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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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Al-Mousa A, Tarifi AA, Shtaya A, Ghanem IM. Transglabellar resection of frontal sinus cholesterol granuloma extending cranially through cecum foramina: Technical note. Surg Neurol Int 2023; 14:238. [PMID: 37560594 PMCID: PMC10408640 DOI: 10.25259/sni_316_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/22/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Cholesterol granuloma (CG) commonly occurs in the petrous apex; their occurrence in the anterior cranial fossa CGs is rare. Subfrontal approaches are the conventional surgical approaches for the resection of midline lesions of the anterior cranial fossa and frontal sinuses. In this article, we describe a successful minimally invasive approach for resection of a small midline anterior cranial fossa CG. METHODS We report a rare case of frontal air sinus CG extending intradurally through the foramen caecum. The surgical management of this patient involved the use of a minimally invasive transglabellar approach and a butterfly incision and the patient outcomes at 1 year after the surgery. RESULTS The lesion was totally resected with no complications and the patient was discharged on the 3rd postoperative day. A 1-year follow-up scan showed neither residual nor recurrence of the lesion. CONCLUSION The transglabellar approach through a butterfly incision offers a safe approach for the resection of a lesion extending from the frontal air sinuses to the anterior cranial fossa with no complications, shorter hospital stay, and good cosmetic results.
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Affiliation(s)
- Alaa Al-Mousa
- Department of Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Amjed A. Tarifi
- Department of Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Anan Shtaya
- Department of Neurosciences, Arab Hospitals Group, Ramallah, Palestinian Territory, Occupied, Jordan
| | - Ishaq M. Ghanem
- Department of Neurosurgery, Al-Kindi Hospital, Amman, Jordan
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3
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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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Cler SJ, Dunn GP, Zipfel GJ, Dacey RG, Chicoine M. A Low Subfrontal Dural Opening for Operative Management of Anterior Skull Base Lesions. J Neurol Surg B Skull Base 2022; 84:201-209. [PMID: 37180868 PMCID: PMC10171938 DOI: 10.1055/a-1774-6281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/14/2022] [Indexed: 10/19/2022] Open
Abstract
Introduction
A low subfrontal dural opening technique that limits brain manipulation was assessed in patients that underwent frontotemporal approaches for anterior fossa lesions.
Methods
A retrospective review was performed for cases using a low subfrontal dural opening including characterization of demographics, lesion size and location, neurological and ophthalmological assessments, clinical course, and imaging findings.
Results
A low subfrontal dural opening was performed in 23 patients (17F, 6M), median age of 53 years (range 23-81) with median follow-up duration of 21.9 months (range 6.2-67.1). Lesions included 22 meningiomas (9 anterior clinoid, 12 tuberculum sellae, and 1 sphenoid wing), 1 unruptured internal carotid artery aneurysm clipped during a meningioma resection, and 1 optic nerve cavernous malformation. Maximal possible resection was achieved in all cases including gross total resection in 16/22 (72.7%), near total in 1/22 (4.5%), and subtotal in 5/22 (22.7%) in which tumor involvement of critical structures limited complete resection. Eighteen patients presented with vision loss; 11 (61%) improved postoperatively, 3 (17%) were stable, and 4 (22%) worsened. The mean ICU stay and time to discharge was 1.3 days (range 0-3) and 3.8 days (range 2-8).
Conclusions
A low subfrontal dural opening for approaches to the anterior fossa can be performed with minimal brain exposure, early visualization of the optico-carotid cistern for cerebrospinal fluid release, minimizing need for fixed brain retraction and Sylvian fissure dissection. This technique can potentially reduce surgical risk and provide excellent exposure for anterior skull base lesions with favorable extent of resection, visual recovery, and complication rates.
