MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Skull Base' source. Wed, 08 Feb 2012 15:44:39 +0100 http://www.medworm.com/index.php?rid=5525695&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1296042 In conclusion, complete excision of SWMs is always recommended whenever possible, but surgeons should acknowledge that there is nonetheless a chance of recurrence and should weigh this against the risk of causing cranial nerve injuries.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=5525695 Wed, 21 Dec 2011 05:00:00 +0100 5525695 http://www.medworm.com/index.php?rid=5525694&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1296036 In this study 5 latex-injected fixated cadaveric specimens were dissected bilaterally (providing a total of 10 IMAX dissections) to determine the precise location of the IMAX in the pterygopalatine fossa in relationship to bone landmarks of the middle fossa floor as seen through an intracranial approach. Drilling of the middle fossa floor was undertaken through both the originally described “anteromedial” approach, and a new “anterolateral” approach. Measurements were taken correlating the position of the IMAX to ipsilateral foramen rotundum, ipsilateral foramen ovale, posterior wall of the maxillary sinus, and distal V2 branches. Median and standard deviation were calculated for each dataset. The IMAX was found, within the pterygopalatine fossa, by drilling the greater wing of the... Skull Base journals http://www.medworm.com/rss/comments.php?id=5525694 Wed, 21 Dec 2011 05:00:00 +0100 5525694 http://www.medworm.com/index.php?rid=5495238&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1296038 Skull BaseDOI: 10.1055/s-0031-1296038We conducted this study to validate the volume/shape of the surgical exposure and to introduce a mathematical model to quantify the maneuverability in a surgical space. We executed the pterional and lateral supraorbital approach four times in fresh cadavers in skull base laboratory. The surgical volumes were filled with a computed tomography (CT)-imageable mixture; CT scans were obtained to evaluate the volume and shape of the surgical space. The volume of the surgical space was 23.60 and 32.90 mL for the lateral supraorbital and pterional approach, respectively, (p < 0.05). The three-dimensional shape of the lateral supraorbital approach was cylindrical and that of the pterional approach pyramidal. The volume of the surgical approach can be used... Skull Base journals http://www.medworm.com/rss/comments.php?id=5495238 Mon, 12 Dec 2011 05:00:00 +0100 5495238 http://www.medworm.com/index.php?rid=5469535&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1296041 Skull BaseDOI: 10.1055/s-0031-1296041The authors reviewed the surgical experience and operative technique in a series of 11 patients with middle fossa tumors who underwent surgery using the transzygomatic approach and intraoperative neuromonitoring (IOM) at a single institution. This approach was applied to trigeminal schwannomas (n = 3), cavernous angiomas (n = 3), sphenoid wing meningiomas (n = 3), a petroclival meningioma (n = 1), and a hemangiopericytoma (n = 1). An osteotomy of the zygoma, a low-positioned frontotemporal craniotomy, removal of the remaining squamous temporal bone, and extradural drilling of the sphenoid wing made a flat trajectory to the skull base. Total resection was achieved in 9 of 11 patients. Significant motor pathway damage can be avoided us... Skull Base journals http://www.medworm.com/rss/comments.php?id=5469535 Fri, 02 Dec 2011 05:00:00 +0100 5469535 http://www.medworm.com/index.php?rid=5469536&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1296035 Skull BaseDOI: 10.1055/s-0031-1296035The usefulness of endoscope-assisted microsurgical removal of vestibular schwannomas in the internal auditory canal (IAC) was evaluated. Microsurgical removal using the endoscope was done in 28 procedures and microsurgical removal without an endoscope was done in 43 procedures. A retrosigmoid approach was used. The tumor location in the IAC was classified as grade 1 (located up to the mid-portion), 2, 3, or 4 (located up to the fundus with bony destruction) according to the tumor extent, and residual tumor in the IAC was evaluated as grade A (remnant tumor was not observed), B, C, or D (remnant tumor was observed over the mid-portion) according to the extent of remnant tumor. The residual tumor in the IAC was less in the endoscope-assisted group than in... Skull Base journals http://www.medworm.com/rss/comments.php?id=5469536 Thu, 01 Dec 2011 05:00:00 +0100 5469536 http://www.medworm.com/index.php?rid=5469534&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1296034 In this study, we investigated the feasibility and the applicability of parallel integration of microscopic, endoscopic, and neuronavigation images by real time displaying the endoscope and neuronavigation image datasets in the main operative microscope oculars. The proposed set-up was effective in displaying the three images dataset in an operationally actionable mode. Ergonomically, the ability of using the different image dataset without the need of taking the eyes off the microscope oculars did not disrupt the flow or the tempo of the operative procedure. However, new endoscopes specific to this application are recommended.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: ... Skull Base journals http://www.medworm.com/rss/comments.php?id=5469534 Thu, 01 Dec 2011 05:00:00 +0100 5469534 http://www.medworm.com/index.php?rid=5469533&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1296039 In this study we evaluate the postoperative facial nerve function after vestibular schwannoma (VS) surgery and analyze the factors that cause it. We included 97 consecutive patients undergoing surgical excision of sporadic unilateral VS. Patient and tumor characteristics, surgical approaches, facial nerve function, extent of tumor removal, perioperative complications are all analyzed through standardized systems. Four different surgical approaches are used: translabyrinthine, retrolabyrinthine, retrosigmoid, and middle cranial fossa. Anatomic preservation of the facial nerve is achieved in 97% of patients. The incidence of postoperative facial palsy is found to be statistically correlated to tumor size, but not to the surgical approach used and to extent of tumor penetration in the interna... Skull Base journals http://www.medworm.com/rss/comments.php?id=5469533 Thu, 01 Dec 2011 05:00:00 +0100 5469533 http://www.medworm.com/index.php?rid=5458631&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1296043 