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Combined Nasal Endoscopic and Subfrontal Craniotomy for Resection Tumors of Anterior Skull Base. J Craniofac Surg 2022; 33:588-591. [DOI: 10.1097/scs.0000000000008066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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2
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Re M, Tomasetti M, Monaco F, Amati M, Rubini C, Sollini G, Bajraktari A, Gioacchini FM, Santarelli L, Pasquini E. MiRNome analysis identifying miR-205 and miR-449a as biomarkers of disease progression in intestinal-type sinonasal adenocarcinoma. Head Neck 2021; 44:18-33. [PMID: 34647653 PMCID: PMC9292973 DOI: 10.1002/hed.26894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/02/2021] [Accepted: 09/30/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Patients with intestinal-type sinonasal adenocarcinoma (ITAC) have an unfavorable prognosis, and new diagnostic and therapeutic approaches are needed to improve clinical management. METHODS Next-generation sequencing-based miRNome analysis was performed on 43 ITAC patients who underwent surgical resection, and microRNA (miRNA) data were obtained from 35 cases. Four miRNAs were identified, and their expression levels were detected by reverse-transcription quantitative polymerase chain reaction and related to the relevant patient outcome. Overall survival and disease-free survival rates were evaluated through the Kaplan-Meier method and log-rank test, and multivariate analysis was performed by means of Cox proportional hazard analysis. RESULTS High levels of miR-205 and miR-34c/miR-449 cluster expression were associated with an increased recurrence risk and, therefore, a worse prognosis. Multivariate analysis confirmed that miR-205 and miR-449 were significant prognostic predictors. CONCLUSIONS A high expression of miR-205 and miR-449 is independent predictors of poor survival for ITAC patients.
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Affiliation(s)
- Massimo Re
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Marco Tomasetti
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Federica Monaco
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Monica Amati
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Corrado Rubini
- Department of Biomedical Sciences and Public Health, Anatomy Pathology and Histopathology Section, Polytechnic University of Marche, Ancona, Italy
| | | | - Arisa Bajraktari
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | - Lory Santarelli
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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Caballero-García J, Cuétara Lugo EB, Lence-Anta JJ, Gonzáles Fernández N, Hidalgo-Gonzáles A, Kindelán-Agustín G. Endoscopic versus open surgery in patients with malignant sinonasal tumours and brain invasion. A case series study. NEUROCIRUGÍA (ENGLISH EDITION) 2021; 33:165-175. [PMID: 34625383 DOI: 10.1016/j.neucie.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the safety, effectiveness and perioperative costs of endonasal endoscopic approach in brain invasive malignant sinonsal tumours patients. MATERIALS AND METHODS This was a case series bidirectional study; that included 30 brain invasive malignant sinonsal tumours patients treated by endonasal endoscopic approach (2015-2017) and 53 by open surgery (2010-2015). Propensity score matching was used to compensate the prognostic factors; in a sample of 50 patients (25 per group). Primary response variables was local control and 3-years overall survival. Perioperative cost variables were analyzed. RESULTS A number of 50 patients were included after matching (25 in each therapeutic group). The age average was 55 years and male proportion was 62%. Squamous cell carcinoma and grade II lesions were the most represented in the sample. Endonasal endoscopic approach reduced surgical time in 1 h 20 min, transfusion needs in 5.5 fold and hospitalization in 19 days; in comparison with open technique. Oncologic control based on surgical free margins, local control, overall survival and progression free survival after three years was higher when the resection was performed endoscopically. Functional status was enhanced and complications diminished by using endoscopic approach. Saving was estimated in $7 355.18 per patient. CONCLUSIONS Endonasal endoscopic approach represents a safe, effective and economic procedure in selected patients with malignant sinonasal tumors and brain invasion.
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4
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Surgical Management of Sinonasal Cancers: A Comprehensive Review. Cancers (Basel) 2021; 13:cancers13163995. [PMID: 34439150 PMCID: PMC8393312 DOI: 10.3390/cancers13163995] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/21/2022] Open
Abstract
Surgery plays an important role in the treatment of sinonasal cancer. Many surgical approaches have been described, including open, endoscopic, or combined approaches. The choice is based on several criteria: general criteria related to the oncological results and morbidity of each technique, specific criteria related to the tumor (tumor extensions, tumor pathology), the patient, or the surgeon himself. The aims of this review are (i) to provide a complete overview of the surgical techniques available for the management of sinonasal malignant tumors, with a special focus on recent developments in the field of transnasal endoscopic surgery; (ii) to summarize the criteria that lead to the choice of one technique over another. In particular, the oncological outcomes, the morbidity of the different techniques, and the specificities of each histologic subtype will be discussed based on a comprehensive literature review.
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5
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Caballero-García J, Cuétara Lugo EB, Lence-Anta JJ, Gonzáles Fernández N, Hidalgo-Gonzáles A, Kindelán-Agustín G. Endoscopic versus open surgery in patients with malignant sinonasal tumors and brain invasion. A case series study. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00051-8. [PMID: 34175220 DOI: 10.1016/j.neucir.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/13/2021] [Accepted: 04/18/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine the safety, effectiveness and perioperative costs of endonasal endoscopic approach in brain invasive malignant sinonsal tumors patients. MATERIALS AND METHODS This was a case series bidirectional study; that included 30 brain invasive malignant sinonsal tumors patients treated by endonasal endoscopic approach (2015-2017) and 53 by open surgery (2010-2015). Propensity score matching was used to compensate the prognostic factors; in a sample of 50 patients (25 per group). Primary response variables was local control and 3-years overall survival. Perioperative cost variables were analyzed. RESULTS A number of 50 patients were included after matching (25 in each therapeutic group). The age average was 55 years and male proportion was 62%. Squamous cell carcinoma and grade II lesions were the most represented in the sample. Endonasal endoscopic approach reduced surgical time in 1 hour 20 minutes, transfusion needs in 5.5 fold and hospitalization in 19 days; in comparison with open technique. Oncologic control based on surgical free margins, local control, overall survival and progression free survival after three years was higher when the resection was performed endoscopically. Functional status was enhanced and complications diminished by using endoscopic approach. Saving was estimated in $7 355.18 per patient. CONCLUSIONS Endonasal endoscopic approach represents a safe, effective and economic procedure in selected patients with malignant sinonasal tumors and brain invasion.
