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Jian ZH, Chen P, Li Y, Liao CC, Yi XF, Zhan RG, Chen G. Surgical Management of Complex Skull Base Tumor Using Preoperative Multimodal Image Fusion Technology. J Craniofac Surg 2024; 35:00001665-990000000-01416. [PMID: 38534161 PMCID: PMC11045550 DOI: 10.1097/scs.0000000000010073] [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: 11/14/2023] [Accepted: 01/11/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE To review our single-institution experience in the surgical management of complex skull base tumors using multimodal image fusion technology. METHODS From October 2019 to January 2022, 7 cases of complex skull base tumors that performed preoperative multimodal image fusion in Zhuhai People's Hospital neurosurgery department were involved in this study. The image data were uploaded to the GE AW workstation. Corresponding image sequences were opened in the workstation to complete registration fusion and 3D reconstruction. We retrospectively reviewed the clinical and imaging data, and surgical strategy, respectively. RESULTS one case of recurrent C2 schwannoma, 1 case of recurrent spindle cell tumor of the left cranio-orbital communication, 1 case of lobular malignant tumor of the left infratemporal fossa, 1 case of central giant cell repairing granuloma, 1 case of mesenchymal malignant tumor in left pharyngeal process, 1 case of meningioma in jugular foramen, and 1 case of hemangioblastoma with vascular malformation in fourth ventricular. All cases underwent preoperative multimodal image fusion for the surgical plan and all cases had gross total resection. Except for one case of mesenchymal malignant tumor in left pharyngeal process that had dysphagia and one case of hemangioblastoma that had discoordination, others cases were without postoperative complication. CONCLUSIONS Preoperative multimodal image fusion and surgical approach simulation benefit complex skull base tumor surgical treatment. Individually multiple image assessment of complex skull base tumors to determine the specific surgical strategy is more rational and should be recommended (Supplemental Digital Content 1, Supplementary Video, http://links.lww.com/SCS/F936).
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Affiliation(s)
- Zhi-heng Jian
- Department of Neurosurgery, Zhuhai’s People Hospital, Zhuhai, China
| | - Peng Chen
- Department of Neurosurgery, Zhuhai’s People Hospital, Zhuhai, China
| | - Yu Li
- Department of Neurosurgery, Zhuhai’s People Hospital, Zhuhai, China
| | - Chang-chun Liao
- Department of Neurosurgery, Zhuhai’s People Hospital, Zhuhai, China
| | - Xin-feng Yi
- Department of Neurosurgery, Zhuhai’s People Hospital, Zhuhai, China
| | - Run-gen Zhan
- Department of Radiology, Zhuhai’s People Hospital, Zhuhai, China
| | - Gang Chen
- Department of Neurosurgery, Zhuhai’s People Hospital, Zhuhai, China
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Bhardwaj A, Priya M, Malhotra M, Varshney S, Tyagi AK, Singh A. Novel Modifications to Total Maxillary Swing Approach in Extensive Nasopharyngeal Angiofibroma to Minimize Complications. Indian J Otolaryngol Head Neck Surg 2022; 74:1120-1127. [PMID: 36452589 PMCID: PMC9702321 DOI: 10.1007/s12070-020-02181-5] [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: 08/20/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022] Open
Abstract
Maxillary swing approaches provide excellent exposure of the anterior, mid, and anterolateral skull base offering a wide window to approach nasopharyngeal neoplasms; however, they are also associated with complications. The present study aimed to evaluate the results of a modified total maxillary swing (TMS) approach developed to minimize postoperative complications. The modified TMS approach was used to treat five patients who had extensive juvenile nasopharyngeal angiofibromas between March and October 2019 at our tertiary care center. Surgical technique, preoperative image findings, and intra-operative findings were recorded. In the postoperative follow-up, patients were examined to rule out all possible complications associated with the procedure according to the literature. A retrospective analysis was performed to assess tumor extensions, surgical modifications, and postoperative complications. All tumors had orbital and infratemporal (lateral limit) involvement while four had intracranial involvement. No per-operative complications were reported, and postoperative clinical and endoscopic evaluation was performed at 1, 2, and 3 months. There was no evidence of complications including residue, recurrence, maxillary necrosis, ophthalmoplegia, epiphora, palatal fistula, or jaw malocclusion. Besides, minor complications such as infraorbital margin skin retraction, infraorbital serous collection, maxillo-zygomatic abscess, and unsightly scar were also not seen. Only one case presented with maxillary osteomyelitis which was resolved with mini-plate removal and antibiotics. A modified TMS approach is a prudent option to ensure complete removal of juvenile nasopharyngeal angiofibromas with negligible complications.