In this study four patients treated with various kinds of planned duraplasty are included. The new 3-D technology was compared with the high-definition 2-D scopes during the different steps of the procedures. The 3-D endoscopic skull base reconstruction obtained primary closure without complications in all cases. According to the subjective opinion of experienced endosurgeons, this novel technique improved depth perception, distance and size estimation, ability to identify specific anatomic structures, and hand–eye coordination. The main drawbacks detected were inferior sharpness, contrast and lighting that impaired the application of the technique in narrow sinonasal spaces. According to our preliminary impressions, 3-D endoscopic skull base reconstruction is an effective and safe proce... Skull Base journals http://www.medworm.com/rss/comments.php?id=5458631 Wed, 30 Nov 2011 05:00:00 +0100 5458631 http://www.medworm.com/index.php?rid=5458630&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1296040 Skull BaseDOI: 10.1055/s-0031-1296040Spontaneous cerebrospinal fluid (CSF) leak through the posterior fossa (PF) aspect of the petrous bone is exceedingly rare. A case series allows analysis of etiologies and how they may differ from the more common middle fossa (MF) route of leakage. The design was a retrospective case series. The setting was a tertiary care institution. A series of three patients with PF spontaneous CSF leaks was identified. High-resolution imaging (CT and MRI) and intraoperative observations were evaluated. Both in this series and in previously reported cases, patients share the demographics typically found in the MF leak population. In our series, two patterns of PF CSF leak were identified: (1) large unilateral with cerebellar encephalocele and (2) small punctate defe... Skull Base journals http://www.medworm.com/rss/comments.php?id=5458630 Wed, 30 Nov 2011 05:00:00 +0100 5458630 http://www.medworm.com/index.php?rid=5458629&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1296037 We report a study of clinical and radiological features as well as the surgical findings and outcomes for patients with GPM treated at our institution over the past 6 years. During a 6-year period (April 2004 to March 2010), 16 patients with GPM underwent surgery by subtemporal transtentorial petrosal apex approach during which electrophysiological monitoring of cranial nerves and brainstem function were reviewed. There were nine females and seven males with a mean age of 56.9 years (range from 32 to 78 years). The most frequent clinical manifestations were headache (93.7%) and dizziness (93.7%). Regions and directions of tumor extension include clivus, parasellar, and cavernous sinus, as well as compression of brainstem, and so on. The trochlear nerve was totally wrapped in nine cases (56... Skull Base journals http://www.medworm.com/rss/comments.php?id=5458629 Wed, 30 Nov 2011 05:00:00 +0100 5458629 http://www.medworm.com/index.php?rid=5286359&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1287678 This study was conducted to investigate the radiological anatomy of the posterior clinoid process (PCP) to highlight preoperative awareness of its variations and its relationships to other skull base landmarks. The PCPs of 36, three-dimensional computed tomographic cadaveric heads were evaluated by studying the gross anatomy of the PCP and by measuring the distances between the PCP and other skull base anatomical landmarks relevant to transnasal or transcranial skull base approaches. PCP variations were found in five specimens (14%): in two the dorsum sellae was absent, in one the PCP and the anterior clinoid process (ACP) were connected unilaterally and in two bilaterally. The mean distance between the right/left PCP and the crista galli was 45.14 ± 4.0 standard deviation (SD_/46.24�... Skull Base journals http://www.medworm.com/rss/comments.php?id=5286359 Tue, 27 Sep 2011 04:00:00 +0100 5286359 http://www.medworm.com/index.php?rid=5286358&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1287684 This study evaluated the outcomes, complications, and recurrence rates of posterior cranial fossa meningiomas. We retrospectively reviewed our surgical experience with 64 posterior cranial fossa meningiomas. Mean age was 56 years with a female preponderance (67.2%). Headache was the most common symptom. Retrosigmoid approach was the commonest surgical procedure (23.4%). The incidence of cranial nerve related complications was 28%. Postoperatively facial nerve weakness was observed in 11%. The incidence of cerebrospinal fluid leak was 4.6%. Gross total resection was achieved in 37 patients (58%). Sixteen patients (25%) with residual tumors underwent Gamma knife radiosurgery. Recurrence or tumor progression was observed in 12 patients (18.7%). Operative mortality was 3.1%. At their last foll... Skull Base journals http://www.medworm.com/rss/comments.php?id=5286358 Tue, 27 Sep 2011 04:00:00 +0100 5286358 http://www.medworm.com/index.php?rid=5226905&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1287677 Skull BaseDOI: 10.1055/s-0031-1287677ABSTRACTLinear measurements have many limitations. The aim of this study is to compare manual and semiautomated volumetric measurements of pituitary adenomas. Magnetic resonance imaging (MRI) scans of 38 patients with pituitary adenomas were analyzed. Preoperative MRI was acquired on a 1.5 T. MRI volumes of the pituitary adenomas were obtained by two methods: manual (MA) and semiautomated (SA). The concurrent validity for SA and MA methods on 38 patients in the form of correlation coefficient was 0.97 (p < 0.0001). The intraobserver and the interobserver correlation coefficients for SA volumes were both 0.98, as for the intraobserver MA volumes were 0.98. Although the results of both methods are comparable, analysis of volumetric measurements by ... Skull Base journals http://www.medworm.com/rss/comments.php?id=5226905 Fri, 16 Sep 2011 04:00:00 +0100 5226905 http://www.medworm.com/index.php?rid=5226903&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1287679 Skull BaseDOI: 10.1055/s-0031-1287679ABSTRACTThe authors present a unique side-cutting instrument (NICO Myriad, Indianapolis, IN) with variable aspiration designed specifically for tumor resection. The study included retrospective review of data collected from 10/2009 to 01/2011. We detail the use of the Myriad in 31 patients with the following pathologies: meningioma (n = 16), chordoma (n = 3), schwannoma (n = 3), pituitary adenoma (n = 2), metastasis (n = 3), hemangioblastoma (n = 1), craniopharyngioma (n = 1), and nasopharyngeal tumors (n = 2). Surgical approaches included expanded endonasal approach (n = 19), endoscopic brain port (n = 3), supraorbital “eyebrow” craniotomy (n = 3), retrosigmoid suboccipital craniotomy (n = 3), pterion... Skull Base journals http://www.medworm.com/rss/comments.php?id=5226903 Fri, 16 Sep 2011 04:00:00 +0100 5226903 http://www.medworm.com/index.php?rid=5226908&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1287682 This study was conducted to report outcomes and identify factors predictive of survival and recurrence in patients undergoing lateral temporal bone resection (LTBR) as part of an extended radical parotidectomy for parotid cancer. This is a retrospective cohort study which includes all patients undergoing LTBR for parotid cancer between 1994 and 2010 at two affiliated academic centers. Survival and recurrence rates were analyzed using the Kaplan-Meier method and Cox multivariate regression. A total of 12 patients with median follow-up duration of 30.6 months were included: 6 de novo cases and 6 patients referred after local recurrence. Actuarial locoregional control at 2 years was 73%. Most patients (11; 92%) developed disease recurrence with distant metastases the most common site of first... Skull Base journals http://www.medworm.com/rss/comments.php?id=5226908 Wed, 14 Sep 2011 04:00:00 +0100 5226908 http://www.medworm.com/index.php?rid=5226907&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1287680 Skull BaseDOI: 10.1055/s-0031-1287680ABSTRACTThe study was conducted to analyze outcomes following surgical management of large and giant vestibular schwannomas and management options for residual disease. This retrospective case note study includes patients who had undergone microsurgical resection of sporadic, large, or giant vestibular schwannomas from 1986 to 2008. Tumors are classified as large if the largest extracanalicular diameter was 3.5 cm or greater and giant if 4.5 cm or greater. The study included 45 patients (33 large, 12 giant tumors), mean tumor size 4.1 cm. Total excision was achieved in 14 cases (31.1%), near-total in 26 (57.8%), and subtotal in 5 (11.1%). Facial nerve outcome was House-Brackmann Grade I/II in 25 cases (55.6%), III/IV in 16 (35.6%), and V/VI in 4 (8.9%).... Skull Base journals http://www.medworm.com/rss/comments.php?id=5226907 Wed, 14 Sep 2011 04:00:00 +0100 5226907 http://www.medworm.com/index.php?rid=5226906&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1287683 Skull BaseDOI: 10.1055/s-0031-1287683ABSTRACTTrigeminal schwannomas (TS), though the second most common intracranial schwannomas, represent only 0.8 to 8% of all Schwannomas. Advancement in imaging and microsurgical techniques has led to a remarkable improvement in the outcome of these benign tumors. Multicompartmental TS, though extensive, have an excellent outcome after surgery. In this article, we present our experience in the management of multicompartmental TS (types middle/posterior [MP], middle/extracranial [ME], and middle/posterior and extracranial [MPE]) and outcome in this rather uncommon group of tumors. This retrospective study included all the cases of multicompartmental TS operated at our institute from 1999 to 2009. The medical data were analyzed retrospectively. The demogr... Skull Base journals http://www.medworm.com/rss/comments.php?id=5226906 Wed, 14 Sep 2011 04:00:00 +0100 5226906 http://www.medworm.com/index.php?rid=5226904&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1287676 Skull BaseDOI: 10.1055/s-0031-1287676ABSTRACTTumors of the skull base are rare in children, and reconstruction in such patients has rarely been reported. We reviewed 16 cases of skull base reconstruction in patients under 18 years. The study group consisted of 10 boys and 6 girls, whose ages ranged from 2 to 17 years. Of the 16 cases, eight tumors were benign and eight were malignant. Defects were anterior in six cases, lateral in eight cases, and anterolateral in two cases. Reconstruction was performed with locoregional flaps in 11 cases and with free flaps in 5 cases. No significant difference was found between locoregional flaps and free flaps in total operative time, intraoperative blood loss, or postoperative hospital stay. However, in some cases, total operative time, reconstruction ... Skull Base journals http://www.medworm.com/rss/comments.php?id=5226904 Wed, 14 Sep 2011 04:00:00 +0100 5226904 http://www.medworm.com/index.php?rid=5226902&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1287681 The objective of this study was to assess the long-term survival of patients with a paraganglioma of the head and neck compared with the survival of the general Dutch population. This historic cohort study was conducted using nationwide historical data of paraganglioma patients. We retrieved a cohort of 86 patients diagnosed with a paraganglioma of the head and neck between 1945 and 1960 in the Netherlands. Dates of death were retrieved from the national bureau of genealogy. Survival after diagnosis was compared with age and sex adjusted survival in the general population, by means of Wilcoxon signed rank test and Kaplan-Meier actuarial survival curves. Although surgery had more complications in the studied era than today and the death of five patients with carotid body tumors caused immed... Skull Base journals http://www.medworm.com/rss/comments.php?id=5226902 Wed, 14 Sep 2011 04:00:00 +0100 5226902 http://www.medworm.com/index.php?rid=5184711&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284213 Skull BaseDOI: 10.1055/s-0031-1284213ABSTRACTWe conducted a study to evaluate the follow-up characteristics of patients with trigeminal neuralgia (TN) and to evaluate the factors affecting long-term outcome of microvascular decompression (MVD) in TN. Between 1983 and 2003, 156 patients with TN treated with MVD by 4 neurosurgeons at University Medical Centre Groningen/the Netherlands were evaluated. Baseline data from operative outcome were evaluated using univariate and multivariate analysis. The group consisted of 156 patients with TN: 90 females and 66 males with a median follow-up period of 9.7 years. The average age of initial symptoms was 51 years. The average duration of symptoms was 58 months. Postoperative 22 patients had a facial hyperpathia or hyperesthesia. Postoperatively, 137 ... Skull Base journals http://www.medworm.com/rss/comments.php?id=5184711 Tue, 30 Aug 2011 23:00:00 +0100 5184711 http://www.medworm.com/index.php?rid=5184710&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284216 We describe our experience with 52 such tumors and illustrate their resections and reconstruction. For full thickness lesions we generally do a wide field resection of skin and underlying calvarium followed by dural resection. Reconstruction is usually with dural replacement, calvarial reconstruction with titanium mesh, and cutaneous reconstruction with a musculocutaneous free flap or muscular free flap with an overlying skin graft. Complications, survival rates, and recurrence rates will be presented.