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Affiliation(s)
- Samuel J Cler
- Neurosurgery, Washington University School of Medicine in Saint Louis, St Louis, United States
| | - Gavin P Dunn
- Neurosurgery, Washington University School of Medicine in Saint Louis, St Louis, United States
| | - Gregory J Zipfel
- Neurosurgery, Washington University School of Medicine in Saint Louis, St Louis, United States
| | - Ralph G Dacey
- Neurosurgery, Washington University School of Medicine in Saint Louis, St Louis, United States
| | - Michael Chicoine
- Neurosurgery, Washington University in Saint Louis, Saint Louis, United States
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Rajendran B. Surgical outcomes of endoscopic versus open resection for the management of sinonasal malignancies. J Korean Assoc Oral Maxillofac Surg 2020; 46:373-378. [PMID: 33377461 PMCID: PMC7783184 DOI: 10.5125/jkaoms.2020.46.6.373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/13/2020] [Accepted: 10/05/2020] [Indexed: 11/07/2022] Open
Abstract
The purpose of this review is to assess the surgical outcomes of two different treatment modalities, endoscopic and open resection, for the management of sinonasal malignancies by comparing the effectiveness of these two methods. A wide search was carried out considering various electronic databases for English language articles from 2013 to 2018 using keywords such as sinonasal malignancies, endoscopic surgery, open resection for sinonasal malignancies, and endoscopic versus open surgery. One thousand articles were identified from the literature for screening. After a thorough systematic assessment and based on the selection criteria, 10 articles with 4,642 patients were included in this quantitative analysis. With a total of 4,642 patients, 1,730 patients were operated on using endoscopic resection and 2,912 patients were operated on using open resection. The endoscopic approach was found to have a shorter hospital stay compared to open surgical resection (P<0.05). The rate of positive margins and the recurrence rate for open surgical resection were both smaller compared to those for endoscopic resection (P>0.05), and the endoscopic approach had smaller complication rates and a higher survival rate compared to open resection (P>0.05). Though endoscopic resection and open surgical resection have comparable postoperative benefits, preoperative evaluation of cases presenting with sinonasal malignancies is necessary for determining the right treatment method to obtain the best possible results postoperatively.
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Affiliation(s)
- Balamurugan Rajendran
- Oral and Maxillofacial Surgeon and Oral Implantologist, RYA Cosmo Foundation, Chennai, India
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6
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Open and Endoscopic Skull Base Approaches. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Xiao R, Joshi RR, Husain Q, Cracchiolo JR, Lee N, Tsai J, Yu Y, Chen L, Kang JJ, McBride S, Riaz N, Roman BR, Ganly I, Tabar V, Gray ST, Cohen MA. Timing of surgery and adjuvant radiation therapy for sinonasal malignancies: Effect of surgical approach. Head Neck 2019; 41:3551-3563. [PMID: 31294897 DOI: 10.1002/hed.25873] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/03/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Timely postoperative radiation therapy (RT) within 50 days of surgery for head and neck cancers provides a survival advantage. METHODS Using the National Cancer Database, we performed a propensity score-matched analysis comparing patients undergoing open or endoscopic surgery for squamous cell carcinoma (SCC) of the nasal cavity and paranasal sinuses from 2010 to 2015. RESULTS Among 168 pairs, patients undergoing endoscopic surgery had shorter time to surgery (24.2 vs 36.7 days, P < .001) and shorter postoperative time to RT (PTTR, 51.2 vs 58.4 days, P = .02). On multivariable linear regression, endoscopic surgery predicted shorter PTTR (β = -7.6, P = .01). Using the Kaplan-Meier method, patients in the longest PTTR quartile had decreased overall survival (OS; Q1 vs Q4, 3-year OS 76.5% vs 53.3%, P = .007), a durable finding when adjusted for covariates (Q1 vs Q4, HR 0.50, P = .008). CONCLUSIONS Patients undergoing endoscopic surgery for sinonasal SCC experience shorter PTTR. Shorter PTTR is associated with extended OS.
