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Pellerano FM, Messilaty MS, Chin SS, Parnes GJ, Akbar NA, Agarwal V, Mbekeani JN. Isolated Third Nerve Palsy as the Initial Manifestation of a Large Clival Chordoma. J Neuroophthalmol 2024; 44:e117-e119. [PMID: 36562553 DOI: 10.1097/wno.0000000000001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Fernando M Pellerano
- Department of Ophthalmology (FMP), Indiana University School of Medicine, Indianapolis, Indiana; Departments of Surgery (Ophthalmology) (MSM, JNM), and Radiology (GJP), Jacobi Medical Center, Bronx, New York; Department of Pathology (SSC), Montefiore Medical Center, Bronx, New York; Departments of Otorhinolaryngology (NAA, VA) and Neurosurgery (VA), Montefiore Medical Center, Bronx, New York; and Department of Ophthalmology and Visual Sciences (JNM), Albert Einstein College of Medicine, Bronx, New York
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Di Somma A, Guizzardi G, Sanchez España JC, Matas Fassi J, Topczewski TE, Ferres A, Mosteiro A, Reyes L, Tercero J, Lopez M, Alobid I, Enseñat J. Complications of the Superior Eyelid Endoscopic Transorbital Approach to the Skull Base: Preliminary Experience With Specific Focus on Orbital Outcome. J Neuroophthalmol 2024; 44:92-100. [PMID: 37410915 DOI: 10.1097/wno.0000000000001899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND The endoscopic superior eyelid approach is a relatively novel mini-invasive technique that is currently investigating for skull base cancers. However, questions remain regarding specific approach-related complications when treating different skull base tumors. This study aims to analyze any surgical complications that occurred in our preliminary consecutive experience, with specific focus on orbital outcome. METHODS A retrospective and consecutive cohort of patients treated via a superior eyelid endoscopic transorbital approach at the Division of Neurosurgery of the Hospital Clinic in Barcelona was analyzed. Patients features were described in detail. Complications were divided into 2 groups to analyze separately the approach-related complications, and those resulting from tumor removal. The ocular complications were subdivided into early ocular status (<3 weeks), late ocular status (3-8 weeks), and persistent ocular complications. The "Park questionnaire" was used to determine patient's satisfaction related to the transorbital approach. RESULTS A total of 20 patients (5 spheno-orbital meningiomas, 1 intradiploic Meningioma, 2 intraconal lesions, 1 temporal pole lesion, 2 trigeminal schwannoma, 3 cavernous sinus lesions, and 6 petroclival lesions) were included in the period 2017-2022. Regarding early ocular status, upper eyelid edema was detected in all cases (100%) associated with diplopia in the lateral gaze in 30% of cases, and periorbital edema in 15% of cases. These aspects tend to resolve at late ocular follow-up (3-8 weeks) in most cases. Regarding persistent ocular complications, in one case of intraconal lesion, a limitation of eye abduction was detected (5%). In another patient with intraconal lesion, an ocular neuropathic pain was reported (5%). In 2 cases of petroclival menigioma, who were also treated with a ventriculo-peritoneal shunt, slight enophthalmus was observed as a persistent complication (10%). According to the Park questionnaire, no cosmetic complaints, no head pain, no palpable cranial irregularities, and no limited mouth opening were reported, and an average of 89% of general satisfaction was encountered. CONCLUSIONS The superior eyelid endoscopic transorbital approach is a safe and satisfactory technique for a diversity of skull base tumors. At late follow-up, upper eyelid edema, diplopia, and periorbital edema tend to resolve. Persistent ocular complications are more frequent after treating intraconal lesions. Enophthalmus may occur in patients with associated ventriculo-peritoneal shunt. According to patient's satisfaction, fairly acceptable results are attained.
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Affiliation(s)
- Alberto Di Somma
- Department of Neurological Surgery (ADS, GG, TET, AF, AM, LR, JE), Institut Clínic de Neurociències, and Departments of Ophthalmology (JCSE, JMF), Anesthesiology (JT), and ENT Surgery (ML, IA), Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
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Bove I, Solari D, Colangelo M, Fabozzi GL, Esposito F, Tranfa F, Cappabianca P, Cavallo LM. Analysis of visual impairment score in a series of 48 tuberculum sellae meningiomas operated on via the endoscopic endonasal approach. J Neurosurg 2024; 140:696-704. [PMID: 37878006 DOI: 10.3171/2023.7.jns23437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/14/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Tuberculum sellae meningioma (TSM) represents a complex skull base tumor. The primary goals of surgical treatment are represented by maximal safe resection and visual recovery; therefore, appropriate patient selection is critical to optimize results. In the last 2 decades, the endoscopic endonasal approach (EEA) has appeared as a successful and viable strategy for the management of these tumors. The authors identified preoperative factors associated with extent of resection and visual outcome after EEA for TSM. METHODS In this retrospective cohort study, the authors analyzed patients who underwent extended endoscopic endonasal surgery for TSM between January 2005 and April 2022 at the Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy. Tumor size, vessel encasement, and optic canal involvement were classified according to University of California, San Francisco, score. Visual acuity and visual fields were analyzed according to the visual impairment score (VIS), defined as a four-level classification: grade 1 (VIS 0-25), grade 2 (VIS 26-50), grade 3 (VIS 51-75), and grade 4 (VIS 76-100). Ophthalmological functions were tested preoperatively and during the early postoperative period (within 6 months after surgery) and late postoperative period. RESULTS A total of 48 patients were enrolled. Forty-one (85.4%) patients experienced blurred vision or visual field defect as a presenting sign. Gross-total resection was achieved in 40 (83.3%), near-total resection in 2 (4.2%), and subtotal resection in 6 (12.5%). Visual defect improved in 82.9% (34/41) of cases, 12.2% (5/41) had no significant changes, and 2.4% (1/41) had worsened visual defect. The mean change in VIS was 42% (95% CI 58.77-31.23). Visual outcome was poorer when preoperative VIS (VIS-pre) was greater than 25 (p = 0.02). Six postoperative CSF leaks occurred (12.5%), and 1 patient (2.1%) required revision surgery. CONCLUSIONS The EEA is a safe and effective approach for TSM removal, with the advantage of preserving optic apparatus vascularization, and can promote gross-total resection and visual improvement. The authors have defined four categories based on VIS that relate to postoperative outcome: the lower the VIS-pre, the higher the rate of postoperative VIS improvement. This finding may be useful for predicting a patient's visual outcome at the preoperative stage.
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Affiliation(s)
- Ilaria Bove
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
| | - Domenico Solari
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
| | - Manuel Colangelo
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
| | - Gianluca Lorenzo Fabozzi
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
| | - Felice Esposito
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
| | - Fausto Tranfa
- 2Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Ophthalmology, University of Naples Federico II, Naples, Italy
| | - Paolo Cappabianca
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
| | - Luigi Maria Cavallo
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
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Park DJ, Kumar KK, Marianayagam NJ, Yener U, Rahimy E, Hancock S, Meola A, Chang SD. Treatment of Trigeminal Neuralgia Secondary to Petroclival Meningioma Using Microsurgical Resection, Microvascular Decompression, and Stereotactic Radiosurgery: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:107-108. [PMID: 38099694 DOI: 10.1227/ons.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/12/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- David J Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin K Kumar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Neelan J Marianayagam
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ulas Yener
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Elham Rahimy
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Steven Hancock
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
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Macarthur JI, O'Brien F, Hannan CJ, Hammerbeck-Ward C, Pathmanaban ON, Rutherford SA, Siripurapu R, King AT, Ng W. Does tumoral cavernous carotid stenosis predict an increased risk of future stroke in skull base meningiomas? J Neurosurg 2023; 139:1613-1618. [PMID: 37178029 DOI: 10.3171/2023.4.jns23378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Skull base meningiomas (SBMs) involving the cavernous sinus encase the internal carotid artery (ICA) and may lead to stenosis of the vessel. Although ischemic stroke has been reported in the literature, there are to the authors' knowledge no reported studies quantifying the risk of stroke in these patients. The authors aimed to determine the frequency of arterial stenosis in patients with SBMs that encase the cavernous ICA and to estimate the risk of ischemic stroke in these patients. METHODS Records of all patients with SBM encasing the ICA whose cases were managed by the skull base multidisciplinary team at Salford Royal Hospital between 2011 and 2017 were reviewed using a two-stage approach: 1) clinical and radiological strokes were identified from electronic patient records, and 2) cases were reviewed to examine the correlation between ICA stenosis associated with SBM encasement and anatomically related stroke. Strokes that were caused by another pathology or did not occur in the perfusion territory were excluded. RESULTS In the review of patient records the authors identified 118 patients with SBMs encasing the ICA. Of these, 62 SBMs caused stenosis. The median age at diagnosis was 70 (IQR 24) years, and 70% of the patients were female. The median follow-up was 97 (IQR 101) months. A total of 13 strokes were identified in these patients; however, only 1 case of stroke was associated with SBM encasement, which occurred in the perfusion territory of a patient without stenosis. Risk of acute stroke during the follow-up period for the entire cohort was 0.85%. CONCLUSIONS Acute stroke in patients with ICA encasement by SBMs is rare despite the propensity of these tumors to stenose the ICA. Patients with ICA stenosis secondary to their SBM did not have a higher incidence of stroke than those with ICA encasement without stenosis. The results of this study demonstrate that prophylactic intervention to prevent stroke is not necessary in ICA stenosis secondary to SBM.