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Cavallo LM, Somma T, Solari D, Iannuzzo G, Frio F, Baiano C, Cappabianca P. Endoscopic Endonasal Transsphenoidal Surgery: History and Evolution. World Neurosurg 2020; 127:686-694. [PMID: 31266131 DOI: 10.1016/j.wneu.2019.03.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/05/2019] [Indexed: 12/30/2022]
Abstract
In previous decades, extensive and disfiguring transfacial and/or transcranial approaches were used to reach the sellar and parasellar areas. However, these surgical routes were burdened by severe complications and high mortality rates. Recently, the development of endoscopic endonasal techniques has revolutionized the surgical strategies for approaching the sella and adjacent areas and increased the development of transsphenoidal surgery. With these techniques, surgeons have been able to overcome the visual limitations of the open surgical approaches and access areas previously hidden from view. After the contributions of the Pittsburgh duo, Carrau and Jho, pioneers of pure endoscopic surgery, our school began to implement this technique, introducing technical innovations and variations, describing the anatomical details and defining new routes, and playing a key role in its widespread clinical application.
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Affiliation(s)
- Luigi M Cavallo
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Teresa Somma
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Gianpiero Iannuzzo
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Federico Frio
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Cinzia Baiano
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
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7
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Zhang QH, Wang ZL, Guo HC, Kong F, Yan B, Li MC, Chen G, Liang JT, Bao YH, Ling F. Endoscopic Approach to Remove Intra-extracranial Tumors in Various Skull Base Regions: 10-year Experience of a Single Center. Chin Med J (Engl) 2017; 130:2933-2940. [PMID: 29237926 PMCID: PMC5742921 DOI: 10.4103/0366-6999.220306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Some problems have been found in the usually adopted combined approach for the removal of intra-extracranial tumors in skull base. Herein, we described a pure endoscopic transnasal or transoral approach (ETA) for the removal of intra-extracranial tumors in various skull base regions. Methods: Retrospectively, clinical data, major surgical complications, pre- and postoperative images, and follow-up information of a series of 85 patients with intra-extracranial tumors in various skull base regions who were treated by surgery via ETA in our skull base center during the past 10 years were reviewed and analyzed. Results: Gross total tumor removal was achieved in 80/85 cases (94.1%) in this study. All 37 cases with tumors in anterior skull base and all 14 cases with tumors in jugular foramen received total tumor removal. Thirteen and three cases with tumors in clivus received total and subtotal tumor removal, respectively. Total and subtotal tumor removal was performed for 16 cases and 2 cases in lateral skull base, respectively. The complications in this study included: cerebrospinal fluid leakage (n = 3), meningitis (n = 3), and new cranial nerve deficits (n = 3; recovered in 3 months after surgery). In the follow-up period of 40–151 months (median: 77 months), seven patients (8.8%) out of the 80 cases of total tumor removal experienced recurrence. Conclusions: Complete resection of intra-extracranial growing tumors in various skull base regions can be achieved via the pure ETA in one stage in selected cases. Surgical procedure for radical removal of tumors is feasible and safe.
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Affiliation(s)
- Qiu-Hang Zhang
- Department of Neurosurgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University; Department of Otorhinolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhen-Lin Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hong-Chuan Guo
- Department of Neurosurgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Feng Kong
- Department of Otorhinolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Bo Yan
- Department of Otorhinolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ming-Chu Li
- Department of Neurosurgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ge Chen
- Department of Neurosurgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jian-Tao Liang
- Department of Neurosurgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yu-Hai Bao
- Department of Neurosurgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Feng Ling
- Department of Neurosurgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Muscatello L, Fortunato S, Seccia V, Marchetti M, Lenzi R. The implications of orbital invasion in sinonasal tract malignancies. Orbit 2016; 35:278-284. [PMID: 27541943 DOI: 10.1080/01676830.2016.1193532] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 05/20/2016] [Indexed: 06/06/2023]
Abstract
In recent decades, the management of sinonasal tumors abutting the orbit has been widely discussed. A real guideline has yet to be proposed, as prospective randomized studies on this topic are very difficult to organize, given the relative rarity of this pathology, the wide spectrum of histologic patterns, and the different clinical behavior of tumors. Nevertheless, in recent years, a better assessment of tumor extension has been obtained thanks to the refinement of preoperative imaging tools and, therefore, more conservative approaches could be adopted, with no worsening of the oncological outcomes and, at the same time, with more attention given to the post-surgical quality of life. Currently, tumors that extend to the bony orbital walls with or without focal infiltration of the periorbit are amenable to orbital preservation. On the other hand, infiltration of extraocular muscles and neurovascular structures are an indication to orbital exenteration. The ideal surgical treatment in cases of limited involvement of orbital fat still remains a matter of debate. We report and discuss the recent English literature on this interesting topic.
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Affiliation(s)
- Luca Muscatello
- a Division of Otorhinolaryngology , " S.s. Giacomo e Cristoforo" General Hospital , Massa , Italy
| | - Susanna Fortunato
- b Department of Neuroscience, Unit of Otolaryngology, Audiology and Phoniatrics , University of Pisa , Italy
| | - Veronica Seccia
- c 1st Otorhinolaryngology Unit , Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Manuela Marchetti
- a Division of Otorhinolaryngology , " S.s. Giacomo e Cristoforo" General Hospital , Massa , Italy
| | - Riccardo Lenzi
- a Division of Otorhinolaryngology , " S.s. Giacomo e Cristoforo" General Hospital , Massa , Italy
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Sinonasal Malignancies of Anterior Skull Base: Histology-driven Treatment Strategies. Otolaryngol Clin North Am 2016; 49:183-200. [PMID: 26614837 DOI: 10.1016/j.otc.2015.09.012] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The advances in endoscopy have revolutionized the management of sinonasal and skull base lesions. Many complex cancers that traditionally required open approaches are now amenable to purely endoscopic endonasal resection, providing less invasive surgery with lower morbidity but with comparable oncologic outcomes in terms of survival rates. This article discusses the current evidence for the multimodal management of sinonasal and anterior skull base cancers focusing on the different treatment protocols driven by histologic subtypes.