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=5184710 Tue, 30 Aug 2011 23:00:00 +0100 5184710 http://www.medworm.com/index.php?rid=5184709&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284215 Skull BaseDOI: 10.1055/s-0031-1284215ABSTRACTInadvertent injury to eustachian tube leading to cerebrospinal fluid rhinorrhea is a known complication associated with drilling of Glasscock's triangle to expose the horizontal petrous internal carotid artery (ICA) for management of difficult tumors (especially malignant) or aneurysms at the cranial base. Contrary to the usual approach, we hypothesize that a “medial-to-lateral” approach to Glasscock's triangle drilling will minimize eustachian tube injury. Four formalin-fixed human cadaveric heads were dissected, and underwent appropriate morphometric analysis; yielding a total of eight datasets. The diameter of the horizontal petrous ICA exposed was 4.7 ± 0.9 mm (range, 3.8 to 5.6 mm).The mean distance from the medial ... Skull Base journals http://www.medworm.com/rss/comments.php?id=5184709 Tue, 30 Aug 2011 23:00:00 +0100 5184709 http://www.medworm.com/index.php?rid=5098475&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284217 We present a case series of two patients who presented with chondroblastomas of the temporal bone over a period of 8 years to the St. Vincent's Hospital in Melbourne, Victoria, Australia. In particular, we outline the presenting complaint, diagnostic imaging undertaken, and the importance of preoperative histopathology in coming to the diagnosis and subsequent resection undertaken. A review of the current literature is presented with a suggested management strategy for these tumors.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=5098475 Wed, 03 Aug 2011 23:00:00 +0100 5098475 http://www.medworm.com/index.php?rid=5098477&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284211 This study discusses the indications, outcomes, and complications in patients that underwent osseointegrated implantation for skull base rehabilitation. We conducted a retrospective review of eight patients with skull base defects who had undergone implantation of a facial prosthetic retention device ± bone-anchored hearing aid at a tertiary academic referral center. Descriptive analysis of applications, techniques, outcomes, and complications were reviewed. The majority of patients were males (n = 6) with previously diagnosed skull base malignancy (n = 5) with an average age of 46 (range, 14 to 77). All patients received an implanted facial prosthetic device either for an aural (n = 7) or orbital (n = 1) prosthesis. There were o... Skull Base journals http://www.medworm.com/rss/comments.php?id=5098477 Tue, 02 Aug 2011 23:00:00 +0100 5098477 http://www.medworm.com/index.php?rid=5098476&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284210 We describe the case history of a young patient found to have a craniofacial mass on routine prenatal ultrasound and subsequently managed with a multidisciplinary team approach.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=5098476 Tue, 02 Aug 2011 23:00:00 +0100 5098476 http://www.medworm.com/index.php?rid=5053496&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284218 Skull BaseDOI: 10.1055/s-0031-1284218ABSTRACTThe analysis of the treatment results in patients with cerebellopontine angle (CPA) tumors, manifested as trigeminal neuralgia (TN). During the 10-year period from 1998 to 2008, 14 patients with verified CPA tumors that had the typical manifestations of TN were operated on at our hospital (5.8% from all patients with TN who underwent surgery). In nine cases the epidermoid was identified; three patients had meningioma, one patient had acoustic neurinoma, and one patient had lipoma. The follow-up of all patients lasted at least 12 months. The intraoperative assessment identified the three variants of relationship between the tumors and neurovascular structures: (1) tumor grows around the trigeminal nerve; (2) the tumor causes compression and displ... Skull Base journals http://www.medworm.com/rss/comments.php?id=5053496 Wed, 20 Jul 2011 23:00:00 +0100 5053496 http://www.medworm.com/index.php?rid=5053495&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284214 Skull BaseDOI: 10.1055/s-0031-1284214ABSTRACTArtificial fixation systems for cranial bone flaps have problems related to their materials and designs. We developed an alternative technique for supratentorial craniotomy that employs a diamond-coated threadwire saw (diamond T-saw), originally developed for spinal surgery, and reduces the bone gap for fitted bone flap fixation. The study subjects were 77 adults undergoing elective supratentorial craniotomy. After placing a burr hole at each corner of the craniotomy, we performed osteotomy between adjacent burr holes to approximately one-third of the length of the osteotomy with a craniotome; this leaves a bony bridge at each corner. The diamond T-saw was introduced between adjacent burr holes through the epidural space and a bridge was cut wit... Skull Base journals http://www.medworm.com/rss/comments.php?id=5053495 Wed, 20 Jul 2011 23:00:00 +0100 5053495 http://www.medworm.com/index.php?rid=5053494&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284212 We report a technique in which Tisseel® fibrin sealant is injected into the ligated sigmoid sinus and internal jugular vein. This forms an internal cast around the tumor in the sigmoid-jugular complex and helps seal the inferior petrosal sinus and condylar veins. This allows for safer dissection with reduced venous bleeding. Our experience in five cases has shown this technique to be effective.