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Affiliation(s)
- Joshua I Macarthur
- 1Faculty of Biology, Medicine and Health, University of Manchester
- 3Geoffrey Jefferson Brain Research Centre, Manchester
| | - Frazer O'Brien
- 2Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester
| | - Cathal John Hannan
- 2Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester
- 3Geoffrey Jefferson Brain Research Centre, Manchester
- 6Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Charlotte Hammerbeck-Ward
- 2Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester
- 3Geoffrey Jefferson Brain Research Centre, Manchester
| | - Omar N Pathmanaban
- 2Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester
- 3Geoffrey Jefferson Brain Research Centre, Manchester
- 4Division of Neuroscience & Experimental Psychology, University of Manchester
| | - Scott A Rutherford
- 2Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester
- 3Geoffrey Jefferson Brain Research Centre, Manchester
| | - Rekha Siripurapu
- 5Department of Neuroradiology, Salford Royal Hospitals NHS Trust, Salford
| | - Andrew T King
- 2Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester
- 3Geoffrey Jefferson Brain Research Centre, Manchester
- 6Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Wayne Ng
- 2Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester
- 7School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Queensland; and
- 8Department of Neurosurgery, Gold Coast University Hospital, Gold Coast, Australia
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Dzhindzhikhadze RS, Polyakov AV, Ermolaev AY, Kambiev RL, Grigoryan GY. [Anterior transpetrosal (Kawase) approach for petroclival meningioma with trigeminal neuralgia: case report and literature review]. Zh Vopr Neirokhir Im N N Burdenko 2023; 87:98-105. [PMID: 37325832 DOI: 10.17116/neiro20238703198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The authors present a patient with petroclival meningioma complicated by trigeminal neuralgia. Resection of tumor via anterior transpetrosal approach with microvascular decompression of the trigeminal nerve was performed. A 48-year-old female patient presented with left-sided (V1-V2) trigeminal neuralgia. Magnetic resonance imaging revealed a tumor 33´27´25 mm with a base adjacent to the top of petrous part of the left temporal bone, tentorium cerebelli and clivus. Intraoperative examination revealed true petroclival meningioma extending to trigeminal notch of petrous part of temporal bone. There was additional compression of trigeminal nerve by caudal branch of superior cerebellar artery. Total resection of tumor was followed by disappearance of vascular compression of trigeminal nerve and regression of trigeminal neuralgia. Anterior transpetrosal approach provides early devascularization and resection of true petroclival meningioma, as well as wide imaging of anterolateral surface of the brainstem, identification of neurovascular conflict and vascular decompression.
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Affiliation(s)
- R S Dzhindzhikhadze
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - A V Polyakov
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - A Yu Ermolaev
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - R L Kambiev
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - G Yu Grigoryan
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
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Wang XB, Tang H, Cheng YJ, Shang HB, Ma JG, Xu Z, He C, Wu Z. [Clinical observation of microsurgical removal of the hemilateral tuberculum sellae meningiomas through contralateral eyebrow arch approach]. Zhonghua Yi Xue Za Zhi 2022; 102:2630-2633. [PMID: 36058690 DOI: 10.3760/cma.j.cn112137-20220208-00261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The current study aimed to investigate the clinical feasibility of microscopic resection of hemilateral tuberculum sellae meningiomas (TSM) via the contralateral eye brow arch approach. The clinical data of 34 patients with TSM who underwent microsurgery from January 2016 to June 2021 in the Neurosurgery Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine and the First Affiliated Hospital of Henan University were collected and reviewed. The postoperative visual acuity improvement rate was 88.5% (23/26), and the total tumor resection rate was 88.2% (30/34); the postoperative visual acuity improvement in patients with total tumor resection was better than that of patients with partial resection [90.9% (20/22) vs 3/4]. Meanwhile, the postoperative visual acuity improvement in patients with the superior optic nerve and laterl-superior optic nerve was better than that of patients with the lateral optic nerve type (12/14, 8/8 vs 3/4). Supraorbital skin numbness occurred in 3 cases after operation, and the symptoms disappeared during follow-up; 2 cases had mild disturbance of hormone level, and urine output of 2 cases increased after operation, which returned to normal level after symptomatic treatment; 1 case had subcutaneous effusion which was absorbed after treatment. There were no complications such as olfactory disturbance and intracranial infection. During follow-up for 3-60 (33±6) months, recurrence occurred in 2 cases and reoperation was performed. For the hemilateral TSM, according to the preoperative evaluation of the origin of the TSM and the side with visual impairment, the contralateral eyebrow approach is selected to fully expose the tumor base below the optic nerve. It is beneficial to fully resect the tumor under direct vision, and the symptoms of postoperative visual impairment are significantly improved, indicating that the current surgical method can be used in the clinical setting.
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Affiliation(s)
- X B Wang
- Department of Neurosurgery, the First Affiliated Hospital of Henan University, Kaifeng 475000, China
| | - H Tang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Y J Cheng
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - H B Shang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - J G Ma
- Department of Neurosurgery, the First Affiliated Hospital of Henan University, Kaifeng 475000, China
| | - Z Xu
- Department of Neurosurgery, the First Affiliated Hospital of Henan University, Kaifeng 475000, China
| | - C He
- Department of Neurosurgery, the First Affiliated Hospital of Henan University, Kaifeng 475000, China
| | - Zhebao Wu
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
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Matoušek P, Cvek J, Čábalová L, Misiorzová E, Krejčí O, Lipina R, Krejčí T. Does Endoscopic Transnasal Optic Nerve Decompression Followed by Radiosurgery Improve Outcomes in the Treatment of Parasellar Meningiomas? Medicina (Kaunas) 2022; 58:medicina58081137. [PMID: 36013604 PMCID: PMC9414861 DOI: 10.3390/medicina58081137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022]
Abstract
Introduction: The clinical management of parasellar meningiomas (PM) is challenging due to their intimate association with critical neurovascular structures. Consensus regarding the recommended treatment protocol is lacking. This study will evaluate patients’ visual outcomes following endoscopic transnasal optic nerve decompression (ETOND) and will investigate the possibility of reducing the rate of complications associated with stereotactic radiosurgery (SRS). Methods: Retrospective analysis was conducted on all patients who underwent ETOND for PM between 2013 and 2020. The study comprised 12 patients (7 women and 5 men aged 36–75 years; mean, 55.2 years; median, 57.6 years) in which 14 optic nerve decompression procedures were carried out. Patients were followed up for 6 to 86 months (mean, 29.3 months; median, 25 months). There were five cases of spheno-orbital meningioma, four cases of cavernous sinus meningioma, and one case each of petro-clival meningioma, optic nerve sheath meningioma, and planum sphenoidale/tuberculum sellae meningioma. Visual outcome was evaluated and any postoperative complications noted. Results: Improvements in visual acuity were noted in 10 of 14 eyes (71.4%) 3 to 6 months postoperation. Visual acuity remained stable in the remaining four eyes. No deterioration of visual acuity was noted during the follow-up period. In total, 9 of the 12 patients underwent SRS. No tumor growth was determined, while reduction in tumor volume was noted in five patients following SRS. No complications associated with SRS or the surgical procedure were noted. Conclusions: ETOND appears to be a promising technique for increasing rates of improved visual function, while reducing the risk of post SRS-related complications. In combination with subsequent SRS, it is an ideal treatment modality in the management of parasellar meningiomas. Confirmation of our findings would require a larger, prospective multicenter study.
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Affiliation(s)
- Petr Matoušek
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, 70852 Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
| | - Jakub Cvek
- Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Department of Oncology, University Hospital Ostrava, 70852 Ostrava, Czech Republic
| | - Lenka Čábalová
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, 70852 Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
| | - Eva Misiorzová
- Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Department of Neurosurgery, University Hospital Ostrava, 70852 Ostrava, Czech Republic
| | - Ondřej Krejčí
- Department of Neurosurgery, University Hospital Ostrava, 70852 Ostrava, Czech Republic
| | - Radim Lipina
- Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Department of Neurosurgery, University Hospital Ostrava, 70852 Ostrava, Czech Republic
| | - Tomáš Krejčí
- Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Department of Neurosurgery, University Hospital Ostrava, 70852 Ostrava, Czech Republic
- Correspondence:
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Byun YH, Kang H, Kim YH. Advances in Pituitary Surgery. Endocrinol Metab (Seoul) 2022; 37:608-616. [PMID: 35982611 PMCID: PMC9449102 DOI: 10.3803/enm.2022.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/01/2022] [Indexed: 11/11/2022] Open
Abstract
Pituitary surgery has advanced considerably in recent years with the exploration and development of various endoscopic approaches and techniques. Different endoscopic skull base approaches are being applied to access sellar tumors in different locations. Moreover, extracapsular dissection and cavernous sinus exploration have enabled gross total resection of sellar tumors where it could not have been achieved in the past. Techniques for skull base reconstruction have also progressed, allowing surgeons to remove larger and more complicated tumors than before. This review article discusses different endoscopic skull base approaches, surgical techniques for removing pituitary adenomas, and reconstruction methods for repairing postoperative low-flow and high-flow cerebrospinal fluid leakage.
