Management of Craniofacial Chondroid Tumors

Nonsyndromic Craniofacial Disorders

We describe the investigation and management of select pediatric craniofacial disorders their recent advances. Positional plagiocephaly: The incidence of positional plagiocephaly has increased since the institution of the "safe to sleep" campaign to reduce sudden infant death syndrome. Positional plagiocephaly may be associated with underlying developmental delay. Nonsyndromic craniosynostosis: Treatment of nonsyndromic craniosynostosis depends on the age of the patient and the suture involved. Pediatric skull lesions: Management of skull lesions depends on histologic diagnosis. Some benign skull lesions are managed conservatively, whereas erosive and malignant lesions may require surgical excision, radiotherapy, chemotherapy, or multimodality treatment.

Efficacy of endovascular superselective chemoembolization with HepaSphere 50–100 μm microspheres saturated with cytostatic in stopping nosebleeds in patients with nasopharyngeal cancer

The OBJECTIVE was to show the effectiveness of a new method for stopping nosebleeds in patients with nasopharyngeal cancer using endovascular superselective chemoembolization of the tumor arterial bed with HepaSphere 50–100 μm microspheres saturated with the cytostatic doxorubicin.METHODS AND MATERIALS. The results of treatment of 94 patients who against the background of progressive growth of nasopharyngeal cancer and ongoing combined treatment in oncology centers experienced nosebleeds are presented. In all these patients, according to the results of examinations in cancer centers, no convincing source of nosebleeds was identified. In the conditions of Polenov Neurosurgical Institute, 94 patients underwent endovascular superselective chemoembolization of the vasculature of nasopharyngeal cancer. The embolizate was a mixture of HepaSphere 50–100 μm microspheres saturated with the cytostatic doxorubicin (50 mg). All patients were included in the study in the absence of contraindications and after signing a voluntary informed consent approved by the ethics committee. The selection of patients was carried out according to the following criteria: thorough morphological verification of the neoplasm; locally advanced process of III and IV stages (T2-4 N0-2M0); no history of other cancers; absence of individual hematogenous metastases; absence of competitive pathology in the stage of decompensation; age was over 18 years old. All patients underwent induction-simultaneous chemoradiotherapy (CRT) with the use of radiation therapy in the usual dose fractionation regimen.RESULTS. The hemostatic effect was achieved in all 94 patients due to sequential superselective chemoembolization of the vasculature of the tumor itself with embolizate, which was a mixture of HepaSphere 50–100 μm microspheres saturated with the cytostatic doxorubicin (50mg). In the future, nosebleeds in these patients did not occur. The main sources of nosebleeds were the following branches of the external carotid artery: in 46.2 % of cases – the maxillary artery, in 37.6 % – the ascending pharyngeal artery, in 8.6 % – the occipital artery, in 5.4 % – the artery of the carotid node, in 2.2 % – other branches of the external and internal carotid arteries on one side or on both sides.CONCLUSION. The method of endovascular superselective chemoembolization with doxorubicin of the vasculature of nasopharyngeal cancer complicated by nosebleeds developed and introduced into medical practice was the initial stage of the combined treatment of these neoplasms. A good hemostatic effect was achieved in all 94 patients.

The distribution of chondromas: Why the hand?

Chondroma is a benign hyaline cartilage tumor and is a relatively common skeletal neoplasm. Uneven distribution of this tumor among the various bones and regions of the skeleton is known but no explanation of this phenomenon followed. The current research aimed to document the exact chondroma distribution in the body. We hypothesized that the cases of all subtypes of chondroma have to be investigated in complex and that obtaining combined data from a large cohort of cases may explain the logic of chondroma distribution and may answer the question of why the hand is the main target of the tumor. We retrospectively analyzed 1529 cases of various subtypes of chondroma. Enchondroma was the most frequent type (65.4%) and the hand was the main target location (49.8% of all cases). The right side of the body was affected in 900 cases (58.9%) and in 629 cases (41.1%) the left side was affected (p = 0.03). The general results for tumor distribution are as follows: head and extremities - 92.8%; head, hands, and feet - 71.8%; and hands and feet - 62.8%. In the hand and the feet, multiple chondromas were distributed along the same digital ray in all cases. The anatomical distribution of various subtypes of chondroma follows "the periphery of the being", the uneven lateral distribution, and the "same digital ray" patterns that permits to suggest that genetic mutations affecting the development of the body during the embryonic period are the main etiological component for this tumor.