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10
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Unusual complication of condrocostal implant in rhinoplasty. J Craniofac Surg 2015; 25:671-2. [PMID: 24621718 DOI: 10.1097/01.scs.0000436748.64094.1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 67-year-old patient with a casual diagnosis of a foreign body within the frontal sinus outreaching the frontal cerebral parenchyma was treated. Results of anamnestic examination revealed that the patient underwent rhinoplasty with condrocostal implant of the nasal dorsum fixed to the anterior wall of the frontal sinus using a Kirschner wire 2 years ago. A combined transnasal endoscopic and transcranic approach was performed to remove the foreign body.
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11
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Nicolai P, Schreiber A, Bolzoni Villaret A, Lombardi D, Morassi L, Raffetti E, Donato F, Battaglia P, Turri-Zanoni M, Bignami M, Castelnuovo P. Intestinal type adenocarcinoma of the ethmoid: Outcomes of a treatment regimen based on endoscopic surgery with or without radiotherapy. Head Neck 2015; 38 Suppl 1:E996-E1003. [PMID: 26040823 DOI: 10.1002/hed.24144] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/08/2015] [Accepted: 05/31/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess survival, prognostic factors, and complications in a cohort of patients with intestinal-type adenocarcinoma (ITAC) treated with transnasal endoscopic surgery ± radiotherapy (RT). METHODS Patients with ITAC who underwent endoscopic surgery ± RT at 2 tertiary centers were retrospectively reviewed. Overall survival (OS) and event-free survival were calculated, and statistically significant variables were entered in a multivariate Cox regression model. Complications were also analyzed. RESULTS One hundred-sixty-nine patients were included. Major complications occurred in 9.5% of patients. Adjuvant RT was delivered in 58.6% of patients. Five-year OS and event-free survival were 68.9% and 63.6%, respectively. Advanced pT classification, high-grade, and positive surgical margins were independently predictive of poor survival. CONCLUSION Endoscopic surgery ± RT is a valid treatment option in most cases of ITAC. When compared with series based on external surgery, our results support a definitive paradigm shift in the management of ITAC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E996-E1003, 2016.
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Affiliation(s)
- Piero Nicolai
- Unit of Otorhinolaryngology, University of Brescia, Brescia, Italy
| | | | | | - Davide Lombardi
- Unit of Otorhinolaryngology, University of Brescia, Brescia, Italy
| | - Laura Morassi
- Unit of Pathology, University of Brescia, Brescia, Italy
| | - Elena Raffetti
- Unit of Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Donato
- Unit of Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - Paolo Battaglia
- Unit of Otorhinolaryngology, Insubria University, Varese, Italy
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12
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Meccariello G, Deganello A, Choussy O, Gallo O, Vitali D, De Raucourt D, Georgalas C. Endoscopic nasal versus open approach for the management of sinonasal adenocarcinoma: A pooled-analysis of 1826 patients. Head Neck 2015; 38 Suppl 1:E2267-74. [DOI: 10.1002/hed.24182] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- Giuseppe Meccariello
- Academic Clinic of Otolaryngology and Head and Neck surgery, Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Alberto Deganello
- Academic Clinic of Otolaryngology and Head and Neck surgery, Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | | | - Oreste Gallo
- Academic Clinic of Otolaryngology and Head and Neck surgery, Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Daniele Vitali
- Academic Clinic of Otolaryngology and Head and Neck surgery, Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | | | - Christos Georgalas
- Endoscopic Skull Base Center, Department of Otorhinolaryngology, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
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13
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The use of photodynamic therapy as adjuvant therapy to surgery in recurrent malignant tumors of the paranasal sinuses. Photodiagnosis Photodyn Ther 2015; 12:414-21. [PMID: 26072296 DOI: 10.1016/j.pdpdt.2015.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 05/12/2015] [Accepted: 06/01/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Malignant tumors of paranasal sinuses and anterior skull base recur frequently after surgery and adjuvant radiotherapy. The vicinity of essential structures limits additional treatment options, such as salvage surgery and re-radiation. We report the feasibility of photodynamic therapy (PDT) as an adjuvant treatment to surgery. METHODS Fifteen patients with recurrent tumors of the paranasal sinuses were treated with mtetrahydroxyphenylchlorin (mTHPC) mediated PDT as an adjuvant treatment to salvage surgery. All patients had previously curative radiotherapy. The treated tumors were squamous cell cancer (8), adenocarcinoma (3), undifferentiated carcinoma (2), adenoid cystic carcinoma (1) and radiotherapyinduced sarcoma (1). In five cases there was extension to the skull base. Two approaches of surgery where used, namely in eight cases an open approach, in the other seven endoscopic approach. Complete macroscopic resection with microscopic tumor positive margins was possible in three patients. The remaining twelve patients received debulking surgery followed by PDT. RESULTS None of the patients had cerebrospinal fluid leak, meningitis, major bleeding or vision loss. Four patients developed temporary diplopia due to edema of the medial rectus muscle, one patient suffered from extensive necrosis leading to oro-nasal fistula. Complete response was observed in five patients. CONCLUSION Photodynamic therapy can be used with relative safety as adjuvant therapy to surgery in recurrent tumors of the paranasal sinuses and the anterior skull base where complete resection is not achievable.
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ALQAHTANI A, PADOAN G, SEGNINI G, LEPERA D, FORTUNATO S, DALLAN I, PISTOCHINI A, ABDULRAHMAN S, ABBATE V, HIRT B, CASTELNUOVO P. Transorbital transnasal endoscopic combined approach to the anterior and middle skull base: a laboratory investigation. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2015; 35:173-9. [PMID: 26246661 PMCID: PMC4510938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/08/2015] [Indexed: 11/15/2022]
Abstract
Orbital approaches provide significant trajectory to the skull base and are used with differently designed pathways. The aim of this study is to investigate the feasibility of a combined transorbital and transnasal approach to the anterior and middle cranial fossa. Cadaveric dissection of five silicon-injected heads was used. A total of 10 bilateral transorbital approaches and 5 extended endonasal approaches were performed. Identification of surgical landmarks, main anatomical structures, feasibility of a combined approach and reconstruction of the superior orbital defect were examined. Rod lens endoscope (with 0° and 45° lenses) and endoscopic instruments were used to complete the dissection. The transorbital approach showed good versatility and provides the surgeon with a direct route to the anterior and middle cranial fossa. The transorbital avascular plane showed no conflict with major nerves or vessels. Large exposure area from crista galli to the third ventricle was demonstrated with significant control of different neurovascular structures. A combined transorbital transnasal approach provides considerable value in terms of extent of exposure and free hand movement of the two surgeons, and allows better visualisation and control of the ventral skull base, thus overcoming the current surgical limits of a single approach. Combination of these two minimally invasive approaches should reduce overall morbidity. Clinical trials are needed to evaluate the virtual applications of this approach.