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Affiliation(s)
- Yoon Hwan Byun
- Pituitary Center, Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Kang
- Pituitary Center, Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Hwy Kim
- Pituitary Center, Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Corresponding author: Yong Hwy Kim. Pituitary Center, Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-4062, Fax: +82-2-744-8459, E-mail:
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10
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Watanabe K, Murayama Y. [Surgical Strategy of Benign Skull Base Tumors Based on Membrane Structure]. No Shinkei Geka 2022; 50:681-694. [PMID: 35670183 DOI: 10.11477/mf.1436204604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Meningiomas, schwannomas, and pituitary adenomas are typically benign tumors of intracranial origin, but all of these tumors have a border with the surrounding tissue. The basic structure is a clear "boundary" between the tumor and its surroundings, with a thin membrane layer to create that separation. This layer of membrane is the boundary between the tumor and its surroundings and provides a space for the tumor to grow its cells, and can be viewed as the so-called "tumor capsule. Based on the relationship between the membrane structure of the tumor capsule and the surrounding normal tissues, we perform surgery to reduce surgical complications. We histologically evaluated three types of tumor capsules(meningioma, schwannoma, and pituitary adenoma)and compared the membrane structure of each tumor with that seen in clinical surgery.
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Affiliation(s)
- Kentaro Watanabe
- Department of Neurosurgery, The Jikei University School of Medicine
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Hegazy A, Al-Shami HA, Arundhati B, Negida A, A Hafez RF, Fahmy OM, Ragab OA, Elkatatny AM, Amin SM, A Ali MF. Microsurgery versus stereotactic radiosurgery for small petroclival meningiomas presenting with intractable trigeminal neuropathy: A historical cohort study. Neurol India 2022; 70:890-896. [PMID: 35864615 DOI: 10.4103/0028-3886.349681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Data on the outcomes of microsurgical resection (SR) and stereotactic gamma knife radiosurgery (GKRS) in patients with trigeminal neuralgia associated with small petrous apex meningiomas are scarce. OBJECTIVE We conducted this study to evaluate the pain relief, tumor control, and procedure costs following SR and GKRS for small petroclival meningiomas (less than 3 cm in maximal diameter) using real-world data from our center in Egypt. MATERIAL AND METHODS We conducted a retrospective cohort study of 47 patients with small petrous apex meningiomas presenting with intractable trigeminal nerve pain (SR: n = 22 and GKRS: n = 25). Data regarding pain relief on Barrow Neurological Institute (BNI), procedure cost, and tumor control were retrieved and analyzed using appropriate statistical tests. RESULTS Patients who underwent SR had lower median BNI pain intensity scores compared to those patients who underwent GKRS, and a significantly higher proportion of patients in the SR group had good BNI scores compared to those in GKRS group (P < 0.05); however, the total costs of SR were significantly less than GKRS (30,519$ vs. 92,372$, respectively). CONCLUSION Both SR and GKRS provide pain relief and tumor control in patients with trigeminal neuralgia associated with petrous apex meningioma. However, in the present study, SR achieved better pain control and was more affordable than GKRS.
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Affiliation(s)
- Ahmed Hegazy
- Department of Neurosurgery, Faculty of Medicine, Kasr Al-Ainy Medical College, Cairo University, Giza, Egypt
| | | | - Biswas Arundhati
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, Illinois, United States
| | - Ahmed Negida
- Department of Global Health and Social Medicine, Program of Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States; Faculty of Medicine, Zagazig University, Egypt; School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Raef F A Hafez
- Department of Neurosurgery and Gamma Knife Center, International Medical Center, Cairo, Egypt
| | - Osama M Fahmy
- Department of Neurosurgery and Gamma Knife Center, International Medical Center, Cairo, Egypt
| | - Omar A Ragab
- Department of Neurosurgery, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - Amr M Elkatatny
- Department of Neurosurgery, Faculty of Medicine, Kasr Al-Ainy Medical College, Cairo University, Giza, Egypt
| | - Sameh M Amin
- Department of Head and Neck Surgery, Fayoum University, Egypt
| | - Mohammed F A Ali
- Department of Neurosurgery, Faculty of Medicine, Kasr Al-Ainy Medical College, Cairo University, Giza, Egypt
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Hall MN, Raviskanthan S, Mortensen PW, Lee AG. Isolated Fourth Nerve Palsy as the Presenting Sign of Clival Chordoma. J Neuroophthalmol 2022; 42:e391-e393. [PMID: 33449491 DOI: 10.1097/wno.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- MacGregor N Hall
- McGovern Medical School at the University of Texas Health Science Center at Houston (MNH), Houston, Texas ; Department of Ophthalmology (SR, PM, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medicine, New York, New York; Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas; University of Texas MD Anderson Cancer Center (AGL), Houston, Texas; Texas A and M College of Medicine (AGL), Bryan, Texas; and Department of Ophthalmology (AGL), the University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Yoo J, Lim SH, Jung IH, Park HH, Han J, Hong CK. Factors Associated With Abducens Nerve Palsy in Patients Undergoing Surgery for Petroclival Meningiomas. J Neuroophthalmol 2022; 42:e209-e216. [PMID: 34974485 DOI: 10.1097/wno.0000000000001473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND During the surgical resection of petroclival meningiomas, preserving the cranial nerves is crucial. The abducens nerve is particularly vulnerable during surgery. However, the preoperative risk factors and postoperative prognosis of abducens nerve palsy (ANP) are poorly understood. METHODS We retrospectively analyzed 70 patients who underwent surgery for petroclival meningiomas between May 2010 and December 2019, divided into gross-total resection (GTR) and subtotal resection (STR) groups. The relationship of preoperative clinical factors with the incidence and recovery of postoperative ANP was analyzed. RESULTS Postoperative ANP was observed in 23 patients (32.9%). Multivariable logistic regression revealed that the tumor-to-cerebellar peduncle T2 imaging intensity index (TCTI) (P < 0.001) and internal auditory canal invasion (P = 0.033) contributed to postoperative ANP. GTR was achieved in 37 patients (52.9%), and 10 (27.0%) of them showed ANP. STR was achieved in 33 patients (47.1%), and 13 (39.4%) of them showed ANP. Recovery from ANP took a median of 6.6 months (range, 4.5-20.3 months). At 6 months after the operation, recovery of the abducens nerve function was observed in 16 patients (69.0%); of whom, 4 (40.0%) were in the GTR group and 12 (92.3%) were in the STR group (P = 0.025). CONCLUSIONS TCTI and internal auditory canal invasion were the risk factors for postoperative ANP. Although intentional STR did not prevent ANP immediately after the operation, recovery of the abducens nerve function after surgery was observed more frequently in the STR group than in the GTR group.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery (JY, SHL, IHJ, HHP), Brain Tumor Center, Gangnam Severance Hospital, Yonsei University, Seoul, Korea ; Yonsei University College of Medicine (JY), Seoul, Republic of Korea ; Department of Ophthalmology (JH), Gangnam Severance Hospital, Yonsei University, Seoul, Republic of Korea ; and Department of Neurosurgery (CKH), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
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Brociek-Piłczyńska A, Brodowska-Kania D, Szczygielski K, Lorent M, Zieliński G, Kowalewski P, Jurkiewicz D. A rare combination of tumor-induced osteomalacia caused by sinonasal glomangiopericytoma and coexisting parathyroid adenoma: case report and literature review. BMC Endocr Disord 2022; 22:31. [PMID: 35090436 PMCID: PMC8796561 DOI: 10.1186/s12902-022-00934-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/05/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Tumor-induced osteomalacia (TIO) is a rare, acquired disease of renal phosphate wasting and disturbed vitamin D homeostasis as a result of the action of a phosphaturic protein - FGF-23, produced by a neoplasm. Although the clinical and biochemical profile of the syndrome is characteristic, it remains underreported and unrecognized by clinicians. Hyperparathyroidism is rarely associated with oncogenic osteomalacia, but it should be considered because of potentially life-threatening hypophosphatemia caused by both conditions. CASE PRESENTATION We report a case of a 42-year-old woman admitted to the Department of Otolaryngology of the Military Institute of Medicine in Warsaw for the endoscopic resection of hormonally active glomangiopericytoma extending into the anterior skull base. She presented with a 5-year history of musculoskeletal pain and progressive weakness of the extremities which finally led her to become bedridden. After the excision of the tumor her symptoms and laboratory results gradually improved except increasing PTH serum levels. Further examination revealed a parathyroid proliferative tumor, which was surgically removed. The patient walked without aids at follow-up 16 months after the surgery. CONCLUSIONS This case is unusual because of tumor-induced osteomalacia and parathyroid adenoma occurring concomitantly. Further investigations of FGF-23 and PTH interplay should be conducted to elucidate the pathogenesis of hyperparathyroidism and tumorigenesis in some cases of TIO. By presenting this case, we wanted to remind clinicians of a rare and misdiagnosed paraneoplastic syndrome and highlight the importance of monitoring PTH concentrations during the follow-up of patients with TIO.