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Affiliation(s)
- Abhishek Bhardwaj
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 India
| | - Madhu Priya
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 India
| | - Manu Malhotra
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 India
| | - Saurabh Varshney
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 India
| | - Amit Kumar Tyagi
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 India
| | - Arpana Singh
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, India
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Zuo F, Ye S, Qian H, Liu S, Wan J. Maxillary Swing Approach for Central Skull Base Lesions in Extreme Situations: A Single-Institutional Case Series. World Neurosurg 2022; 166:e337-e344. [PMID: 35817346 DOI: 10.1016/j.wneu.2022.07.009] [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: 04/15/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Radical resection of complex lesions occupying multiple compartments at the central skull base remains a significant challenge, since surgical outcomes may be compromised by insufficient exposure and inappropriate techniques. However, the efficiency of the maxillary swing approach for these lesions has not been sufficiently evaluated. Careful assessment of lesion characteristics must be performed when selecting the appropriate procedure. METHODS Between May 2006 and February 2017, 17 patients underwent resection of extensive lesions in the central skull base using the maxillary swing approach. As shown in the representative cases, data regarding clinical findings and technical considerations were reviewed. RESULTS Complete resection was achieved in all patients. The pathological findings were diverse, and the majority were schwannomas (9 cases, 52.94%), followed by meningiomas (World Health Organization II) (3 cases, 17.65%). Complications were managed as described in the case illustrations, and symptoms improved with time. The follow-up duration ranged from 62 to 192 months (median, 114 months), while 2 patients were lost to the follow-up. No mortality was observed. Two patients who experienced malignancy relapse were still under observation due to their asymptomatic status. CONCLUSIONS Our preliminary results suggest that the maxillary swing approach can be an alternative option for managing extreme cases, such as large, extensive, hypervascularized masses with fibrous or calcified consistency, or for recurrent lesions in the central skull base. En bloc resection can be successfully obtained, resulting in long-term local control.
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Affiliation(s)
- Fuxing Zuo
- Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shilu Ye
- Department of Neurosurgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Haipeng Qian
- Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaoyan Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinghai Wan
- Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Cho SW, Han SY, Song Y, Kim JW, Kim HJ, Kim DY, Rhee CS, Bae YJ, Kim JH, Wu HG, Bang JS, Won TB. Aggressive Treatment Including Endonasal Surgical Sequestrectomy with Vascularized Nasoseptal Flap Can Improve Outcomes of Skull Base Osteoradionecrosis. J Neurol Surg B Skull Base 2022; 83:e15-e23. [PMID: 35832995 PMCID: PMC9272258 DOI: 10.1055/s-0040-1722669] [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: 05/17/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022] Open
Abstract
Objective Skull base osteoradionecrosis (SB-ORN) is a serious, potentially lethal complication of radiation therapy. We aimed to review the clinical characteristics and outcomes of SB-ORN according to the extent of treatment. Design Retrospective analysis design was used for this study. Setting The study was conducted in two tertiary care hospitals. Participants Patients included who had been clinically diagnosed with SB-ORN from January 2006 to 2017. Main Outcome Measures Clinical characteristics, including demographics, predisposing factors, presenting symptoms, radiological findings, treatment modalities, and treatment outcomes, were reviewed. Treatment was classified into conservative and aggressive types. Aggressive treatment included radical surgical removal of soft tissue and bony sequestrum with the placement of vascularized tissue. Treatment outcome was analyzed in terms of clinical control, survival, and carotid artery blow out. Results Fifteen patients (11 males and 4 females) were identified during the study period. Eight patients were managed conservatively, whereas seven patients were managed with aggressive treatment. The 2-year survival was 75% in the aggressive treatment group and 15% in the conservative group (log-rank, p = 0.049). The estimated 2-year blow out free rate was 46.7% for the conservative group and 100% for the aggressive group (log-rank, p = 0.100). Conclusion In patients with SB-ORN, aggressive management, including surgical removal of sequestrum and coverage with a pedicled flap, is associated with increased survival.