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Affiliation(s)
- A. ALQAHTANI
- Department of Otorhinolaryngology/Head and neck surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia;, Department of Otorhinolaryngology, University of Insubria, Varese, Italy;,Address for correspondence: Abdulaziz AlQahtani, Department of Otorhinolaryngology-Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia, Tel. +966504814819. Fax +966114738100. E-mail:
| | - G. PADOAN
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - G. SEGNINI
- First Otorhinolaryngology unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - D. LEPERA
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - S. FORTUNATO
- First Otorhinolaryngology unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - I. DALLAN
- First Otorhinolaryngology unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - A. PISTOCHINI
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - S. ABDULRAHMAN
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - V. ABBATE
- Maxillofacial Department, University of Naples "Federico II", Naples, Italy
| | - B. HIRT
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Tubingen Medical Center, Tubingen, Germany
| | - P. CASTELNUOVO
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
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15
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Belli E, Liberatore G, Elidon M, Dell'Aversana Orabona G, Piombino P, Maglitto F, Catalfamo L, De Riu G. Surgical evolution in the treatment of mandibular condyle fractures. BMC Surg 2015; 15:16. [PMID: 25884324 PMCID: PMC4365967 DOI: 10.1186/s12893-015-0001-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/02/2015] [Indexed: 11/18/2022] Open
Abstract
Background In Literature fractures of the mandible that involve the condyle ranges from 20% to 35% and various possible surgical options are described according to the varying pathological situations. Up to the present, numerous techniques have been used for the surgical treatment of condylar fractures. In this article we are proposing the combination of two surgical techniques as therapy for extra-capsular condylar fractures with dislocation. Methods From June 2003 to July 2007 30 patients were treated for condylar fractures with the application of a Rigid External Fixator under endoscopic assistance. This method includes a surgical reduction of the fracture with the aid of an endoscope, performing a transcutaneous insertion of a Rigid External Fixator to stabilize the fracture. Results Out of the total number of patients, 28 reached an optimal result without the need for temporary immobilization of the temporal mandibular joint and pre-auricular cutaneous access, thanks to the decisive aid of the video-endoscope. Conclusions The endoscope allows perfect control over both the positioning of the external fixator and the surgical reduction, restoring the normal movement of the mandible with a return to full anatomical functioning of the temporo-mandibular joint. This approach avoids possible damages to the facial nerve branches. The rigid external fixation system is better than an internal one, because it is less restrictive in precise anatomical reduction, since with an REF the condylar fragment is kept in the correct anatomical position but is not obliged to maintain that exact position, and therefore it is possible to carry out all the repair mechanisms listed above. Endoscopic assistance allows a good positioning control of the REF although the endoscopy permits an optimal control of the condylemeniscal complex mobility after REF application.
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Affiliation(s)
- Evaristo Belli
- Maxillofacial Surgery Department, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Gianmauro Liberatore
- Maxillofacial Surgery Department, Azienda Ospedaliera Universitaria Pisana of Pisa, Pisa, Italy
| | - Mici Elidon
- Maxillofacial Surgery Department, University of study of Messina, Messina, Italy
| | | | - Pasquale Piombino
- Maxillofacial Surgery Department, Federico II University of Naples, Naples, Italy.
| | - Fabio Maglitto
- Maxillofacial Surgery Department, Federico II University of Naples, Naples, Italy
| | - Luciano Catalfamo
- Maxillofacial Surgery Department, University of study of Messina, Messina, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Department and Dentistry Department, University Hospital of Sassari, Sassari, Italy
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Endoscopic endonasal surgery for malignancies of the anterior cranial base. World Neurosurg 2015; 82:S22-31. [PMID: 25496631 DOI: 10.1016/j.wneu.2014.07.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 07/25/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Data from several centers worldwide have demonstrated that transnasal endoscopic surgery performed with or without a transcranial approach is capable of achieving radical resection of selected sinonasal malignancies. We report our experience with endoscopic management of sinonasal cancers, with emphasis on naso-ethmoidal malignancies encroaching on the anterior skull base. METHODS Major series reporting results concerning the endoscopic endonasal approach with or without craniectomy for treatment of sinonasal and anterior skull base cancers were reviewed. Preoperative work-up, indications and exclusion criteria, surgical techniques, postoperative management, and adjuvant therapy are reported. RESULTS In the 2 largest series analyzed, the most common malignancies were adenocarcinoma (28%), olfactory neuroblastoma (14.5%), and squamous cell carcinoma (13.5%). The 5-year disease-specific survival rate ranged from 81.9%-87%, with no major differences in the mean follow-up time (34.1 months vs. 37 months). CONCLUSIONS Endoscopic endonasal resection performed with or without a transcranial approach, when properly planned and in expert hands, has an accepted role with precise indications in the surgeon's armamentarium for the treatment of sinonasal and skull base malignancies.
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Endoscopic endonasal surgery for nonadenomatous sellar/parasellar lesions. World Neurosurg 2015; 82:S138-46. [PMID: 25496625 DOI: 10.1016/j.wneu.2014.07.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 07/24/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This article demonstrates the experience with endoscopic transphenoidal anterior skull base surgery for lesions other than pituitary adenomas. The spectrum of lesions, results, and complications are presented. PATIENTS AND METHODS This series includes patients with 102 lesions other than pituitary adenomas operated upon using the endoscopic approach. The results and complications were reviewed retrospectively. RESULTS The most common lesions treated were Rathke Cleft Cysts (n = 39) and craniopharyngiomas (n = 18) in a total of 82 tumors. There were 8 patients with inflammatory lesions, and the remainder had a variety of unusual pathologies. Complications other than diabetes insipidus (n = 12) were uncommon, with 6 postoperative cerebrospinal fluid leaks. CONCLUSIONS The endoscopic anterior skull base approach is highly effective in treating a large variety of lesions other than pituitary adenomas. The adoption of the nasoseptal flap for closure has markedly reduced the incidence of spinal fluid leaks, and is used routinely for lesions that violate the intracranial compartment.