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Affiliation(s)
- Agnieszka Brociek-Piłczyńska
- Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw, Poland.
| | - Dorota Brodowska-Kania
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Poland
| | - Kornel Szczygielski
- Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw, Poland
| | - Małgorzata Lorent
- Department of Pathology, Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Zieliński
- Department of Neurosurgery, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Kowalewski
- Department of General Surgery, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Dariusz Jurkiewicz
- Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw, Poland
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Park HH, Kim WH, Jung HH, Chang JH, Lee KS, Chang WS, Hong CK. Radiosurgery vs. microsurgery for newly diagnosed, small petroclival meningiomas with trigeminal neuralgia. Neurosurg Rev 2020; 43:1631-1640. [PMID: 32642933 DOI: 10.1007/s10143-020-01346-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022]
Abstract
Trigeminal neuralgia (TN) is an excruciating pain that can occur with petroclival meningiomas (PCMs). Gamma knife radiosurgery (GKRS) is an appealing option for small PCMs, but the role of microsurgery (MS) compared to GKRS is not well defined for small PCMs with regard to TN relief. From January 2009 to September 2019, 70 consecutive patients were treated by GKRS or MS for newly diagnosed, small (< 3.5 cm) PCMs with TN. GKRS or MS were performed for 35 patients each. The surgical outcome and TN control according to Barrow Neurological Institute (BNI) score were retrospectively analyzed and compared between GKRS and MS. The predominant origin of PCMs was upper clival (49%) with trigeminal nerve compression at the medial dorsal root entry zone. Tumor control rates were equally 94% with GKRS or MS for a mean tumor size and volume of 2.3 cm and 5.3 cm3, respectively. The preoperative BNI scores were mostly II (40%) and IV (37%) with GKRS and MS, respectively. TN relief without medications (BNI scores I and II) was achieved in 13 of 35 patients (37%) with GKRS and 32 of 35 patients (91%) with MS during a mean follow-up of 50.5 months. The most common complications after GKRS and MS were dysesthesia (23%) and diplopia (9%), respectively. MS could be more effective than GKRS in providing prompt, medication-free pain relief from TN for small PCMs. The risks of MS have to be considered carefully in experienced hands, especially for small PCMs.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Woo Hyun Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Hyun-Ho Jung
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Gamma Knife Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Gamma Knife Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Kyu-Sung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Gamma Knife Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
- Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
| | - Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
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Catapano JS, Almefty RO, Ding D, Whiting AC, Pines AR, Richter KR, Ducruet AF, Albuquerque FC. Onyx embolization of skull base paragangliomas: a single-center experience. Acta Neurochir (Wien) 2020; 162:821-829. [PMID: 31919599 DOI: 10.1007/s00701-019-04127-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Skull base paragangliomas are highly vascular tumors that are often embolized before surgical resection; however, the safety and efficacy of preoperative embolization using an ethylene vinyl alcohol copolymer (Onyx; Medtronic, Dublin, Republic of Ireland) in these tumors is unknown. This retrospective cohort study evaluated patient outcomes after preoperative embolization of skull base paragangliomas using Onyx. METHODS We retrospectively analyzed data from all patients with skull base paragangliomas who underwent preoperative Onyx embolization at our institution (January 01, 2005-December 31, 2017). Patient, tumor, embolization, and outcomes data were extracted by reviewing inpatient and outpatient clinical and imaging records. RESULTS Seven patients were studied (5/7 [71%] female), 6 with glomus jugulares and 1 with a glomus vagale. The median age was 52 years, and the most common presenting symptom was cranial neuropathy (6/7 [86%]). The tumor vascular supply was from the ascending pharyngeal artery in all 7 cases (100%) with additional feeders including the occipital artery in 5 (71%); internal carotid artery in 3 (43%); middle meningeal, vertebral, and internal maxillary artery each in 2 (29%); and posterior auricular artery in 1 (14%). The median postembolization tumor devascularization was 80% (range, 64-95%). The only postembolization complication was a facial palsy in 1 patient. CONCLUSION Preoperative embolization with Onyx affords excellent devascularization for the majority of skull base paragangliomas, and it may facilitate resection of these hypervascular lesions. The advantages provided by Onyx with respect to penetration of intratumoral vessels must be weighed against the risk of cranial neuropathy.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Rami O Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Dale Ding
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Alexander C Whiting
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Andrew R Pines
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Kent R Richter
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center c/o Neuroscience Publications, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
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Kim SH. Posterior Cranial Fossa Meningioma Presenting With Hearing Impairment and Recurrent Vertigo. Ear Nose Throat J 2019; 99:353-355. [PMID: 31132901 DOI: 10.1177/0145561319825712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Se-Hyung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeju National University School of Medicine, Jeju, Republic of Korea
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Kheiri G, Habibi Z, Nejat F. Contralateral facial nerve paresis subsequent to posterior fossa meningioma surgery in a child: case report. Childs Nerv Syst 2019; 35:897-898. [PMID: 30643949 DOI: 10.1007/s00381-019-04053-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Meningiomas are relatively uncommon neoplasms in the pediatric population and posterior fossa is a very rare location for these tumors. Only a few cases of contralateral cranial nerve deficits have been reported but no cases of pediatric meningioma with contralateral facial nerve paresis have been documented in literature. CEREBELLOPONTINE ANGLE MENINGIOMA WHO CASE REPORT We present a 4 year old girl with found postoperative contralateral facial nerve paresis. DISCUSSION The possible pathogenesis and literature review concerning this complication are discussed. The mechanisms leading to this complication could be distortion of brainstem, traction during resection and subsequent compression of brainstem against the contralateral petrous or tentorium.
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Affiliation(s)
- Ghazaleh Kheiri
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Gharib Street, Tehran, 141557854, Iran
| | - Zohreh Habibi
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Gharib Street, Tehran, 141557854, Iran
| | - Farideh Nejat
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Gharib Street, Tehran, 141557854, Iran.
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Azami A, Azami Y, Ohtake T, Tachibana K, Tomura N, Seto I, Todate Y, Waragai M, Suzuki N, Sato A, Takano Y, Abe T, Teranishi Y. [Indication for Radiotherapy for Breast Cancer Metastasis to the Skull Base Accompanied by Cranial Nerve Palsies]. Gan To Kagaku Ryoho 2018; 45:1806-1808. [PMID: 30692360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Distant metastasis to the skull base region frequently manifests various cranial nerve symptoms and reduces patients' quality of life(QOL). We report a 62-year-old woman with skull base metastasis of breast cancer, whose condition clinically improved following palliative radiotherapy. The patient presented to our hospital with hoarseness. CT screening revealed a tumor in the right breast, axial lymph node swelling, and osteoblastic change at multiple sites. A core needle biopsy of the breast tumor revealed invasive lobular carcinoma. She also had nausea, anorexia, vertigo, lower left angle of the mouth, apraxia of lid closing, and dysphagia owing to several cranial nerve palsies. MRI T1- and T2-weighted images showed a diffuse low-signal intensity of the skull base region, and the patient was diagnosed as having breast cancer with symptomatic skull base metastases. Her cranial nerve symptoms improved after 1 week of palliative irradiation to the skull base. We conclude that, even among terminal-stage patients, palliative radiotherapy to the skull base region is an effective treatment option to improve patients' QOL.
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Affiliation(s)
- Ayaka Azami
- Dept. of Surgery, Southern Tohoku General Hospital
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Gioacchini FM, Cassandro E, Alicandri-Ciufelli M, Kaleci S, Cassandro C, Scarpa A, Re M. Surgical outcomes in the treatment of temporal bone cerebrospinal fluid leak: A systematic review. Auris Nasus Larynx 2018; 45:903-910. [PMID: 29636204 DOI: 10.1016/j.anl.2018.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/11/2018] [Accepted: 03/26/2018] [Indexed: 12/23/2022]
Abstract
Objective Temporal bone CSF leak represents a rare condition that may be associated to some particular symptoms as hearing loss, otorrhea and tinnitus. In the opinion of many authors a surgical treatment is mandatory to avoid serious consequences as meningitis. Middle cranial fossa (MCF), transmastoid (TM) and combined approaches are all described to manage this condition. The objective of this paper was firstly to analyze the overall outcomes of this surgery. Our second aim was to make a comparison between different surgical modalities on the basis of their rate of success and complications. Methods A search thorough Ovid MEDLINE was organized in January 2017 to enroll all eligible articles. A statistical analysis of the obtained data was performed. Results Thirtythree studies comprising a total of 873 procedures were included. The overall rate of success resulted 95.6% (94.1–96.8). The rate of major complications analyzed for 818 procedures was 3.4% (2.3–4.8). Subgroups analysis showed a success rate of 97.1% (90.7–99.5) for TM approach. A success rate of 94.1% (89.1–97.3) was calculated for MCF approach. Combined procedure (TM + MCF) showed a success rate of 97.9% (92.9–99.7). Conclusion The results of our review showed as the surgical treatment for CSF leak of temporal bone origin represents a safe option with high rate of success. Moreover our statistical data suggested that no significant differences are present in terms of outcomes between the analyzed surgical approaches.