An Intracerebral Type of Cranial Chondroma

The vast majority of intracranial chondromas are located in the base of the cranium. Their presentation as an intracerebral neoplasm is considered to be extremely rare. A previously healthy 45-year-old man experienced recurrent seizure attacks over a period of 6 months. Imaging studies of the brain revealed an ovoid and calcified mass which involve the cortex in the left frontal lobe. Intraoperatively, the mass had no adhesion to the dura and arachnoid membrane. The tumor was completely removed and the final diagnosis was intracerebral chondroma. The patient remained free of disease over the period of 18-years follow-up. This communication adds an unusual case to the literature on the chondroma that expressed in the form of an intra-axial space-occupying lesion in the frontal lobe.

Intracranial Dural Parafalcine Chondroma: Case Report and Systematic Review of the Literature

Intracranial chondromas are rare, benign neoplasms representing only 0.2%-0.3% of neoplastic intracranial lesions. They commonly originate from the skull base but can infrequently arise from the falx, convexity dura, or ventricular ependyma. Diagnosis requires histopathologic confirmation, as patients present with nonspecific symptoms related to mass effect, and imaging characteristics often resemble meningiomas, oligodendrogliomas, and vascular malformations. We describe the case of a patient harboring a parafalcine dural chondroma that was discovered incidentally and was managed surgically at our institution. We also provide a systematic review of the literature to elucidate incidence, origin, imaging findings, surgical management approaches, and prognosis of this rare tumor.

[Craniofacial tumors blood supply]

Because of the spread to different anatomical regions, craniofacial tumors (CFTs) usually receive blood supply from several arterial systems, and CFT removal is often accompanied by abundant blood loss.

PURPOSE

The study purpose was to develop an algorithm of diagnostic angiography for planning surgical treatment of CFT patients.

MATERIAL AND METHODS

Complex preoperative angiography was performed in 72 patients with craniofacial tumors, aged 10 to 78 years (mean age, 45.5 years), who underwent surgical treatment at the Burdenko Neurosurgical Institute in the period from 2012 to 2015. At the first stage, blood supply to tumors was quantified using SCT perfusion. Then, depending on an assessed degree of tumor vascularization, direct angiography or modern minimally invasive angiographic techniques (3D TOF HR MR angiography, SCT angiography) were applied.

RESULTS

In 12 cases of hypervascular tumors, accessible afferents were preoperatively embolized through the external carotid artery, which was accompanied by an increase in the blood supply to tumors via alternative routes of the external and internal carotid arteries. The obtained data were used to plan the surgical approach. A comparative analysis of the SCT perfusion data and the expression level of endothelial markers in histological specimens revealed no significant correlation.

CONCLUSION

The study demonstrated the importance of a comprehensive assessment of the blood supply to CFTs in planning of the surgical treatment and enabled the development of algorithms for preoperative angiographic diagnosis, depending on the baseline clinical and radiological data.

Exceptional Rare Giant Craniofacial Chondroid Tumor in Adult

We present a rare case of giant soap bubble-shaped cystic lesion in the craniofacial region in an adult female. Histopathologic examination revealed the tumor consisted of 3 components including chondroblastoma, chondromyxoid fibroma, and hemorrhagic aneurysmal bone cyst. The present case is rare in terms of size, location, and histopathologic diagnosis, which is probably the result of underdeveloped health care in the remote place.