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Surgical outcomes of malignant sinonasal tumours: open versus endoscopic surgical approaches. The Journal of Laryngology & Otology 2014; 128:784-90. [PMID: 25077511 DOI: 10.1017/s0022215114001583] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sinonasal malignancies are rare tumours, which can be resected using an open or endoscopic approach. The current study evaluated the outcome of both approaches. METHODS A total of 160 patients with malignant nasal tumours were evaluated in an academic tertiary care hospital. The patients were allocated to 'open' or 'endoscopic' surgery groups, based on the surgical approach employed. The following data were evaluated and compared: patient and tumour characteristics; oncological treatments; and oncological outcomes, including complications, surgical margin, recurrence, overall survival and disease-free survival. RESULTS The maxillary sinus was the most common tumour location and squamous cell carcinoma was the most common histopathology-based diagnosis. Younger patients had lower grades of tumour. Higher survival rates were significantly related to lower tumour stages in both surgery groups. There were no differences between the two relatively similar groups in terms of surgical margin, the need for adjunctive therapy, and recurrence and survival rates. In addition, multivariate logistical regression analysis indicated no correlations between the type of surgical approach employed and the rates of recurrence and complications. CONCLUSION Endoscopic surgery for sinonasal malignancies is comparable to the conventional open approach in carefully selected patients.
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Antognoni P, Turri-Zanoni M, Gottardo S, Molteni M, Volpi L, Facco C, Freguia S, Mordacchini C, AlQahtani A, Bignami M, Capella C, Castelnuovo P. Endoscopic resection followed by adjuvant radiotherapy for sinonasal intestinal-type adenocarcinoma: Retrospective analysis of 30 consecutive patients. Head Neck 2014; 37:677-84. [DOI: 10.1002/hed.23660] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 11/25/2013] [Accepted: 03/01/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Paolo Antognoni
- Department of Radiotherapy; Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Mario Turri-Zanoni
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Stefania Gottardo
- Department of Radiotherapy; Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Marinella Molteni
- Department of Radiotherapy; Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Luca Volpi
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Carla Facco
- Department of Pathology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Stefania Freguia
- Department of Pathology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Cinzia Mordacchini
- Department of Medical Physics, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Abdulaziz AlQahtani
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Carlo Capella
- Department of Pathology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi; University of Insubria; Varese Italy
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Castelnuovo P, Turri-Zanoni M, Battaglia P, Bignami M, Bolzoni Villaret A, Nicolai P. Endoscopic Endonasal Approaches for Malignant Tumours Involving the Skull Base. CURRENT OTORHINOLARYNGOLOGY REPORTS 2013. [DOI: 10.1007/s40136-013-0028-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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PIOMBINO P, ORABONA GDELL, ABBATE V, FINI G, LIBERATORE G, MICI E, BELLI E. Circumscribed myositis ossificans of the masseter muscle: report of a case. G Chir 2013; 34:271-274. [PMID: 24629814 PMCID: PMC3926482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Myositis Ossificans (MO) is an unusual pathological entity still largely unknown, characterized by dystrophic calcification leading to heterotopic ossification of intramuscular connective tissue. The masticatory muscles are exceptionally involved. Four distinct types of myositis ossificans have been described: MO Progressiva, which is a genetic disorder involving several muscular groups; MO Circumscripta, limited to a single muscle and generally due to calcification of an intramuscular haematoma following severe trauma and progressive ossification; MO Pseudo-malignant limited to soft tissue and not associated to any trauma; MO associated to paraplegia. A case of circumscribed myositis ossificans of the masseter muscle in a 62 years-old woman is reported.
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Affiliation(s)
- P. PIOMBINO
- ENT Unit, Second University of Naples, Naples, Italy
| | | | - V. ABBATE
- Maxillofacial Resident Department, “Federico II” University of Naples, Naples, Italy
| | - G. FINI
- Maxillofacial Unit, Faculty of Medicine and Psychology, “Sapienza“ University of Rome, Rome, Italy
| | - G.M. LIBERATORE
- Unit of Maxillo-Facial Surgery, Univerity of Pisa, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - E. MICI
- Maxillofacial Resident, Faculty of Medicine and Surgery, University of Messina, Messina, Italy
| | - E. BELLI
- Maxillofacial Unit, Faculty of Medicine and Psychology, “Sapienza” University of Rome, Rome, Italy
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Burduk PK, Kaźmierczak W, Dalke K, Beuth W, Siedlecki Z, Prywiński M. [Craniofacial resection for tumors of paranasal sinuses involving the anterior skull base]. Otolaryngol Pol 2012; 66:96-101. [PMID: 22500498 DOI: 10.1016/s0030-6657(12)70755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 12/12/2011] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Craniofacial resection is a treatment of choice for paranasal malignant and benign tumors invading the skull base. THE AIM OF THE STUDY In this article the authors present the experience in craniofacial resection for malignant tumors invading the anterior skull base. MATERIALS AND METHODS The material consisted of four patients operated in the Department of Otolaryngology and Laryngology Oncology CM UMK between 2007 and 2010. The patients were treated for malignant neoplasms of the paranasal sinuses with anterior skull base involvement. THe age range of the group were between 60 and 75 years. Of these patients three were females and one male. RESULTS We performed a lateral rhinotomy for laryngological acces for the tumor. The neurosurgeon performed anterior skull base osteotomy at and appropriate site above. The patients recovered uneventfully. The follow up period ranged between 13 and 42 months. The overall 3-year survival for all patients in our series was 66,6%. CONCLUSIONS Combined craniofacial resection of tumors of the anterior skull base is an effective approach for the management of these pathologies. This type of approach in elderly patients over 70 years old could be associated with increased mortality and complications leading to poorer outcome.
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Affiliation(s)
- Paweł K Burduk
- Katedra i Klinika Otolaryngologii i Onkologii, Laryngologicznej Collegium Medium, w Bydgoszczy, UMK w Toruniu.