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=5053494 Wed, 20 Jul 2011 23:00:00 +0100 5053494 http://www.medworm.com/index.php?rid=5053493&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284219 Skull BaseDOI: 10.1055/s-0031-1284219ABSTRACTWe conducted a retrospective observational study to assess the consequences of conservative management of vestibular schwannoma (VS). Data were collected from tertiary neuro-otological referral units in United Kingdom. The study included 59 patients who were managed conservatively with radiological diagnosis of VS. The main outcome measures were growth rate and rate of failure of conservative management. Multivariate analysis sought correlation between tumor growth and (i) demographic features, (ii) tumor characteristics. The mean tumor growth was 0.66 mm/y. 11 patients (19%) required intervention. Mean time to intervention was 37 months with two notable late “failures” occurring at 75 and 84 months. Tumors extending into the cerebel... Skull Base journals http://www.medworm.com/rss/comments.php?id=5053493 Wed, 20 Jul 2011 23:00:00 +0100 5053493 http://www.medworm.com/index.php?rid=4999797&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280683 In this report, we review Dr. Cushing's early surgical cases at the Johns Hopkins Hospital, revealing details of his early operative approaches to tumors of the skull base and cranial vault. Following Institutional Review Board approval, and through the courtesy of the Alan Mason Chesney Archives, we reviewed the Johns Hopkins Hospital surgical files from 1896 to 1912. Participants included four adult patients and one child who underwent surgical resection of bony tumors of the skull base and the cranial vault. The main outcome measures were operative approach and condition recorded at the time of discharge. The indications for surgery included unspecified malignant tumor of the basal meninges and temporal bone, basal cell carcinoma, osteoma of the posterior skull base, and osteomas of the... Skull Base journals http://www.medworm.com/rss/comments.php?id=4999797 Tue, 21 Jun 2011 23:00:00 +0100 4999797 http://www.medworm.com/index.php?rid=4999796&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280680 Skull BaseDOI: 10.1055/s-0031-1280680ABSTRACTThe primary objective of this study was to evaluate morbidity associated with facial translocation approaches for skull base and results of various technical modifications. Forty consecutive patients who underwent facial translocation approaches for accessing skull base tumors from July 2005 to June 2010 were included in this study. There were 25 patients who underwent standard facial translocation, 4 patients medial mini, and 11 patients underwent extended facial translocation. Thirteen patients had benign disease and 27 patients had malignant disease. Resection was R0 in 36 and R1 in 4 patients. Most patients had acceptable cosmetic results. None of the patients had problems related to occlusion or speech and swallowing. The commonest complica... Skull Base journals http://www.medworm.com/rss/comments.php?id=4999796 Tue, 21 Jun 2011 23:00:00 +0100 4999796 http://www.medworm.com/index.php?rid=4999795&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280679 Skull BaseDOI: 10.1055/s-0031-1280679ABSTRACTWe performed a trauma database analysis to identify the effect of concomitant cranial injuries on outcome in patients with fractures of the axis. We identified patients with axis fractures over a 14-year period. A binary outcome measure was used. Univariate and multiple logistic regression analysis were performed. There were 259 cases with axis fractures. Closed head injury was noted in 57% and skull base trauma in 14%. Death occurred in 17 cases (6%). Seventy-two percent had good outcome. Presence of abnormal computed tomography head findings, skull base fractures, and visceral injury was significantly associated with poor outcome. Skull base injury in association with fractures of the axis is a significant independent predictor of worse outcom... Skull Base journals http://www.medworm.com/rss/comments.php?id=4999795 Tue, 21 Jun 2011 23:00:00 +0100 4999795 http://www.medworm.com/index.php?rid=4999798&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280685 Skull BaseDOI: 10.1055/s-0031-1280685ABSTRACTComplex intracranial aneurysms (CIAs) include those classified as giant, those located in brain regions of technically difficult access, or that involve arterial trunks/branches, and/or have complicated wall structure. We reviewed retrospectively our management of such lesions in a 12-year period. From 1997 to 2009, 192 patients were admitted with CIAs (133 females, 59 males; average age 55 years); 128 presented with subarachnoid hemorrhage (SAH) and 64 with unruptured, symptomatic CIAs. The SAH group had 73 anterior- and 55 posterior-circulation aneurysms. Most frequent location was middle cerebral artery. Treatment strategies included clipping (65.6%), coiling/stenting (28.1%), bypass (3.1%), no treatment (3.1%). Coiling/stenting was exclusive... Skull Base journals http://www.medworm.com/rss/comments.php?id=4999798 Mon, 20 Jun 2011 23:00:00 +0100 4999798 http://www.medworm.com/index.php?rid=4999801&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280682 We report a technical variation of the endoscopic endonasal approach to the sellar and suprasellar regions which relies on the use of a 45-degree angled endoscope. The so-called “infrasellar approach” aims at excising lesions situated within the intermediate and posterior lobes of the pituitary gland without damaging the anterior lobe, thus potentially minimizing endocrinological morbidity. In this regard the endoscopic infrasellar approach might be advantageous in selected cases when compared with the traditional transsphenoidal approach with the microscope. We describe the technique and illustrate it with representative clinical cases.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4999801 Wed, 08 Jun 2011 23:00:00 +0100 4999801 http://www.medworm.com/index.php?rid=4999800&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280686 We present a retrospective analysis of surgical outcome of sinonasal malignant tumors. Overall survival (OS), disease-specific survival (DSS), local control (LC), and disease-free survival (DFS) were calculated in 32 patients. Prognostic factors for survival and functional outcomes were investigated. The median follow-up period was 70 months. At 5 years, OS, DSS, LC, and DFS rates were 0.722, 0.745, 0.851, and 0.707, respectively. Prognostic factors for poor OS were involvement of the frontal sinus (p = 0.023), T classification (T4, p = 0.025), surgical complications (p = 0.029), chemotherapy (p = 0.035) postsurgical infection (p = 0.043), involvement of the orbit (p = 0.048), histology (squamous cell carcinoma, p&#820... Skull Base journals http://www.medworm.com/rss/comments.php?id=4999800 Wed, 08 Jun 2011 23:00:00 +0100 4999800 http://www.medworm.com/index.php?rid=4999799&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280681 