L, Carrau RL, Hachem RA, Ditzel L, Campbell R, Prevedello DM, Prevedello L, Filho LFSD, Campbell RG. Role of 18 F-FDG PET/CT differentiating olfactory neuroblastoma from sinonasal undifferentiated carcinoma. Laryngoscope 2016; 127:321-324. [PMID: 27481043 DOI: 10.1002/lary.26194] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/10/2016] [Accepted: 06/22/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The purpose of this study is to demonstrate the potential contribution of positron emission tomography (PET)/computed tomography (CT) to help differentiate olfactory neuroblastoma (ONB) from sinonasal undifferentiated carcinoma (SNUC). METHODS Following approval by the institutional review board at the Wexner Medical Center at the Ohio State University, Columbus, Ohio, a pilot study with retrospective review of patients with biopsy-proven diagnosis of ONB s and SNUC s was conducted. Staging PET/CT scans were reviewed to document the maximum standardized uptake value (SUVmax). A statistical comparison of SUVmax was performed. RESULTS We identified 13 patients (7 with ONBs and 6 with SNUCs) with mean age 60.2 years who had undergone staging F-18 fluorodeoxyglucose (18 F-FDG) PET/CT of the primary tumor at the time of their diagnosis. Mean SUVmax was found to be five-fold higher in SNUC patients (35.63, range 10.8-77.9) than in ONB patients (7.24, range 4.6-10.7) (P ≤ 0.00169). CONCLUSION Maximum standardized uptake value of 18 F-FDG PET/CT can be used to initially discriminate between ONB and SNUC. This finding may prove helpful to guide diagnostic and treatment planning when the histopathologic diagnosis is inconclusive. LEVEL OF EVIDENCE 4. Laryngoscope, 2016 127:321-324, 2017.
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Affiliation(s)
- Ahmad H Elkhatib
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Ohio, U.S.A
| | - Liuba Soldatova
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Ohio, U.S.A.,Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Ohio, U.S.A
| | - Ralph Abi Hachem
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Ohio, U.S.A
| | - Leo Ditzel
- Department of Neurosurgery, Hospital Santa Cruz, Curitiba, Brazil
| | - Raewyn Campbell
- Department of Otolaryngology-Head & Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Daniel M Prevedello
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Ohio, U.S.A.,Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Ohio, U.S.A
| | - Luciano Prevedello
- Department of Radiology, The Ohio State University Wexner Medical Center, Ohio, U.S.A
| | | | - Raewyn G Campbell
- Department of Otolaryngology-Head & Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Gassner HG, Schwan F, Schebesch KM. Minimally invasive surgery of the anterior skull base: transorbital approaches. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 14:Doc03. [PMID: 27453759 PMCID: PMC4940979 DOI: 10.3205/cto000118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach.
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Affiliation(s)
- Holger G Gassner
- Department of Otolaryngology, Head & Neck Surgery, University Medicine of Regensburg, Germany
| | - Franziska Schwan
- Department of Otolaryngology, Head & Neck Surgery, University Medicine of Regensburg, Germany
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García-Garrigós E, Arenas-Jiménez JJ, Monjas-Cánovas I, Abarca-Olivas J, Cortés-Vela JJ, De La Hoz-Rosa J, Guirau-Rubio MD. Transsphenoidal Approach in Endoscopic Endonasal Surgery for Skull Base Lesions: What Radiologists and Surgeons Need to Know. Radiographics 2015; 35:1170-85. [PMID: 26046941 DOI: 10.1148/rg.2015140105] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal invasiveness, lower incidence of complications, and lower morbidity and mortality rates compared with traditional approaches. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and the pituitary gland above. More recently, extended approaches have expanded the indications for transsphenoidal surgery by using different corridors leading to specific target areas, from the crista galli to the spinomedullary junction. Computer-assisted surgery is an evolving technology that allows real-time anatomic navigation during endoscopic surgery by linking preoperative triplanar radiologic images and intraoperative endoscopic views, thus helping the surgeon avoid damage to vital structures. Preoperative computed tomography is the preferred modality to show bone landmarks and vascular structures. Radiologists play an important role in surgical planning by reporting extension of sphenoid pneumatization, recesses and septations of the sinus, and other relevant anatomic variants. Radiologists should understand the relationships of the sphenoid bone and skull base structures, anatomic variants, and image-guided neuronavigation techniques to prevent surgical complications and allow effective treatment of skull base lesions with the endoscopic endonasal transsphenoidal approach.