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Harvey RJ, Winder M, Parmar P, Lund V. Endoscopic skull base surgery for sinonasal malignancy. Otolaryngol Clin North Am 2012; 44:1081-140. [PMID: 21978897 DOI: 10.1016/j.otc.2011.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Management of malignant neoplasms of the sinonasal tract and skull base is hampered by the relative low incidence and pathologic diversity of patient presentations. Many studies have reported successful outcomes in the endoscopic management of malignancy since 1996, and these are summarized in this article. Nonsurgical adjuvant therapies are important for locoregional control because surgery occurs in a restricted anatomic space with close margins to critical structures, and distant disease is an ongoing concern in these disorders. There remains a need for collaborative consistent multicenter reporting, and international registries have been established to assist in such efforts.
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Affiliation(s)
- Richard J Harvey
- Department of Otolaryngology/Skull Base Surgery, St Vincent's Hospital, Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
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Vergez S, Martin-Dupont N, Lepage B, De Bonnecaze G, Decotte A, Serrano E. Endoscopic vs Transfacial Resection of Sinonasal Adenocarcinomas. Otolaryngol Head Neck Surg 2012; 146:848-53. [DOI: 10.1177/0194599811434903] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives. Compare the survival and the complication rates of 2 comparable groups of patients who underwent either endoscopic or transfacial resection of a sinonasal adenocarcinoma. Study Design. Historical cohort study. Setting. Tertiary referral center. Subjects and Methods. Twenty-four patients with sinonasal adenocarcinomas who recently underwent an endoscopy (the ENDO group, 1999-2009) were compared with 24 patients who underwent a lateral rhinotomy procedure (the LR group, 1993-2007). The present retrospective study included patients who would have had an endoscopic resection in 2011. Results. The groups were comparable in terms of age and sex ( P = .49), as well as tumor stages; 43 of the 48 patients had undergone postoperative radiotherapy. There were 13 T1-T2 and 11 T3-T4 tumors in the ENDO group compared with 12 T1-T2 and 12 T3-T4 tumors in the LR group ( P = .77). The mean length of follow-up was 38 months for the ENDO group and 89 for the LR group. The overall survival and recurrence-free rates were not significantly different ( P = .3 and P = .87, respectively). The median duration of hospitalization was significantly shorter in the ENDO group than in the LR group (4 vs 8 days, P < .0001). The rate of early complications was identical in both groups (12.5%). Conclusion. The endoscopic approach is a safe and effective treatment in selected sinonasal adenocarcinoma cases. The early oncological outcome and morbidity associated with the endoscopic approach were comparable with a transfacial approach. Hospitalization was significantly reduced by the endoscopic approach. Although the endoscopic approach is less invasive, it requires an optimal preoperative imaging protocol and an experienced surgical team.
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Affiliation(s)
| | | | | | | | - Anne Decotte
- University Hospital Rangueil-Larrey, Toulouse, France
| | - Elie Serrano
- University Hospital Rangueil-Larrey, Toulouse, France
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Revenaugh PC, Seth R, Pavlovich JB, Knott PD, Batra PS. Minimally invasive endoscopic resection of sinonasal undifferentiated carcinoma. Am J Otolaryngol 2011; 32:464-9. [PMID: 21041001 DOI: 10.1016/j.amjoto.2010.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 09/10/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the study was to review a single-institution experience with endoscopic resection of sinonasal undifferentiated carcinoma (SNUC). MATERIALS AND METHODS Thirteen patients underwent treatment of SNUC between January 2002 and July 2009. Retrospective data were collected including demographics, tumor characteristics, surgical strategy, adjuvant therapies, local and regional recurrence, distant metastasis, overall survival, and disease-free survival. RESULTS The mean age was 51.8 years. The most common tumor stage at presentation was T4 (92%). Seven patients (53%) were treated with minimally invasive endoscopic resection (MIER) with negative intraoperative margins. Endoscopic anterior skull base resection was performed in 5 patients, and endoscopic-assisted bifrontal craniotomy was performed in 1 patient to clear the superior tumor margin. Six patients received pre- or postoperative chemoradiation. One patient underwent palliative chemoradiation, and one patient underwent open craniofacial resection. In the MIER group, simultaneous local and regional recurrence was observed in 1 patient (14%) after 30 months. Distant metastases were observed in 2 other patients (28%) without local or regional recurrence. All 3 patients with recurrences died of their disease. The remaining 4 patients were clinically, endoscopically, and radiographically free of disease, resulting in overall and disease-free survival rates of 57% with mean follow-up of 32.3 months. CONCLUSIONS These preliminary data suggest a potential role for MIER in the comprehensive management algorithm of SNUC in appropriately selected patients. Patient outcomes including local and regional recurrence, distant metastases, and overall and disease-free survival were comparable to a treatment strategy using traditional craniofacial resection. LEVEL OF EVIDENCE 2b.
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Breheret R, Laccourreye L, Jeufroy C, Bizon A. Adenocarcinoma of the ethmoid sinus: retrospective study of 42 cases. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:211-7. [PMID: 21616740 DOI: 10.1016/j.anorl.2011.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 02/21/2011] [Accepted: 02/23/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Retrospective analysis of the oncological results and morbidity of ethmoid sinus adenocarcinoma surgery, and identification of survival factors. MATERIAL AND METHODS Forty-two patients were treated from 1990 to 2009. The study covered clinical presentation, medical imaging, histologic data, TNM grade, treatment, morbidity and overall recurrence-free survival. RESULTS Forty-one men and one woman, with mean age at diagnosis of 61.5 years, were included. 85.7% had been exposed to wood dust. Twenty patients (47.6%) were graded T4 at diagnosis. Thirty-three (78.5%) were treated by surgery followed by radiation therapy; nearly half of these showed recurrence. Overall specific 5-year survival was 44.2% at 5 years and recurrence-free 5-year survival 46.4%. The factors of poor prognosis found were cerebromeningeal or orbital invasion and local recurrence. CONCLUSION This series confirms the epidemiological literature on ethmoid adenocarcinoma and the influence of poor prognosis factors. Survival depended directly on local tumor control and seemed to be enhanced on an isolated transfacial approach.
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Affiliation(s)
- R Breheret
- Service d'oto-rhino-laryngologie et de chirurgie cervicofaciale, centre hospitalier universitaire d'Angers, 20, rue de Savoie, 49100 Angers cedex 01, France.