We present a comparison of our clinical experience with three portable scanners in skull base and craniofacial surgery. We present clinical case series and the participants were from the Northwestern Memorial Hospital. Three scanners are studied: one conventional multidetector CT (MDCT), two digital flat panel cone-beam CT (CBCT) devices. Technical considerations, ease of use, image characteristics, and integration with image guidance are presented for each device. All three scanners provide good quality images. Intraoperative scanning can be used to update the image guidance system in real time. The conventional MDCT is unique in its ability to resolve soft tissue. The flat panel CBCT scanners generally emit lower levels of radiation and have less metal artifact effect. In this series, in... Skull Base journals http://www.medworm.com/rss/comments.php?id=4999799 Wed, 08 Jun 2011 23:00:00 +0100 4999799 http://www.medworm.com/index.php?rid=4999802&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280684 Skull BaseDOI: 10.1055/s-0031-1280684ABSTRACTCranial base reconstructions associated with tumor resections around the orbital wall often require that both the upper and lateral orbital walls be reconstructed during a single procedure. Previously, we used titanium mesh plates that were preoperatively fabricated based on three-dimensional models. Although these plates are precise and do not increase the probability of infection, we still had to use autologous bones to reconstruct the orbital walls. Recently, we developed a new titanium mesh plate—called Skull-Fit®—with orbital wall (Skull-Fit WOW®), enabling us to reconstruct the cranial base and orbital walls without bone grafts. Here, we report on three reconstruction cases in which the novel titanium mesh-orbital wall system... Skull Base journals http://www.medworm.com/rss/comments.php?id=4999802 Thu, 02 Jun 2011 23:00:00 +0100 4999802 http://www.medworm.com/index.php?rid=4795519&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1277261 Skull BaseDOI: 10.1055/s-0031-1277261ABSTRACTWe analyzed the effect of predefined patient demographic, disease, and perioperative variables on the rate of complications in the perioperative period following subcranial surgery for anterior skull base lesion. A secondary goal of this study was to provide a benchmark rate of perioperative mortality and morbidity through comprehensive analysis of complications. Retrospective review of a consecutive series of patients (n = 164) who underwent the transglabellar/subcranial approach to lesions of the anterior skull base between December 1995 and November 2009 in a tertiary referral center. Main outcome measures were perioperative morbidity and mortality. No perioperative mortalities were observed over the period of consecutive review. ... Skull Base journals http://www.medworm.com/rss/comments.php?id=4795519 Thu, 05 May 2011 23:00:00 +0100 4795519 http://www.medworm.com/index.php?rid=4783210&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1277262 We present the largest series in North America examining the role of iMRI for pituitary adenoma resection. We retrospectively reviewed our institutional experience of 59-patients who underwent transsphenoidal procedures for sellar and suprasellar tumors with iMRI guidance. Of these, 52 patients had a histological diagnosis of pituitary adenoma. The technical results of this subgroup were examined. A 1.5-T iMRI was integrated with the BrainLAB (Feldkirchen, Germany) neuronavigation system. The majority (94%) of tumors in our series were macroadenomas. Seventeen percent of tumors were confined to the sella, 49% had suprasellar extensions without involvement of the cavernous sinus, 34% had frank cavernous sinus invasion. All patients underwent at least one iMRI, and 19% required one or more a... Skull Base journals http://www.medworm.com/rss/comments.php?id=4783210 Mon, 02 May 2011 23:00:00 +0100 4783210 http://www.medworm.com/index.php?rid=4720528&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275247 Skull BaseDOI: 10.1055/s-0031-1275247ABSTRACTThe “Agnes Fast” craniotomy is a fast and simple way of performing the pterional craniotomy while preserving the temporalis muscle, together with its fascia and bony attachment. Using this technique, the surgeon need not divide the temporalis muscle, separate it from its bony attachment, or perform an interfacial dissection. With a little practice, this craniotomy can be performed in less than 5 minutes and is highly recommended in emergent settings. The modified pterional craniotomy was performed in 10 cadaveric specimens, preserving the temporalis muscle with its attachment. An interfascial dissection was not performed while exposing the frontozygomatic process. The exposure gained, the length of the procedure, and the ease of appl... Skull Base journals http://www.medworm.com/rss/comments.php?id=4720528 Thu, 14 Apr 2011 23:00:00 +0100 4720528 http://www.medworm.com/index.php?rid=4715923&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275257 Skull BaseDOI: 10.1055/s-0031-1275257ABSTRACTNonmissile penetrating intracranial injuries are uncommon events in modern times. Most reported cases describe trajectories through the orbit, skull base foramina, or areas of thin bone such as the temporal squama. Patients who survive such injuries and come to medical attention often require foreign body removal. Critical neurovascular structures are often damaged or at risk of additional injury resulting in further neurological deterioration, life-threatening hemorrhage, or death. Delayed complications can also be significant and include traumatic pseudoaneurysms, arteriovenous fistulas, vasospasm, cerebrospinal fluid leak, and infection. Despite this, given the rarity of these lesions, there is a paucity of literature describing the managemen... Skull Base journals http://www.medworm.com/rss/comments.php?id=4715923 Wed, 13 Apr 2011 23:00:00 +0100 4715923 http://www.medworm.com/index.php?rid=4677855&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275249 We present the case of a 70-year-old woman with a long-standing history of headaches and progressive ocular neuropathy who underwent an endoscopic resection of a large sphenoid sinus mucocele resulting in immediate improvement of her neurological symptoms. The endoscopic endonasal transsphenoidal approach offers a minimally invasive method to manage and treat symptomatic sinus mucoceles.