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Affiliation(s)
- Elena García-Garrigós
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Juan José Arenas-Jiménez
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Irene Monjas-Cánovas
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Javier Abarca-Olivas
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Jesús Julián Cortés-Vela
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Javier De La Hoz-Rosa
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Maria Dolores Guirau-Rubio
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
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Choudhri AF, Patel RM, Wilroy RS, Pivnick EK, Whitehead MT. Trigeminal nerve agenesis with absence of foramina rotunda in Gómez-López-Hernández syndrome. Am J Med Genet A 2014; 167A:238-42. [DOI: 10.1002/ajmg.a.36830] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/16/2014] [Accepted: 09/19/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Asim F. Choudhri
- Department of Radiology; University of Tennessee Health Science Center; Memphis Tennessee
- Department of Ophthalmology; University of Tennessee Health Science Center; Memphis Tennessee
- Department of Neurosurgery; University of Tennessee Health Science Center; Memphis Tennessee
- Le Bonheur Children's Hospital; Memphis Tennessee
| | - Rakesh M. Patel
- College of Medicine; University of Tennessee Health Science Center; Memphis Tennessee
| | - Robert S. Wilroy
- Le Bonheur Children's Hospital; Memphis Tennessee
- Department of Pediatrics; Division of Genetics; University of Tennessee Health Science Center; Memphis Tennessee
| | - Eniko K. Pivnick
- Department of Ophthalmology; University of Tennessee Health Science Center; Memphis Tennessee
- Le Bonheur Children's Hospital; Memphis Tennessee
- Department of Pediatrics; Division of Genetics; University of Tennessee Health Science Center; Memphis Tennessee
| | - Matthew T. Whitehead
- Department of Radiology; University of Tennessee Health Science Center; Memphis Tennessee
- Le Bonheur Children's Hospital; Memphis Tennessee
- Department of Radiology; Children's National Medical Center; Washington DC
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Kanumuri VV, Raikundalia MD, Khan MN, Husain Q, Vasquez A, Eloy JA. Clival keloid after nasopharyngeal radium irradiation masquerading as skull base malignancy. Laryngoscope 2013; 124:1767-70. [DOI: 10.1002/lary.24449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 09/16/2013] [Accepted: 09/24/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Vivek V. Kanumuri
- Department of Otolaryngology-Head and Neck Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - Milap D. Raikundalia
- Department of Otolaryngology-Head and Neck Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - Mohemmed N. Khan
- Department of Otolaryngology-Head and Neck Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Department of Neurological Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - Qasim Husain
- Department of Otolaryngology-Head and Neck Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai School of Medicine; New York New York U.S.A
| | - Alejandro Vasquez
- Department of Otolaryngology-Head and Neck Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Department of Otolaryngology-Head and Neck Surgery; Weill Cornell Medical College; New York New York U.S.A
- Department of Otolaryngology-Head and Neck Surgery; Columbia University Medical Center; New York New York U.S.A
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Klimo P, Jha T, Choudhri AF, Joyner R, Michael LM. Fibromyxoma of the lateral skull base in a child: case report. J Neurol Surg Rep 2013; 74:105-10. [PMID: 24303345 PMCID: PMC3836972 DOI: 10.1055/s-0033-1351115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/14/2013] [Indexed: 10/29/2022] Open
Abstract
Purpose Fibromyxomas and myxomas are benign tumors of mesenchymal origin usually found outside the nervous system, most commonly in the atrium of the heart. They can also arise in the mandible or maxilla, but it is exceedingly rare to find them within the skull base. The history, histologic features, and the literature, with emphasis on other pediatric cases, are reviewed for this uncommon skull base neoplasm. Methods We describe the case of a 13-year-old girl who presented with a 1-year history of facial weakness, numbness, and hearing loss. A large locally destructive tumor centered in the petrous bone was found on magnetic resonance imaging. Results A mastoidectomy combined with a middle fossa craniotomy was performed for gross total resection. The child is disease free 12 months after surgery. Conclusion Diagnosis could not be made solely on radiographic studies because of the lack of pathognomonic imaging features. Radical resection provided the patient the best chance of cure. Long-term surveillance is necessary to monitor for tumor recurrence.
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Affiliation(s)
- Paul Klimo
- Murphey Neurologic & Spine Institute, Semmes, Memphis, Tennessee, United States ; Le Bonheur Children's Hospital, Memphis, Tennessee, United States ; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States ; St. Jude Children's Research Hospital, Memphis, Tennessee, United States
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