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Affiliation(s)
- Roy Xiao
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Rohan R Joshi
- Department of Otolaryngology - Head and Neck Surgery, Case Western Reserve University, Cleveland, Ohio
| | - Qasim Husain
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Jennifer R Cracchiolo
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Linda Chen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jung J Kang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin R Roman
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stacey T Gray
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Marc A Cohen
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Lu VM, Ravindran K, Phan K, Van Gompel JJ, Smith TR, Donaldson AM, Quinones-Hinojosa A, Mekary RA, Chaichana KL. Surgical Outcomes of Endoscopic Versus Open Resection for Primary Sinonasal Malignancy: A Meta-analysis. Am J Rhinol Allergy 2019; 33:608-616. [PMID: 31219311 DOI: 10.1177/1945892419856976] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Endoscopic resection (ER) for uncommon sinonasal malignancies (SNMs) has been reported to confer superior surgical outcomes compared to open resection (OR) based on indirect comparisons of limited evidence. Objective The aim of this study was to pool all direct comparative studies in the literature to validate this potential superior association. Methods Systematic searches of 7 electronic databases from their inception to April 2019 were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 1001 articles identified for screening. Outcomes of interest were pooled as risk ratios (RRs) and mean difference (MD) and analyzed using a random-effects model. Results There were 10 studies included in this meta-analysis, with 900 SNM patients in total where ER and OR were utilized in 399 (44%) and 501 (56%) cases, respectively. Compared to OR, random-effects (RE) modeling indicated ER resulted in statistically comparable complications (RR = 0.68; P-effect = .12) and recurrence (RR = 0.84; P-effect = .35). ER was associated with significantly shorter length of stay (LOS) compared to OR (MD = −2.9 days; P-effect <.01). Conclusions The use of ER to manage SNM was associated with significantly favorable reduction in LOS compared to OR. However, with respect to other surgical outcomes and recurrence, the current literature does not indicate either ER or OR as statistically superior. Therefore, until greater validation of these associations can be proven, expectations that ER for SNMs confers superior surgical outcomes compared to OR should be tempered.
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Affiliation(s)
- Victor M Lu
- 1 Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Krishnan Ravindran
- 2 Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin Phan
- 1 Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.,3 Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
| | | | - Timothy R Smith
- 2 Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Rania A Mekary
- 2 Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,7 School of Pharmacy, MCPHS University, Boston, Massachusetts
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Hufschmidt K, Camuzard O, Balaguer T, Baqué P, de Peretti F, Santini J, Bronsard N, Qassemyar Q. The infraorbital artery: From descriptive anatomy to mucosal perforator flap design. Head Neck 2019; 41:2065-2073. [PMID: 30684276 DOI: 10.1002/hed.25653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/06/2018] [Accepted: 01/03/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The terminal and perforating branches of the infraorbital artery (IOA) are poorly described. Its anatomical situation and mucosal component could provide an interesting donor site for mucosal reconstruction. The aims of the following study were to establish an anatomical description and to assess the feasibility of mucosal perforator flaps for eyelid and nasal reconstruction. METHODS Twenty-three fresh cadaver hemifaces were studied in order to perform an IOA anatomical classification by recording the artery's characteristics, its course, number, type, and diameter of terminal branches. We also examined the feasibility of local flaps for facial reconstruction. RESULTS We highlighted five different types of courses. All cadavers had at least one superior vestibular branch with a caliber of ≥0.4 mm. A pedicled flap arising from the vestibular branch was raised in all dissections. CONCLUSION The vestibular perforator flap based on the IOA seems to be a reliable flap in reconstruction of mucosal defects.
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Affiliation(s)
- Katharina Hufschmidt
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Olivier Camuzard
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Thierry Balaguer
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Patrick Baqué
- Department of General and Emergency Surgery, University Hospital Nice, Nice, France
| | - Fernand de Peretti
- Department of Locomotor and Sport Surgery (IULS), University Hospital Nice, Nice, France
| | - Joseph Santini
- Department of Head and Neck Surgery, University Hospital of Nice, Nice, France
| | - Nicolas Bronsard
- Department of Locomotor and Sport Surgery (IULS), University Hospital Nice, Nice, France
| | - Quentin Qassemyar
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital Tenon, Paris, France
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10
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Rennert RC, Ravina K, Strickland BA, Bakhsheshian J, Fredrickson VL, Russin JJ. Complete Cavernous Sinus Resection: An Analysis of Complications. World Neurosurg 2018; 119:89-96. [PMID: 30075273 DOI: 10.1016/j.wneu.2018.07.206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Complete cavernous sinus resection has been described for patients with malignant or recurrent cavernous sinus tumors without other therapeutic options but has been associated with high morbidity and mortality rates. We reviewed the complications associated with complete cavernous sinus resection to gain insights for future complication avoidance. METHODS A retrospective analysis of a prospective, single-institution database was performed to identify patients who had undergone complete cavernous sinus resection from July 2014 to October 2017. Patient- and disease-specific data, surgical complications, and clinical outcomes were recorded. RESULTS Two male patients underwent complete cavernous sinus resection (aged 60 and 47 years) for recurrent maxillary tumors with secondary cavernous sinus extension. Revascularization was performed based on balloon test occlusion (BTO) results, with extracranial-to-intracranial bypass performed in 1 patient with a concerning hemispheric flow pattern found during BTO. Vascularized free flaps were used in both patients to assist with closure of the resulting skull base defect. Three complications related to surgery occurred in 1 patient (thigh hematoma, recurrent cerebrospinal fluid leak, and meningitis). One patient died of pneumonia approximately 2 weeks postoperatively, and the other experienced an acceptable neurologic and oncologic outcome. CONCLUSIONS Despite the high peri- and postoperative risks, complete cavernous sinus resection can be considered for select patients with tumors involving the cavernous sinus without other treatment options. Familiarity with cerebral bypass and free flap reconstruction of skull base defects is critical for complication avoidance and management.
