Diagnosis and microsurgical treatment of chondromas and chondrosarcomas of the cranial base

The Combined Endoscopic Endonasal Far Medial and Open Postauricular Transtemporal Approaches As a Lesser Invasive Approach to the Jugular Foramen: Anatomic Morphometric Study With Case Illustration

BACKGROUND

Access to the jugular foramen (JF) requires extensive approaches. An endoscopic endonasal far medial (EEFM) approach combined with a postauricular transtemporal (PTT) approach may provide adequate exposure with limited morbidities.

OBJECTIVE

To provide a quantitative anatomic comparison of the EEFM, the PTT, and the combined EEFM/PTT approaches. A clinical case of the combined approach is presented.

METHODS

Five cadaveric heads were dissected. Each specimen received PTT and EEFM approaches on opposite sides followed by an EEFM approach on the side of the PTT approach. Morphometric and quadrant analyses were conducted. Three groups were obtained and compared: PTT (group A), EEFM (group B), and combined (group C).

RESULTS

Group B had a significantly higher area of exposure of the JF as compared to group A (112.3 and 225 mm2, respectively, P = .004). The average degree of freedom (DOF) in the cranio-caudal plane for groups A and B was 63.6 and 12.6 degrees, respectively (P < .00001). Group A had a higher DOF in the medial-lateral plane than group B (49 vs 13.4 degrees, respectively, P < .00001. The average volume of exposure in groups A and B was 1469.2 and 1897.4 mm3, respectively (P = .02). By adding an EEFM approach to the PTT approach, an additional 56.1% of the anterior quadrant was exposed, representing a 584.4% increase in the anterior exposure.

CONCLUSION

The PTT and EEFM approaches provide optimal exposures to different aspects of the JF and in combination may constitute a less invasive alternative to the more extensive approaches.

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.

Training the skull base surgeon of the future: a comprehensive approach

The tremendous advances in endoscopic skull base surgery added a new set of intricate less invasive approaches to the neurosurgical armamentarium. The new generations of neurosurgeons face the challenge of adopting the ever-changing technology and quickly learning modern surgical techniques beyond the traditional neurosurgery comfort zone. The future skull base surgeon must be well trained and knowledgeable in all surgical portals to the skull base in order to select the safest, least invasive, most direct approach that offers the optimum exposure to handle a complex skull base pathology. The multi-portal/corridor philosophy is often adopted in order to achieve superior surgical and clinical outcomes. Neurosurgeons need to consider such an approach when appropriate as it may offer a superior outcome while minimizing the morbidity associated with large exposures.

Resveratrol in management of bone and spinal cancers

Bone cancer is a malignant primary tumour of the bone with different typing, such as, osteosarcoma, chondrosarcoma, Ewing's sarcoma and fibrosarcoma. Despite the clinical efficacy of conventional therapies of bone cancer, most patients eventually relapse and the disease remains incurable. Therefore, new therapeutic strategies are needed to improve patient outcome. In this review article, we have discussed the role of resveratrol in preventing bone and spinal cancers and therapeutics. Resveratrol (3,5,4'-trihydroxy-trans-stilbene) is a natural polyphenol, which has been widely reported as an anticancer molecule. Resveratrol exhibits multiple tumour-suppressing activities in bone cancer by affecting a series of critical events. It has the protective effects against oxidative injury, possesses antiproliferative activity and induces apoptosis in cancer cells. Resveratrol might be a good option for the treatment of different types of bone and spinal cancers.

Giant Dural Supratentorial Chondroma Generating the Question of How Large Can a Tumor Become Without Revealing Itself

Chondromas usually affect the small bones of hand and feet and account for only 0.5% of all intracranial tumors. We present a case of a giant, supratentorial meningeal chondroma in a 19-year old male patient and discuss the preoperative diagnostic findings as well as the appropriate treatment options. A 19-old male presented with headache, new onset of focal seizures and paresis of left upper extremity. Magnetic resonance imaging revealed a large right parietal tumor in the precentral region with local mass effect. The patient underwent right parietal craniotomy and gross total resection of the tumor. The histopathological report revealed a chondroma. Intradural supratentorial chondromas are extremely rare. As with other slow growing intracranial masses, they often reach a relatively large size before generating symptoms. Maximal surgical resection is the treatment of choice and if this is achieved no adjuvant therapy is necessary.

Endoscopic Endonasal Approach in Skull Base Chondrosarcoma Associated with Maffucci Syndrome: Case Series and Literature Review

BACKGROUND

Maffucci syndrome is a nonhereditary disorder in which patients develop multiple enchondromas and cutaneous, visceral, or soft tissue hemangiomas. The potential malignant progression of enchondroma into a secondary chondrosarcoma is a well-known fact. Nevertheless, chondrosarcoma located at the skull base in patients with Maffuci syndrome is a very rare condition, with only 18 cases reported in the literature.

CASE DESCRIPTION

We report 2 other cases successfully treated through an expanded endoscopic endonasal approach and discuss the condition based on the literature review.

CONCLUSIONS

Skull base chondrosarcoma associated with Maffucci syndrome is a rare condition. The disease cannot be cured, therefore surgical treatment should be performed in symptomatic patients aiming for maximal tumor resection with function preservation. The endoscopic endonasal approach is a safe and reliable alternative for the management of these tumors.

Wnt/β-catenin pathway in bone cancers

The Wnt signaling pathway regulates some of the crucial aspects of cellular processes. The beta-catenin dependent Wnt signaling (Wnt/β-catenin) pathway controls the expression of key developmental genes, and acts as an intracellular signal transducer. The association of Wnt/β-catenin pathway is often reported with different cancers. In this study, we have reviewed the association of Wnt/β-catenin pathway with bone cancers, focusing on carcinogenesis and therapeutic aspects. Wnt/β-catenin pathway is a highly complex and unique signaling pathway, which has ability to regulate gene expression, cell invasion, migration, proliferation, and differentiation for the initiation and progression of bone cancers, especially osteosarcoma. Association of Wnt/β-catenin pathway with chondrosarcoma, Ewing's sarcoma and chondroma is also documented. Recently, targeting Wnt/β-catenin pathway has gained significant interests as a potential therapeutic application for the treatment of bone cancers. Small RNA technology to knockdown aberrant Wnt/β-catenin or inhibition of β-catenin expression by natural component has shown promising effects against bone cancers. Advances in understanding the mechanisms of Wnt signaling and new technologies have facilitated the discovery of agents that can target and regulate Wnt/β-catenin signaling pathway, and these may provide a basement for the innovative therapeutic approaches in the treatment of bone cancers.