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4677855 Sun, 03 Apr 2011 23:00:00 +0100 4677855 http://www.medworm.com/index.php?rid=4677854&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275631 In this report, we review Dr. Cushing's early surgical cases at the Johns Hopkins Hospital, revealing details of his early use of craniofacial approaches for malignant pathology of the skull base. Following Institutional Review Board approval, and through the courtesy of the Alan Mason Chesney Archives, we reviewed the Johns Hopkins Hospital surgical files from 1896 to 1912, which included three patients who underwent surgical treatment of lesions involving the skull base through craniofacial approaches: two adults and one child (range 3 to 43 years). The main outcome measures were length of stay and condition recorded at the time of discharge. The indications for surgery included osteochondroma of the sphenoid sinus, sarcoma of the maxillary sinus and middle fossa, and osteoma of the fron... Skull Base journals http://www.medworm.com/rss/comments.php?id=4677854 Sun, 03 Apr 2011 23:00:00 +0100 4677854 http://www.medworm.com/index.php?rid=4677853&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275634 We describe two cases of dural arteriovenous fistula (DAVF) developing in a delayed fashion after translabyrinthine resection of cerebellopontine angle tumors. Two patients in an academic tertiary referral center, a 46-year-old woman and a 67-year-old man, underwent translabyrinthine resection of a 2-cm left vestibular schwannoma and a 4-cm left petrous meningioma, respectively. Both patients subsequently developed DAVF, and in each case the diagnosis was delayed despite serial imaging follow-up. In one patient, cerebrospinal fluid diversion before DAVF was identified as the cause of her intracranial hypertension; the other patient was essentially asymptomatic but with a high risk of hemorrhage due to progression of cortical venous drainage. Endovascular treatment was effective but require... Skull Base journals http://www.medworm.com/rss/comments.php?id=4677853 Sun, 03 Apr 2011 23:00:00 +0100 4677853 http://www.medworm.com/index.php?rid=4659679&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275241 We describe a series of patients who underwent endoscopic frontal sinus CSF leak repair utilizing a unilateral approach, to evaluate the utility and outcomes of this method. We performed a retrospective review of four cases in tertiary care centers. Participants included patients with CSF leak involving the frontal sinus. Main outcome measures included cessation of CSF leak and frontal sinus patency. Three patients were closed on the first surgical attempt; one with a communicating hydrocephalus required a revision procedure. Leak etiologies included prior craniotomy for frontal sinus mucopyocele, spontaneous meningoencephalocele, erosion due to mucormycosis, and prior endoscopic sinus surgery. The frontal sinus remained patent in three of four patients. No patients have evidence of a leak... Skull Base journals http://www.medworm.com/rss/comments.php?id=4659679 Tue, 29 Mar 2011 23:00:00 +0100 4659679 http://www.medworm.com/index.php?rid=4659678&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275242 Skull BaseDOI: 10.1055/s-0031-1275242ABSTRACTAdding posterolateral orbitotomy to pterional craniotomy allows greater exposure of the anterolateral skull base. However, there is a paucity of literature quantifying the relative benefit of adding posterolateral orbitotomy for various surgical targets. Our study is a step to address this issue. We performed dissections of five cadaveric heads (10 sides). The anterior communicating artery (A-Com) complex, posterior chiasm (anterior third ventricular region), ipsilateral optic canal, and ipsilateral supraclinoid internal carotid artery (ICA) bifurcation were chosen as targets. A pterional craniotomy was performed and the targets were morphometrically analyzed. Subsequently, posterolateral orbitotomy was done and analysis repeated. The field of v... Skull Base journals http://www.medworm.com/rss/comments.php?id=4659678 Tue, 29 Mar 2011 23:00:00 +0100 4659678 http://www.medworm.com/index.php?rid=4659677&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275253 We describe the technical nuances pertinent to the endonasal endoscopic management of a recurrent symptomatic PACG and review the literature. A 19-year-old woman presented with a recurrent right abducens nerve paresis. Four months prior, she underwent an endonasal transsphenoidal surgery (TSS) for drainage of a symptomatic PACG. Current imaging documented recurrence of the right PACG. Transsphenoidal and infrapetrous approaches were performed to obtain a wider bony opening along the petrous apex and drain the cyst. A Doyle splint was inserted into the cyst's cavity and extended out into the sphenoid, maintaining patency during the healing process. Three months after surgery, the splint was removed endoscopically, allowing visualization of a patent cylindrical communication between both aer... Skull Base journals http://www.medworm.com/rss/comments.php?id=4659677 Tue, 29 Mar 2011 23:00:00 +0100 4659677 http://www.medworm.com/index.php?rid=4659676&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275243 Skull BaseDOI: 10.1055/s-0031-1275243ABSTRACTLesions of the lower clivus represent a technically challenging subset of skull base disease that requires careful treatment. A 75-year-old woman with tongue atrophy was referred for resection of a presumed clival chordoma. The lesion was resected via an endoscopic transnasal transclival approach with no complications. Pathology revealed only chronic inflammatory tissue consistent with a degenerative pannus. Degenerative pannus should be included in the differential diagnosis of lower clival extradural lesions. The endoscopic transnasal transclival corridor should be considered for resection of such lesions as an alternative to larger, more morbid, traditional skull base approaches.