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Affiliation(s)
- Sung-Woo Cho
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Sang Y. Han
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yoonjae Song
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hyun J. Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong-Young Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yun J. Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae S. Bang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
- Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Transfacial Exposures of the Anterior Skull Base and Cervical Spine: Straightforward "Line-of-Sight" Algorithm for Selection of Approach. J Craniofac Surg 2021; 32:1269-1274. [PMID: 33710058 DOI: 10.1097/scs.0000000000007332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Surgical treatment for tumors of the skull base remains gross total resection with microscopic negative margins. Sufficient surgical access is paramount to adequate treatment but must be balanced with patient morbidity and protection of vital neurovascular structures. While endoscopic surgery has made transfacial access less common, there are still indications for open transfacial exposure including tumors that involve facial soft tissues, the palate, anterolateral frontal sinus, dural involvement lateral to the mid-pupillary line, tumor recurrence/repeat resection, and/or lack of access to endoscopic equipment or expertise. The authors present a "line-of-sight" algorithm for selection of approach, discuss pre-operative planning, review selected clinical experiences, and discuss the role of microsurgery and prevention of complications.
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Xie L, Huang W, Wang J, Zhou Y, Chen J, Chen X. Modified Maxillary-Swing Approach for Resection of Primary Malignancies in the Pterygopalatine Fossa. Front Oncol 2020; 10:530381. [PMID: 33240804 PMCID: PMC7682189 DOI: 10.3389/fonc.2020.530381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background En bloc resection of malignancies in the pterygopalatine fossa (PPF) poses critical challenges. Using the modified maxillary-swing (MMS) approach, we achieved monobloc removal of primary malignancies in this region. This study provides a detailed account of the surgical techniques and indications used. Methods We enrolled seven patients with primary malignancies in the PPF during a period from January 2012 to January 2019 in this retrospective study. After malignancies were confirmed by biopsy as well as evaluation with computed tomography (CT) and magnetic resonance imaging (MRI) scans, all of the patients underwent MMS surgery under general anesthesia to extirpate these tumors. We performed regular postoperative follow-up using CT and MRI scans. Results En bloc resection was successfully performed in all cases. We observed negative margins in six cases and positive margins in one patient with adenoid cystic carcinoma, who received postoperative radiotherapy. The most common complication was facial numbness. During the follow-up period (range, 6-69 months), one patient suffered from recurrence, while the others did not. Conclusion The advantages of the MMS include a wide surgical field, full exposure, and easy manipulation. We expect this approach to become an alternative to the monobloc resection of malignancies in the PPF that involve the infratemporal fossa, maxillary sinus, nasal cavity, orbit, or oral cavity.
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Affiliation(s)
- Li Xie
- Department of Head and Neck Surgery, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
| | - Wenxiao Huang
- Department of Head and Neck Surgery, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
| | - Junqi Wang
- Department of Head and Neck Surgery, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
| | - Yue Zhou
- Department of Radiation Oncology, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
| | - Jie Chen
- Department of Head and Neck Surgery, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
| | - Xue Chen
- Department of Head and Neck Surgery, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
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London NR, Chan JYW, Carrau RL. Transpalatal Approaches to the Skull Base and Reconstruction: Indications, Technique, and Associated Morbidity. Semin Plast Surg 2020; 34:99-105. [PMID: 32390777 DOI: 10.1055/s-0040-1709432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Multiple anterior surgical approaches are available to obtain access to the nasopharynx, clivus, and craniocervical junction. These include the direct and transoral robotic surgery transpalatal, maxillary swing, and endoscopic endonasal approaches. In this article, we describe the indications for these techniques, surgical steps, and associated morbidities. This article is a PubMed literature review. A review of the literature was conducted to assess the techniques, surgical steps, and associated morbidities with transpalatal approaches to the skull base and nasopharynx. The transpalatal approach has been traditionally utilized to obtain surgical access to the nasopharynx, clivus, and craniocervical junction. Morbidity includes velopalatine insufficiency due to shortening of the soft palate from scar contraction or neuromuscular damage, thus leading to hypernasal speech and dysphagia. Middle ear effusion and oronasal or oronasopharyngeal palatal fistula are additional potential morbidities. The choice of surgical approach depends on a variety of factors including the disease location and extent, surgeon experience, and available resources.
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Affiliation(s)
- Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.,Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland
| | - Jimmy Y W Chan
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, People's Republic of China
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio.,Department of Neurological Surgery, The Ohio State University, Columbus, Ohio
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