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Affiliation(s)
- Federico Maria Gioacchini
- Otolaryngology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
| | - Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Shaniko Kaleci
- Department of Diagnostic Medicine, Clinical and Public Health, University Hospital of Modena, Italy
| | - Claudia Cassandro
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Massimo Re
- Otolaryngology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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Garcia-Madrona S, Corral-Corral I. [Occipital condyle syndrome as the first symptom of a metastatic hepatocellular carcinoma. Two case reports]. Rev Neurol 2018; 66:154-156. [PMID: 29480511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Occipital condyle syndrome consists of the presence of unilateral occipital headache exacerbated by moving the head and is accompanied by paralysis of the ipsilateral hypoglossal nerve. One of its causes is infiltration of the base of the skull by bone metastases, especially those affecting the hypoglossal nerve due to infiltration as it passes through the osseous canal. CASE REPORTS We report two clinical cases of occipital condyle syndrome secondary to metastatic hepatocarcinoma. The first is that of a 52-year-old male with liver cirrhosis secondary to liver pathology caused by hepatitis C virus with occipital condyle syndrome as the presenting symptom in disseminated hepatocarcinoma. The second case is that of a 56-year-old male after recurrence of hepatocarcinoma following a liver transplant, despite not fulfilling the Milan criteria. CONCLUSION Occipital condyle syndrome is an alarm symptom and requires a thorough study by means of imaging tests, since it may be the first symptom of an undetected hepatocarcinoma.
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Đerić D, Dudvarski Z, Cvorović L. OTOLOGICAL MANIFESTATIONS OF TURNER SYNDROME: CLINICAL AND RADIOLOGICAL FINDINGS. Med Pregl 2016; 69:45-47. [PMID: 27498533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Turner syndrome is a chromosomal abnormality where all or a part of one of the X chromosomes is absent or it has other abnormalities. Besides characteristic abnormalities of short stature and infertility, women with Turner syndrome have increased risks for tumors of the central nervous system, especially meningioma and an otologic disease. Meningioma involving the middle ear is extremely rare, and this condition has never been published in association with Turner syndrome. CASE REPORT We present an otologic manifestation associated with other abnormalities in a patient with Turner syndrome and discuss diagnosis and possible treatment options. CONCLUSION Multidisciplinary team approach is essential in these patients in order to evaluate their vulnerability and define therapeutic priorities.
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Abstract
CONCLUSION Lesions involving the jugular foramen (JF) present as various diagnoses. Pulsatile tinnitus is more common in glomus jugulare (GJ) tumors, whereas otalgia and facial nerve paresis are more prevalent in temporal bone malignancies (TBMs). Preoperative facial nerve electroneurography (ENoG) was significantly correlated with postoperative facial nerve function. OBJECTIVE To describe the diagnosis and surgical management of lesions involving the JF. METHODS The charts were reviewed for 38 patients who had lesions involving the JF, including 14 patients with TBMs, 11 with GJ tumors, 7 with cholesteatomas, 2 with facial nerve schwannomas, 2 with JF schwannomas, and 2 with cholesterol granulomas. The follow-up data were recorded. RESULTS The most frequent symptoms included hearing loss (89.47%), followed by otorrhea (47.37%) and pulsatile tinnitus (39.47%). With respect to TBMs, 57.14% of patients complained of otorrhea and otalgia, and 50.00% presented with facial nerve paresis. Among the 13 patients with facial nerve paresis, 53.85% were diagnosed with TBMs. Regarding GJ tumors, 81.82% had pulsatile tinnitus and hearing loss. Among the 25 patients with normal preoperative facial nerve function, the mean facial nerve ENoG reduction was 29.48 ± 29.15%, and the mean postoperative facial nerve score was 77.48 ± 33.13. The correlation coefficient was -0.973 (p = 0.000).
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Affiliation(s)
- Wei Li
- Otology & Skull Base Surgery Department
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Liu MT, Lin GY, Lin CC, Cheng CA, Chen MH, Lee JT. Occipital Condyle Syndrome as an Initial Presentation of Lung Cancer: A Case Report. Acta Neurol Taiwan 2015; 24:11-14. [PMID: 26179684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Occipital condyle syndrome (OCS) is a rare cause of headache. This study herein reports a case in which a unique headache and tongue deviation appear as symptoms of the first presentation of a malignant tumor. CASE REPORT A healthy 67-year-old male presented with a unilateral shooting pain in the occipital region, accompanied by slurred speech and difficulty swallowing. Neurological examinations later revealed atrophy and mild fasciculation of the tongue. The clinical symptoms and MRI results suggested OCS. Screening for tumor markers showed an elevated CEA. The chest CT revealed a lobulated soft-tissue mass in the lower left lobe, and a CTguided biopsy confirmed the diagnosis of adenocarcinoma. A whole body bone scan found multiple foci. The adenocarcinoma was graded pT2bN3M1b, stage IV. The headache improved with a prescription of prednisone, 60 mg to be taken daily. With three months of treatment, clinical examinations showed that the patient was free of pain and that there had been no progression of the atrophy or deviation of the tongue. CONCLUSION The possible etiology of OCS includes a primary tumor or metastatic lesion that directly invades the base of the skull. Determining the underlying causes of OCS can be challenging, but MR imaging is currently the diagnostic tool of choice. An awareness of the features of OCS in healthy adults may be able to lead to earlier diagnosis of the underlying etiology and efficient relief of the symptoms.
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Affiliation(s)
- Meng-Ta Liu
- Department of Medicine, Hualien Armed Forces General Hospital
| | - Guan-Yu Lin
- Departments of Neurology, Tri-Service General Hospital, National Defense Medical Center
| | - Chun-Chieh Lin
- Departments of Neurology, Tri-Service General Hospital, National Defense Medical Center
| | - Chun-An Cheng
- Departments of Neurology, Tri-Service General Hospital, National Defense Medical Center
| | - Ming-Hua Chen
- Departments of Neurology, Tri-Service General Hospital, National Defense Medical Center
| | - Jiunn-Tay Lee
- Departments of Neurology, Tri-Service General Hospital, National Defense Medical Center
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Zhang FP, She CP, Bing J, Zhang QF. [One case of meningioma of middle and posterior fossae and skull base: as monaural secretory otitis media for the first performance]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 48:842-843. [PMID: 24406183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Hattori Y, Tahara S, Ishii Y, Kitamura T, Inomoto C, Osamura RY, Teramoto A, Morita A. A case of prolactinoma with chordoma. Clin Neurol Neurosurg 2013; 115:2537-9. [PMID: 24129004 DOI: 10.1016/j.clineuro.2013.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/07/2013] [Accepted: 09/14/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Yujiro Hattori
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
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Marcus H, Schwindack C, Santarius T, Mannion R, Kirollos R. Image-guided resection of spheno-orbital skull-base meningiomas with predominant intraosseous component. Acta Neurochir (Wien) 2013; 155:981-8. [PMID: 23474732 DOI: 10.1007/s00701-013-1662-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 02/18/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although meningiomas of the spheno-orbital region commonly result in hyperostosis, intraosseous meningiomas, which feature extensive full thickness infiltration of the anterolateral skull base, are rare. In this study, we assess the value of image guidance during surgery for intraosseous spheno-orbital skull-base meningiomas in achieving safe and maximal abnormal bone resection. METHOD Only cases with a full thickness and extensive intraosseous component were included. Image guidance was used to guide drilling of hyperostotic bone. Extensive resulting defects of the orbital wall were reconstructed with titanium mesh. Post-operative CT scans were used to assess completeness of abnormal bone resection in the skull base, and MRI scans used to evaluate residual intradural disease. Operative complications to neurovascular structures in adjacent foramina were recorded. RESULTS Nineteen patients with full-thickness intraosseous spheno-orbital meningiomas underwent image-guided resection. Anterior clinoidectomy to variable extent was necessary in 11 cases with decompression of the optic canal in five. In ten cases, hyperostotic bone was drilled from the middle fossa around the exit foramina of the trigeminal nerve and base of the pterygoid plates. Proptosis was corrected in all cases, and of 11 patients presenting with reduced visual acuity, symptoms improved or stabilized in ten cases. Post-operative CT scans confirmed gross resection of abnormal bone in all cases, but limited residual tumor was present around the cavernous sinus or orbital apex in eight patients. One patient died from a pulmonary embolism, the only mortality of the series. One patient had worsening of pre-existing poor visual acuity, and three patients had worsening of pre-existing ophthalmoplegia. Five patients developed new facial numbness post-operatively, which persisted in three cases. CONCLUSIONS Intra-operative image guidance allowed total or near-total resection of the hyperostotic skull base around the cranial nerve foramina with minimal morbidity in a group of patients with extensive spheno-orbital meningiomas.