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27
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Devaiah AK, Lee MK. Endoscopic skull base/sinonasal adenocarcinoma surgery: what evidence exists? Am J Rhinol Allergy 2010; 24:156-60. [PMID: 20338117 DOI: 10.2500/ajra.2010.24.3449] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study reviewed the published outcomes literature on endoscopic or endoscopic-assisted treatment of sinonasal and skull base adenocarcinoma (SSBA). A systematic literature review was performed. METHODS A PubMed search of English language articles on endoscopic or endoscopic-assisted SSBA was performed. Each article was examined for patient data and outcomes for analysis. RESULTS Sixteen articles (150 retrospective cases) using endoscopic or endoscopic-assisted SSBA were identified. Three (19%) reported at least 15 cases of adenocarcinoma with 5-year survival ranging from 53 to 83%. In all identified studies, five (31%) reported adenocarcinoma-specific survival statistics and eight (50%) provided complete patient information. Adjuvant therapy was used in 12 studies (75%), with details outlined in 6 (38%) articles, accounting for 52 of 74 cases (70% of those patients and 35% overall). Adenocarcinoma-specific follow-up was reported in only nine studies (56%); four of these nine articles had a median/mean follow-up time of <3 years. Six articles (38%) used American Joint Committee on Cancer guidelines and four articles (25%) used International Union Against Cancer guidelines. The remaining six articles (38%) did not report on the stage of treated tumors. Four articles (25%) reported length of hospital stay and eight (50%) reported complication data. Three studies comprising 61 cases (41% of overall patients) recorded disease status, tumor stage, site involvement, and complication rates for each patient. CONCLUSION From the existing body of data, one can not conclude that endoscopic methods are superior or inferior to open methods, but there is growing evidence that this is an efficacious technique. Future studies should have emphasis on detailed, prospective reporting.
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Affiliation(s)
- Anand K Devaiah
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.
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Elbabaa SK, Al-Mefty O. Craniofacial approach for anterior skull-base lesions. Atlas Oral Maxillofac Surg Clin North Am 2010; 18:151-160. [PMID: 21036316 DOI: 10.1016/j.cxom.2010.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Samer K Elbabaa
- Department of Neurosurgery, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 507, Little Rock, AR 72205, USA.
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Greenfield JP, Anand VK, Kacker A, Seibert MJ, Singh A, Brown SM, Schwartz TH. Endoscopic endonasal transethmoidal transcribriform transfovea ethmoidalis approach to the anterior cranial fossa and skull base. Neurosurgery 2010; 66:883-92; discussion 892. [PMID: 20414977 DOI: 10.1227/01.neu.0000368395.82329.c4] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The anterior skull base, in front of the sphenoid sinus, can be approached using a variety of techniques including extended subfrontal, transfacial, and craniofacial approaches. These methods include risks of brain retraction, contusion, cerebrospinal fluid leak, meningitis, and cosmetic deformity. An alternate and more direct approach is the endonasal, transethmoidal, transcribriform, transfovea ethmoidalis approach. METHODS An endoscopic, endonasal approach was used to treat a variety of conditions of the anterior skull base arising in front of the sphenoid sinus and between the orbits in a series of 44 patients. A prospective database was used to detail the corridor of approach, closure technique, use of intraoperative lumbar drainage, operative time, and postoperative complications. Extent of resection was determined by a radiologist using volumetric analysis. RESULTS Pathology included meningo/encephaloceles (19), benign tumors (14), malignant tumors (9), and infectious lesions (2). Lumbar drains were placed intraoperatively in 20 patients. The CSF leak rate was 6.8% for the whole series and 9% for intradural cases. Leaks were effectively managed with lumbar drainage. Early reoperation for cerebrospinal fluid (CSF) leak occurred in 1 patient (2.2%). There were no intracranial infections. Greater than 98% resection was achieved in 12 of 14 benign and 5 of 9 malignant tumors. CONCLUSION The endoscopic, endonasal, transethmoidal, transcribriform, transfovea ethmoidalis approach is versatile and suitable for managing a variety of pathological entities. This minimal access surgery is a feasible alternative to transcranial, transfacial, or combined craniofacial approaches to the anterior skull base and anterior cranial fossa in front of the sphenoid sinus. The risk of CSF leak and infection are reasonably low and decrease with experience. Longer follow-up and larger series of patients will be required to validate the long-term efficacy of this minimally invasive approach.
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Affiliation(s)
- Jeffrey P Greenfield
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York 10065, USA
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Abstract
Craniofacial resection has been adopted worldwide as the standard therapy for tumors of the paranasal sinuses involving the anterior skull base. Recent refinements in endoscopic techniques together with the development of related surgical instruments allow complete radical resection of complex anatomic structures through combined transcranial and endonasal approaches without compromising any oncological principles. We use a transcranial nasoendoscopic approach for ethmoid malignant tumors in stage I and II according to the Instituto Nazionale Tumori, Milano staging. With this technique, no cutaneous incisions and no approaching osteotomies of the facial skeleton were performed. This approach reduces the period of hospitalization and speeds recovery. Furthermore, intraoperative endoscopy facilitates placement of the osteotomies in the optimal position and improves the likelihood of achieving a complete en bloc resection with removal of all disease hitherto obscured from vision. It represents the choice indication to increase precocious postsurgery radiotherapy possibilities.