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Affiliation(s)
- Robert C Rennert
- Department of Neurological Surgery, University of California-San Diego, San Diego, California, USA
| | - Kristine Ravina
- Neurorestoration Center, Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ben A Strickland
- Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Joshua Bakhsheshian
- Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Vance L Fredrickson
- Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jonathan J Russin
- Neurorestoration Center, Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
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Kılıç S, Kılıç SS, Baredes S, Chan Woo Park R, Mahmoud O, Suh JD, Gray ST, Eloy JA. Comparison of endoscopic and open resection of sinonasal squamous cell carcinoma: a propensity score-matched analysis of 652 patients. Int Forum Allergy Rhinol 2017; 8:421-434. [DOI: 10.1002/alr.22040] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Suat Kılıç
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Sarah S. Kılıç
- Department of Radiation Oncology; Rutgers New Jersey Medical School; Newark NJ
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey; Rutgers New Jersey Medical School; Newark NJ
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Omar Mahmoud
- Department of Radiation Oncology; Rutgers New Jersey Medical School; Newark NJ
| | - Jeffrey D. Suh
- Department of Head and Neck Surgery; University of California at Los Angeles David Geffen School of Medicine; Los Angeles CA
| | - Stacey T. Gray
- Department of Otolaryngology; Harvard Medical School; Boston MA
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston MA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey; Rutgers New Jersey Medical School; Newark NJ
- Department of Neurological Surgery; Rutgers New Jersey Medical School; Newark NJ
- Department of Ophthalmology and Visual Science; Rutgers New Jersey Medical School; Newark NJ
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Gol'bin DA, Cherekaev VA, Kozlov AV, Parshunina AM. [Choosing an anterior midline approach to skull base tumors]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 81:103-114. [PMID: 28524132 DOI: 10.17116/neiro2017812103-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this review is to analyze used anterior midline approaches to the skull base, identify their advantages and disadvantages, and, after reviewing the literature data, submit a developed algorithm for choosing an optimal approach to the approval of colleagues. We provide brief information on approach techniques, indications and contraindications, and advantages and disadvantages as well as analyze international experience of using the discussed approaches. On the basis of literature data, we have developed a prototype algorithm for choosing an optimal approach to medial tumors of the anterior skull base. The situation of choosing an optimal approach reveals the absence of a clear understanding of the boundaries between capabilities and limitations of approaches. To solve this problem, an original prospective study is required.
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Affiliation(s)
- D A Gol'bin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A V Kozlov
- Burdenko Neurosurgical Institute, Moscow, Russia
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Abstract
A variety of histologic tumor types are present in the anterior skull base. Primary tumors of this area may be derived from the bone, paranasal sinuses, nasopharynx, dura, cranial nerves, pituitary gland and brain. Symptoms are caused mostly through mass effect but, if the tumor becomes aggressive, also through invasion. Selection of surgical approaches to the anterior skull base is based upon balancing risk reduction with maximizing extent of resection. Here we review a spectrum of neoplastic entities found in the anterior skull base in adults and discuss clinical and radiographic presentation, treatment options, and outcomes. Surgical resection remains the mainstay in treatment of these tumors, particularly in the hands of experienced surgeons exercising proper patient and case selection.
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Affiliation(s)
- Michael E Ivan
- Department of Neurological Surgery, University of California, San Francisco, CA, USAand
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