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Affiliation(s)
- Hani Marcus
- Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK.
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Zielinski G, Grala B, Koziarski A, Kozlowski W. Skull base secretory meningioma. Value of histological and immunohistochemical findings for peritumoral brain edema formation. Neuro Endocrinol Lett 2013; 34:111-117. [PMID: 23645307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 02/18/2013] [Indexed: 06/02/2023]
Abstract
Meningiomas are very common neurosurgical problem. Their histological appearance, different size and localization, adherence to vital neural and vascular structures or extensive peritumoral brain edema (PTBE), especially in deep seated tumors, may lead to severe, life-threatening complications. We report a case of tuberculum sellae meningioma (TSM). A 48-year old female presented with 7-month history of blurred vision and progressive visual impairment. Intracranial tumor was confirmed by magnetic resonance imaging (MRI). After ophtalmological and endocrinological evaluation, the patient underwent surgical removal of the tumor. She immediately recovered from her visual disturbances and no tumor recurrences were seen during follow-up. Pathological diagnosis showed a meningioma of the secretory subtype (MS). We discuss the role of immunohistochemical staining in the diagnosis and the role of different factors in the PTBE formation. Selection of surgical route to the TSM is discussed, as well. Review of the literature is presented.
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Affiliation(s)
- Grzegorz Zielinski
- Department of Neurosurgery, Military Institute of Medicine, Warsaw, Poland.
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Abstract
OBJECTIVE Patients with prolactinoma seem to be at high risk for osteopenia. However, whether patients with various pathological sellar tumors have risk for osteopenia remains unclear. The aim of the present study is to assess the bone mass alteration in patients with various sellar tumors and further to investigate the risk factors of bone mass alteration. MATERIALS AND METHODS 65 premenopausal female patients with diverse sellar tumors and 325 normal controls were enrolled in this study. Bone mineral density (BMD) of lumbar spine and comprehensive endocrinological evaluations were undergone. RESULTS Compared to the matched controls, BMD of patients with prolactinoma or craniopharyngioma significantly decreased. Patients with sellar meningioma and nonfunctioning adenoma are with a decreasing tendency and patients with growth hormone-secreting adenoma are with an increasing tendency compared to controls. Univariate and multivariate regression analysis indicated that the bone loss in prolactinomas was significantly correlated to disease duration and hypogonadism. CONCLUSION In the premenopausal women, patients with prolactinoma or craniopharyngioma are often accompanied with osteopenia or osteoporosis, and disease duration and hypogonadism are the risk factors of bone loss in prolactinoma. Continuous surveillance of BMD is recommended in patients with meningioma or nonfunctioning adenoma.
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Affiliation(s)
- Yongbo Zhao
- Institute of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
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Amiraraghi N, Syed MI, Syed S, Williams AT. Paraganglioma of the skull base presenting as nasal polyps. Laryngoscope 2012; 123:577-80. [PMID: 23027682 DOI: 10.1002/lary.23645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/27/2012] [Accepted: 07/09/2012] [Indexed: 11/07/2022]
Abstract
The authors report a case of paraganglioma of the skull base presenting as nasal polyps. A 29-year-old patient presented with epistaxis and was found to have nasal polyps. The patient underwent a nasal polypectomy. After pathology showed an unusual appearance, the mass was subsequently excised endoscopically using radiofrequency coblation, and it was found to be originating from the skull base. The diagnosis was made using a combination of clinical findings, radiology, and histopathology examination. It is important to consider paraganglioma in the differential diagnosis of unusual tumors of the nose and skull base.
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Affiliation(s)
- Natasha Amiraraghi
- Department of Otolaryngology, The Royal Infirmary, Edinburgh, United Kingdom
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31
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Tanaka S, Pollock BE, Stafford SL, Link MJ. Stereotactic radiosurgery for trigeminal pain secondary to benign skull base tumors. World Neurosurg 2012; 80:371-7. [PMID: 22381855 DOI: 10.1016/j.wneu.2012.01.057] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/05/2011] [Accepted: 12/31/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the outcome of stereotactic radiosurgery (SRS) for patients with benign skull base tumors and trigeminal-related facial pain. METHODS We undertook a retrospective review of 31 consecutive patients (25 women, 6 men) with benign skull base tumors and trigeminal pain who underwent SRS between 1991 and 2008. The tumors included 17 posterior fossa meningiomas, 9 cavernous sinus meningiomas, and 5 trigeminal schwannomas. The median patient age was 62 years (range, 17-81 years). In all cases the tumor was the primary target for SRS. The median follow-up after SRS was 50 months (range, 12-184 months). RESULTS The actuarial tumor control rate after SRS was 95% at both 3 years and 5 years. Eighteen patients (58%) initially achieved complete resolution of trigeminal pain. Higher maximum dose was associated with initial complete pain resolution on a multivariate analysis. However, 7 patients had recurrent pain during follow-up. At last follow-up, only 7 patients (23%) remained pain-free off medications. Further treatment in addition to medical therapy was required for 6 patients (19%). CONCLUSION Although SRS offers excellent radiographic tumor control for benign skull base tumors, durable relief of tumor-related trigeminal pain without medication was noted in only one-fourth of patients at last follow-up.
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Affiliation(s)
- Shota Tanaka
- Department of Neurologic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Abstract
A 58-year-old man with clinical diagnosis of phacomatosis pigmentovascularis (PPV) experienced tinnitus and progressive hearing loss due to a jugular foramen tumor.Attached to the tumor capsule, were several pigmented spots. Pathological examination revealed a tumor composed by two different tissues, namely a Schwannoma grade I associated with a leptomeningeal blue nevus. The neuropathological aspects of this unusual association are discussed. The association of PPV with a pigmented skull base tumor has not been described to date and illustrates the importance of systemic examination in PPV.
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Rogers DJ, Boseley ME, Stephan MJ, Browd S, Semerad DC. Enchondroma of the skull base secondary to generalized enchondromatosis: a case report and review of the literature. Ear Nose Throat J 2011; 90:535-537. [PMID: 22109922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Generalized enchondromatosis, of which Ollier disease is the most common type, is a rare bone dysplasia characterized by multiple intraosseous tumors near growth-plate cartilage. These cartilaginous tumors have a propensity to transform into chondrosarcomas. Enchondromas of the skull base are exceedingly rare. We present the case of a patient with generalized enchondromatosis who developed a large enchondroma of the clivus, and we discuss the clinical presentation and potential treatments for this entity.
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Affiliation(s)
- Derek J Rogers
- Division of Otolaryngology, Dwight David Eisenhower Army Medical Center, Augusta, GA 30905, USA.
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Thakar A, Sikka K, Verma R, Preetam C. Cricothyroid approximation for voice and swallowing rehabilitation of high vagal paralysis secondary to skull base neoplasms. Eur Arch Otorhinolaryngol 2011; 268:1611-6. [PMID: 21739100 DOI: 10.1007/s00405-011-1614-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 04/14/2011] [Indexed: 11/26/2022]
Abstract
This study documents the speech and swallowing outcomes of isolated ipsilateral cricothyroid approximation (aka tensioning thyroplasty; Type IV thyroplasty) for the treatment of high vagal paralysis (combined superior laryngeal nerve and recurrent laryngeal nerve paralysis). This is a pilot study of five cases with high vagal paralysis consequent to skull base neoplasms. Unilateral cricothyroid tensioning sutures were used. In all cases, vocal fold tensioning and vertical realignment of lax vocal folds were achieved. A partial, but acceptable medialization of vocal cord position was achieved. In all cases, aspiration was minimized and normal swallow function was restored by 6 weeks. The voice outcome was excellent in four cases and acceptable in one. Cricothyroid approximation restores vocal fold tension; in addition, it restores vertical vocal fold position and partially restores horizontal vocal fold position. Good voice and swallowing outcomes have been achieved. The procedure is quick, safe, and convenient when combined with a skull-base excision procedure. Further evaluation is merited.