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31
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Endoscopic versus traditional craniofacial resection for patients with sinonasal tumors involving the anterior skull base. Clin Exp Otorhinolaryngol 2008; 1:148-53. [PMID: 19434247 PMCID: PMC2671747 DOI: 10.3342/ceo.2008.1.3.148] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 04/05/2008] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES With the advent of microdebriders and image guidance systems, endoscope-assisted surgery is now more widely used for the treatment of tumors involving the base of the skull. The aim of this study was to analyze the clinical features of tumors involving the anterior skull base and to evaluate the treatment outcomes according to the surgical approach, which included the traditional craniofacial resection (TCFR) and the endoscopic craniofacial resection with craniotomy (ECFR). METHODS Forty-six patients who underwent craniofacial resection from 1989 through 2006 at Seoul National University Hospital and Seoul National University Bundang Hospital were included in this study. Demographics, histology, surgical management, surgical outcomes, complications, and morbidity were analyzed. RESULTS The number of malignant and benign lesions was 40 and 6 cases respectively. The most common diagnosis was olfactory neuroblastoma occurring in 41% of the cases followed by squamous cell carcinoma and malignant melanoma. Thirty-six patients underwent TCFR, while ECFR was performed with or without adjunctive chemotherapy or radiotherapy in 10 patients. The overall five-year survival rate for patients with malignant tumors of the anterior skull base was 47.4%. Out of 19 patients with olfactory neuroblastomas, 10 patients had TCFR and six among them died of their disease. Nine patients underwent ECFR, and none of them died of their disease. The ECFR group had lower morbidity and cosmetic deformity than did the TCFR group. CONCLUSION The ECFR may be considered as an alternative option for the treatment of selected tumors with anterior skull base invasion. This approach offers the advantages of avoiding facial incisions with comparable treatment results.
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Felisati G, Borloni R, Maccari A, Mele V, Chiapasco M. Endoscopic removal of alloplastic sinus graft material via a wide middle antrotomy. Int J Oral Maxillofac Surg 2008; 37:858-61. [PMID: 18562175 DOI: 10.1016/j.ijom.2008.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Revised: 01/27/2008] [Accepted: 04/25/2008] [Indexed: 11/27/2022]
Abstract
The purpose of this paper is to discuss the treatment required for a patient affected by chronic maxillary sinusitis following a sinus grafting procedure with an alloplastic material. Sinusitis was not the consequence of migration of alloplastic material into the maxillary sinus, but rather the consequence of overfilling the subantral space followed by obstruction of the ostium. The treatment involved removal of the alloplastic material and correction of the ostium obstruction via a nasal endoscopic approach.
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Affiliation(s)
- G Felisati
- Department of Otorhinolaryngology, San Paolo Hospital, University of Milan, Italy.
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Nicolai P, Battaglia P, Bignami M, Villaret AB, Delù G, Khrais T, Lombardi D, Castelnuovo P. Endoscopic Surgery for Malignant Tumors of the Sinonasal Tract and Adjacent Skull Base: A 10-year Experience. ACTA ACUST UNITED AC 2008; 22:308-16. [DOI: 10.2500/ajr.2008.22.3170] [Citation(s) in RCA: 337] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The increasing expertise in the field of transnasal endoscopic surgery recently has expanded its indications to include the management of sinonasal malignancies. We report our experience with the endoscopic management of nasoethmoidal malignancies possibly involving the adjacent skull base. Methods A retrospective analysis was performed of patients treated by an exclusive endoscopic approach (EEA) or a cranioendoscopic approach (CEA) from 1996 to 2006 managed by two surgical teams at the Departments of Otorhinolaryngology of the University of Brescia, and the University of Pavia/Insubria-Varese, Italy. Results One-hundred eighty-four patients were considered eligible for the present analysis. An EEA was performed in 134 patients and the remaining 50 patients underwent the CEA. The most frequent histotypes encountered were adenocarcinoma (37%), squamous cell carcinoma (13.6%), olfactory neuroblastoma (12%), mucosal melanoma (9.2%), and adenoid cystic carcinoma (7.1%). Overall, 86 (46.7%) patients received some form of adjuvant treatment. The patients were followed up for a mean of 34.1 months (range, 2-123 months). The 5-year disease-specific survival was 91.4 ± 3.9% and 58.8 ± 8.6% (p = 0.0004) for the EEA and CEA group, respectively. Conclusion To the best of our knowledge, this is the largest series reported to date of malignant tumors of the sinonasal tract and adjacent skull base treated with pure endoscopic or cranioendoscopic techniques. A 5-year disease-specific survival of 91.4% and 58.8% for the EEA and the CEA groups, respectively, seem to indicate that endoscopic surgery, when properly planned and in expert hands, may be a valid alternative to standard surgical approaches for the management of malignancies of the sinonasal tract.
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Affiliation(s)
- Piero Nicolai
- Department of Otorhinolaryngology, University of Brescia, Brescia, Italy
| | - Paolo Battaglia
- Department of Otorhinolaryngology, Insubria University, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, Insubria University, Varese, Italy
| | | | - Giovanni Delù
- Department of Otorhinolaryngology, Insubria University, Varese, Italy
| | - Tarek Khrais
- Depart-ment of Otorhinolaryngology, Jordan University of Science and Technology, Irbid, Jordan
| | - Davide Lombardi
- Department of Otorhinolaryngology, University of Brescia, Brescia, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, Insubria University, Varese, Italy
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Składzień J, Oleś K, Moskała M, Strek P, Urbanik A, Stachura J, Zagólski O. [Own experience in treatment of patients with advanced tumours of the paranasal sinuses and the orbit, penetrating to the anterior and medial cranial fossa--preliminary report]. Otolaryngol Pol 2008; 61:416-22. [PMID: 18260224 DOI: 10.1016/s0030-6657(07)70454-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Craniofacial resection provides multidirectional approaches to remove nasal and paranasal tumours that involve the skull base. Vital structures, such as the dura, brain, and blood vessels, can be protected or resected and reconstructed safely. An en bloc excision of the tumour can be accomplished. The purpose of this study was to analyse oncological and functional results of craniofacial resection in our series of patients. MATERIAL AND METHODS The medical records of 40 consecutive patients who had undergone craniofacial resection for tumours of the nasal cavity, paranasal sinuses, and adjacent areas were reviewed. The extent of disease, treatment results (the length of disease-free survival), complications, and prognoses were analysed. RESULTS Lesions were malignant in 7 patients and benign in the remaining 33. All the patients had dural or intradural involvement. There was no operative death, and the rate of surgical morbidity was 20%. Craniofacial resection is the only surgical approach with acceptable rate of complications in selected patients with tumour comprising the anterior and medial cranial base, nasal cavity, paranasal sinuses, nasopharynx and orbits. Heroic resections are modern surgical procedures challenging both for ENT surgeons and neurosurgeons. The result is satisfactory when they are performed by a multi-specialist team.
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Gras Cabrerizo JR, García AS, Montserrat i Gili JR, Dotú CO. Revision of Carcinomas in Paranasal Sinus. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s2173-5735(07)70347-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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