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Affiliation(s)
- Alok Thakar
- Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Yamakami I, Higuchi Y, Horiguchi K, Saeki N. Treatment policy for petroclival meningioma based on tumor size: aiming radical removal in small tumors for obtaining cure without morbidity. Neurosurg Rev 2011; 34:327-34; discussion 334-5. [PMID: 21340545 DOI: 10.1007/s10143-011-0308-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Revised: 09/02/2010] [Accepted: 11/10/2010] [Indexed: 11/26/2022]
Abstract
Aggressive tumor removal is not always the best treatment for petroclival meningioma (PCM). However, radical removal actually provides the cure with minimal morbidity. We evaluated the relation of surgical results and tumor size in the PCM removal to clarify the treatment policy for PCM. This study comprised 32 consecutive patients with newly-diagnosed PCM who underwent tumor removal; tumor size was small (< 3 cm) in 12 patients and large (≥3 cm) in 20. Tumor removal was classified into radical (Simpson's grade I/II) and non-radical (Simpson's grade III/IV). Removal of small PCM was 11 radical and one non-radical; no surgical morbidity/mortality occurred and postoperative regular follow-up using magnetic resonance imaging showed no recurrence in the period of 66±45 months. Removal of large PCM was eight radical and 12 non-radical; despite no mortality, the incidence of permanent cranial nerve deficits and major neurological deficits newly developed postoperatively was 35% and 25%, respectively. Radical removal was significantly more frequent in small PCMs than in large PCMs. Permanent cranial nerve deficits newly developed postoperatively and poor outcome (Karnofsky score ≤80) were significantly more frequent in large PCMs than in small PCMs. Radical removal of small PCM is achieved with minimal morbidity and results in the cure. Notwithstanding high morbidity, aggressive removal of large PCM does not achieve a high rate of radical removal. To find and remove PCM radically while it is small is the only way to cure the disease with minimal morbidity.
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Affiliation(s)
- Iwao Yamakami
- Neurosurgery, Chiba Central Medical Center, 1835-1 Kasori-cho, Wakaba-ku, Chiba, Japan.
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Saeed P, van Furth WR, Tanck M, Kooremans F, Freling N, Streekstra GI, Regensburg NI, van der Sprenkel JWB, Peerdeman SM, van Overbeeke JJ, Mourits MP. Natural history of spheno-orbital meningiomas. Acta Neurochir (Wien) 2011; 153:395-402. [PMID: 21120550 PMCID: PMC3029659 DOI: 10.1007/s00701-010-0878-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 11/08/2010] [Indexed: 11/29/2022]
Abstract
Background To investigate the natural history and the growth rate of spheno-orbital meningiomas (SOMs). Methods Ninety patients with a diagnosis of SOM were included, and patient charts and imaging were evaluated. In a subset of 32 patients, volumetric studies were performed. Results The median follow-up for the entire group was 4 years (range, 1–15); the mean age was 47.8 (range, 26–93) years; 94% of the patients were female. The most common clinical signs and symptoms were proptosis (93%), visual deterioration (65%), retro-bulbar pain (23%) and diplopia (6%). In 35% of patients in this series, no visual deterioration occurred, and in 30% only mild proptosis was present. The median annual growth rate of the SOMs in the subset of 32 patients was 0.3 cm3/year (range, 0.03–1.8 cm3/year). We assessed a trend for more rapid tumour growth in younger patients and found the initial volume of the tumour (rho = 0.63) and of the soft tissue component (rho = 074) to be significantly related to the growth rate. Conclusion SOMs are slow-growing tumours that cause primarily proptosis and visual deterioration. In a significant number of patients, these tumours cause minimal discomfort and symptomatology. Therefore, in the absence of risk factors, we advocate a “wait and see” policy. For patients with large SOMs or with a large soft tissue component at first visit or with fast growing SOMs (>1cm3/year), a follow-up examination every 6 months is indicated.
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Affiliation(s)
- Peerooz Saeed
- Academic Medical Centre, University of Amsterdam, The Netherlands.
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37
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Affiliation(s)
- Annette Maznyczka
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
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Hiyashi S, Cheng PW, Young YH. Posterior fossa metastasis in lung cancer patients with vertigo. Eur Arch Otorhinolaryngol 2010; 268:303-7. [PMID: 20680638 DOI: 10.1007/s00405-010-1351-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Accepted: 07/22/2010] [Indexed: 11/26/2022]
Abstract
This study investigated whether vertiginous attacks indicate a high probability for posterior fossa metastasis in lung cancer patients. Twenty-five lung cancer patients having vertiginous episodes were enrolled in this study. All patients underwent a battery of audiovestibular function testing and MR imaging study. Ten (40%) of 25 lung cancer patients with vertigo were proven to have posterior fossa metastasis (PM1 group), while the other 15 patients had no posterior fossa metastasis (PM0 group). Of the PM1 group, all were adenocarcinoma with the women predominant (80%). Seven (70%) and two (13%) patients of PM1 and PM0 groups had other (bone, liver) systemic metastases before the vertigo episodes, respectively, exhibiting significant difference between them. However, no statistical differences existed in the audiovestibular function testing between the two groups. In contrast with 58% of PM0 group, none of the patients in PM1 group survived for > 3 years after the vertiginous attacks. The mean interval from vertiginous episode to death was 16 months (range 5-27). In conclusion, vertiginous attack in a lung cancer patient having other systemic metastases indicates a high probability of posterior fossa metastasis.
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Affiliation(s)
- Shunji Hiyashi
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
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39
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Gavriushin A, Lubnin AI, Konovalov AN, Shchekut'ev GA. [Compression cervical spine cord injury in patients with posterior cranial fossa tumors operated on in the sitting position: two cases with different outcomes]. Anesteziol Reanimatol 2010:72-75. [PMID: 20919546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The paper describes two cases of posterior cranial fossa pathology, operated on in the sitting position on the operating table. In one case, symptoms of cervical spine injury caused by undiagnosed preoperative cervical spine pathology emerged in a female patient in the early postoperative period. In the other case, cervical spine pathology was diagnosed before surgery and evoked potentials were monitored to prevent possible cervical spine injury in the sitting position during an operation.
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Golanov AV, Cherekaev VA, Serova NK, Pronin IN, Gorlachev GE, Kotel'nikova TM, Podoprigora AE, Kudriavtseva PA, Galkin MV. [Linear accelerator-based stereotactic radiation treatment of patients with medial middle fossa meningiomas]. Zh Vopr Neirokhir Im N N Burdenko 2010:13-18. [PMID: 20429360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Medial middle fossa meningiomas are challenging for neurosurgical treatment. Invasion of cranial nerves and vessels leads to high risk of complications after removal of such meningiomas. Currently methods of conformal stereotactic radiation treatment are applied wider and wider for the discussed lesions. During a 3.5-year period 80 patients with medial middle fossa meningiomas were treated in Burdenko Moscow Neurosurgical Institute using linear accelerator "Novalis". In 31 case radiation treatment was preceded by surgical resection. In majority of patients symptoms included cranial nerve dysfunction: oculomotor disturbances in 62.5%, trigeminal impairment--in 37.5%, visual deficit--in 43.8%, facial nerve palsy--in 1.25%. 74 patients underwent radiotherapy with classical fractioning, 2--in hypofractionated mode and 4 received radiosurgery. In cases of classical fractioning mean marginal dose reached 46.3 Gy during 28-33 fractions, in hypofractioning (7 fractions)--31.5 Gy, in radiosurgery--16.25 Gy. Mean follow-up period was 18.4 months (6-42 months). Control of tumor growth was achieved in 97.5% of cases (78 patients): in 42 (52.5%) lesion shrinked, in 36 (45%) stabilization was observed. Clinical examination revealed improvement of visual function in 15 patients (18%) and deterioration in 2 (2.5%). No new neuropathies were found. Stereotactic radiation treatment is the method of choice for medial anterior and middle fossa meningiomas due to effective control of tumor progression and minimal rate of complications.
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El Hassani Y, Burkhardt K, Delavellle J, Vargas MI, Boex C, Rilliet B. Symptomatic syringomyelia occurring as a late complication of posterior fossa medulloblastoma removal in infancy in a boy also suffering from scaphocephaly. Childs Nerv Syst 2009; 25:1633-7. [PMID: 19662425 DOI: 10.1007/s00381-009-0968-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The association of a medulloblastoma and a syringomyelia has been already described in rare instances albeit without symptoms related to the syrinx. CASE REPORT The case of a 23-year-old man operated in infancy for a medulloblastoma and then treated solely with adjuvant chemotherapy is reported. He was also operated in infancy for a scaphocephaly. With a very long time delay, he has developed a Chiari I and a symptomatic cervico-dorsal syringomyelia. The symptoms attributed to the syrinx consisted of a unilateral prurigo over the left arm which was so severe to lead to self-mutilation. DISCUSSION Clinical and magnetic resonance imaging follow-up after cervico-dorsal decompression shows a significant improvement of the symptoms together with a reduction of the size of the syrinx. This case is discussed in the light of the presumed pathophysiology of the syrinx and its exceptional clinical presentation.
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Affiliation(s)
- Yassine El Hassani
- Service de Neurochirurgie, Hôpital Cantonal Universitaire, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
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Abstract
A 34-year-old white man with a six month history of a feeling of déjà vu presented with an acute onset of headache and blurred vision associated with nausea and vomiting. Neurological examination was significant for a right third cranial nerve palsy. Computerized tomography (CT) demonstrated a 2.0 cm rim calcified right paracavernous mass with intratumoral hemorrhage and an adjacent 2.6 cm by 2.0 cm right temporal lobe hematoma. Intraventricular hemorrhage (IVH) was present in both lateral ventricles, right more than left (Figure 1). Diagnostic cerebral angiography demonstrated no evidence of aneurysm. Brain magnetic resonance (MR) imaging revealed a 2 cm mass in the right paracavernous region extending into the suprasellar region with heterogeneous signal intensity on T1- and T2-weighted images and heterogeneous enhancement after gadolinium administration. Adjacent to the lesion was a right temporal lobe hematoma; intraventricular hemorrhage was also observed in the right lateral ventricle (Figure 2). The patient underwent a right pterional craniotomy for gross total resection of the tumour. Histopathological examination of the tumour demonstrated a low grade hyaline chondrosarcoma. The patient subsequently underwent proton beam radiotherapy and is currently 82 months out from surgery with no evidence of recurrence.
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Affiliation(s)
- Gary L Gallia
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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Yu E, Vescan A, Perez-Ordonez B, Lazinski D, Bartlett E. Chondromyxoid fibroma of the skull base: case report and review of the literature. J Otolaryngol Head Neck Surg 2009; 38:E114-E117. [PMID: 19769816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Eugene Yu
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
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Samprón N, Arrazola M, Urculo E. [Skull-base plasmacytoma with craniocervical instability]. Neurocirugia (Astur) 2009; 20:478-483. [PMID: 19830373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Cranio-cervical instability is, in some cases, the main surgical concern in posterior skull base tumors. We report on a case in which a solitary plasmacytoma of the skull base presented with cranio-cervical instability. Vertebral artery was injured during surgery. The surgical anatomy is reviewed, with emphasis in vascular complications avoidance. CASE REPORT A 66 year-old woman was diagnosed of a cranial base solitary plasmacytoma and treated with radio and chemotherapy with complete remission. After receiving that treatment, she presented with tetraparesis and a cranio-cervical instability was diagnosed. She was operated on, under cranial traction, of posterior occipito-cervical instrumentation with C1 to C2 transarticular Magerl screws. The right vertebral artery was injured during surgery without additional neurological deficit. Two years after the operation she remains independent for daily activities. CONCLUSIONS Transarticular screws at the C1 to C2 level of the cervical spine may provide rigid fixation in posterior cranio-cervical instrumentation for osteolytic lesions, but there is a risk of injury to the vertebral artery, specially when some variations in the surgical anatomy exist.
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Affiliation(s)
- N Samprón
- Servicio de Neurocirugía. Hospital Donostia. San Sebastián. España
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Alharbi FA, Lenarz T, Stoever T. A case of unilateral hypoglossus nerve palsy associated with chordoma in the region of clivus. Eur Arch Otorhinolaryngol 2009; 266:2001-3. [PMID: 19590882 DOI: 10.1007/s00405-009-1037-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Accepted: 06/26/2009] [Indexed: 11/26/2022]
Abstract
We had a rare case of 50-year-old woman with a unilateral hypoglossus nerve palsy as a sign of clival chordoma. A computed tomography (CT) scan of the skull base showed bone destruction at the anterior part of the foramen magnum and CT scan of the neck reveals asymmetrical area at the base of the tongue. Magnetic resonance imaging showed a mass at the skull base in the region of the clivus with bone destruction in the middle and right side of the clivus. The tumor was biopsied through transnasal biopsy from the region of the clivus using a navigation system and microscopical surgical technique. Postoperatively, the patient received radiotherapy. Surgery is the most effective treatment of chordomas. An endoscopic approach provides easy, rapid and direct access to the clivus. A postoperative radiation therapy is recommended. A carbon ion radiotherapy is an effective treatment for chordomas of the skull base with minimal side effects. Close interdisciplinary collaboration between ORL, neuroradiology, pathology and oncology is desirable for effective therapy.
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Affiliation(s)
- Fahd Ali Alharbi
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Hannover, Carl-Neuberg-Strasse, 30625 Hannover, Germany.
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Otani N, Muroi C, Yano H, Khan N, Pangalu A, Yonekawa Y. Surgical management of tuberculum sellae meningioma: Role of selective extradural anterior clinoidectomy. Br J Neurosurg 2009; 20:129-38. [PMID: 16801044 DOI: 10.1080/02688690600776747] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A retrospective analysis of 32 patients with tuberculum sellae meningiomas who underwent surgery via a unilateral pterional approach was performed. A selective extradural anterior clinoidectomy (SEAC) technique was added in 20 patients. All patients had visual dysfunction preoperatively. Macroscopically complete removal with Simpson grade II was performed in 28 patients (87.5%). The postoperative visual function improved in 25 (78.1%), did not change in 3 (9.4%), and worsened in 4 patients (12.5%). The SEAC technique was effective, especially for removal of the tumour extending into the sellae/pituitary stalk (9 patients), the optic canal (4 patients) and hypothalamus (4 patients) with preservation of the visual and endocrinological function. These results were superior to those of surgery without SEAC technique. This technique is therefore recommended for complete resection of the tuberculum sellae meningiomas extending to the surrounding anatomical structures as the SEAC procedure reduces the risk of intraoperative optic nerve injury considerably.
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Affiliation(s)
- Naoki Otani
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
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Barber AJ, Lawson DDA, Field EA. Two case reports of orofacial paraesthesia demonstrating the role of the general dental practitioner in identifying patients with intracranial tumours. Prim Dent Care 2009; 16:55-58. [PMID: 19366520 DOI: 10.1308/135576109787909427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The following case reports describe the clinical features, diagnosis and management of two patients who presented to their general dental practitioner with a complaint of orofacial paraesthesia. After appropriate investigations, both patients were diagnosed as having benign intracranial tumours and were managed by a neurosurgeon. These cases illustrate the important role the general dental practitioner has in the early recognition of potentially life-threatening conditions.
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Affiliation(s)
- Andrew J Barber
- Liverpool University Dental Hospital and School of Dentistry, Liverpool, UK
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Abstract
The coexistence of brain tumours and aneurysms is rare. In all previously reported cases the aneurysm was detectable by angiography. We report here a case in which a paraclinoid internal carotid artery aneurysm was coexistent and concealed from angiographic detection by an adjacent parasellar meningioma.
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Affiliation(s)
- Kevin Petrecca
- Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Quebec, Canada.
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Ramina R, Neto MC, Fernandes YB, Silva EB, Mattei TA, Aguiar PHP. Surgical removal of small petroclival meningiomas. Acta Neurochir (Wien) 2008; 150:431-8; discussion 438-9. [PMID: 18309454 DOI: 10.1007/s00701-007-1403-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 09/11/2007] [Indexed: 11/30/2022]
Abstract
UNLABELLED Treatment of large petroclival meningiomas causing brain stem compression is surgical removal followed by radiotherapy or radiosurgery if the lesion was partially resected. The management of small petroclival meningiomas is, however, controversial. Clinical observation, radiosurgery and surgical removal are the options of treatment. The natural history of these tumours is not well known. Published series of patients treated with radiosurgery are not comparable with surgical series because the latter also includes large size tumours. In this paper we present a series of 18 patients with small petroclival meningiomas (diameter <or= 2.8 cm) treated with radical surgical removal. Total resection (Simpson's Grade 1) [43] was possible with minimal morbidity and no mortality. BACKGROUND We present a series of small petroclival meningiomas (SPM) treated by radical surgical removal and compare the outcome with other management modalities proposed for these lesions. METHODS Eighteen patients with SPM were surgically treated at our department of neurological surgery. The tumours were classified as small when they had a diameter < 3.0 cm. Headaches (n = 12), diplopia (n = 8), facial hypoaesthesia (n = 3) and tinnitus (n = 6) were the most frequent symptoms at presentation. The approaches used were retrosigmoid (n = 14), fronto-orbito-zygomatic (n = 3) and presigmoid (n = 1). The post-operative follow-up ranged from 1 to 110 months (mean 41.8 months). FINDINGS Radical tumour resection (Simpson's Grades 1 and 2) was achieved in all patients. There was no major morbidity or mortality related to the surgical procedure. Transient abducent nerve palsy was the only post-operative complication. The pre-operative cranial nerves deficits improved after surgery. Only one patient had persistent diplopia postoperatively. CONCLUSION Radical surgical removal of SPM is possible with minimal morbidity and may cure the patient. The effectiveness and outcome of surgery for small petroclival meningiomas should be compared with series treated by radiosurgery.
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Affiliation(s)
- R Ramina
- Department of Neurosurgery, Neurological Institute of Curitiba, Curitiba, Brazil.
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Palacios E. Vocal fold paralysis secondary to a jugular foramen schwannoma. Ear Nose Throat J 2007; 86:596-598. [PMID: 17990676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- Enrique Palacios
- Department of Radiology, Tulane University Medical Center, New Orleans. USA
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