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Tab... Skull Base journals http://www.medworm.com/rss/comments.php?id=4659676 Tue, 29 Mar 2011 23:00:00 +0100 4659676 http://www.medworm.com/index.php?rid=4659675&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275635 Skull BaseDOI: 10.1055/s-0031-1275635ABSTRACTWe assessed the accuracy of a surgeon's localization of sella margins during endoscopic transsphenoidal surgery for pituitary adenomas, as verified using a neuronavigational system, and we identify types of pathology in which neuronavigation is of most benefit. We performed a prospective cohort study of 32 consecutive patients undergoing image-guided endoscopic transsphenoidal surgery for pituitary adenomas. We assessed the margin of error in the surgeon's localization of the superior and inferior margins of the sella and the lateral margins as determined by the medial border of left and right carotid arteries, using a magnetic resonance-based neuronavigational system. The overall mean error of localization of sella margins by the surgeon was 4.... Skull Base journals http://www.medworm.com/rss/comments.php?id=4659675 Tue, 29 Mar 2011 23:00:00 +0100 4659675 http://www.medworm.com/index.php?rid=4659674&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275633 We describe a case of a 57-year-old woman with a self-inflicted bullet piercing the MCF, creating a persistent CSF leak. The details regarding the removal of this penetrating foreign body from the MCF, including the unique management in the setting of a contralateral spontaneous CSF leak, are discussed.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4659674 Tue, 29 Mar 2011 23:00:00 +0100 4659674 http://www.medworm.com/index.php?rid=4637191&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275638 Skull BaseDOI: 10.1055/s-0031-1275638ABSTRACTThe case of a 51-year-old man with a large temporal mass is presented. The mass eroded the floor of the middle fossa medially to the sphenoid sinus. A combined approach with neurosurgery and otolaryngology was performed to achieve maximal resection of the mass. Pathology was typical for chondroblastoma: a rare, benign but locally invasive chondroid tumor. Genetic testing revealed a translocation of (2;5) (q33;q13). This is a unique genetic mutation in all chondroid tumors to our knowledge. The diagnostic utility or role of this mutation in the pathobiology of this tumor remains to be determined.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4637191 Fri, 25 Mar 2011 00:00:00 +0100 4637191 http://www.medworm.com/index.php?rid=4637190&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275637 We report a rare subfrontal schwannoma with extension into the nasal cavity that mimicked neuroblastoma. Low FDG accumulation and compressive deformation of the anterior skull base may help in the differential diagnosis of these tumors.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4637190 Fri, 25 Mar 2011 00:00:00 +0100 4637190 http://www.medworm.com/index.php?rid=4637189&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275636 Skull BaseDOI: 10.1055/s-0031-1275636ABSTRACTWe explored the general feasibility of proton beam therapy for chordoma and chondrosarcoma of the skull base. Clinical records and treatment-planning data of patients with the pathological diagnosis of chordoma or chondrosarcoma were examined. Proton beam therapy was administered for gross tumor mass as well as microscopic residual disease after surgery. The prescribed dose was determined to maximize the coverage of the target and to not exceed predefined constraints for the organs at risk. Eight cases of chordoma and eight cases of chondrosarcoma were enrolled. The median tumor volume was 40 cm3 (range, 7 to 546 cm3). The prescribed dose ranged from 50 to 70 Gy (relative biological effectiveness [RBE]), with a median of 63 Gy RBE. The median fo... Skull Base journals http://www.medworm.com/rss/comments.php?id=4637189 Fri, 25 Mar 2011 00:00:00 +0100 4637189 http://www.medworm.com/index.php?rid=4632606&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275250 Skull BaseDOI: 10.1055/s-0031-1275250ABSTRACTWe assessed the feasibility and safety of free flap reconstruction in children undergoing extensive surgical excision of malignant head and neck tumors. We performed a retrospective review in a tertiary referral center of all patients aged 18 years or younger who underwent free flap reconstruction following resection of malignant head and neck tumors at our institution. Main outcome measures included complications at the primary and donor sites, functional and esthetic outcome, and tumor control. Eight of the 237 (3.4%) free flap reconstructions were performed on children. All tumors were malignant sarcomas. Ablative surgery was via a transfacial (n = 4) or a combined approach (n = 4). Transferred free flaps were the rectus abdominis (n = 3), gr... Skull Base journals http://www.medworm.com/rss/comments.php?id=4632606 Thu, 24 Mar 2011 00:00:00 +0100 4632606 http://www.medworm.com/index.php?rid=4632605&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275632 Skull BaseDOI: 10.1055/s-0031-1275632ABSTRACTThe endoscopic endonasal approach offers a wide, panoramic exposure of the sellar floor, planum, and clivus. The ability to expose fully the tumor margins, through lateral extension of cavernous sinuses, increases the exposure and ability to resect the tumor but increases the risk of bleeding. The authors describe achieving hemostasis using a hemostatic matrix, FloSeal (Baxter Biosciences, Vienna, Austria) sealant, during endoscopic endonasal tumor removal, specifically for pituitary and suprasellar tumors. Thirty-nine cases (33 pituitary adenomas, 4 craniopharyngiomas, 1 clival plasmacytoma, and 1 planum meningioma) are described using this technique. FloSeal was injected directly to the site of bleeding, and a cottonoid was used for further ta... Skull Base journals http://www.medworm.com/rss/comments.php?id=4632605 Thu, 24 Mar 2011 00:00:00 +0100 4632605 http://www.medworm.com/index.php?rid=4623374&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275260 In this report, we show the iliotibial tract-harvesting technique under endoscopic guidance with a minimally invasive approach using a cadaveric model. Two longitudinal incisions of 1 cm each were made at 4 cm down a line drawn between the anterior-superior iliac spine and the lateral margin of patella at the extremities of the middle third of the thigh. By using a set of instruments for endoscopic face-lifting, the graft was easily set up and harvested. The endoscopic approach is associated with less visible scars, but longer operative time in comparison with open traditional procedure. The pros and cons in terms of morbidity need to be evaluated by further studies on actual cases.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full ... Skull Base journals http://www.medworm.com/rss/comments.php?id=4623374 Tue, 22 Mar 2011 00:00:00 +0100 4623374 http://www.medworm.com/index.php?rid=4623373&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275244 Skull BaseDOI: 10.1055/s-0031-1275244ABSTRACTWe sought to characterize the effectiveness of concomitant chemoradiotherapy (CCRT) for patients with squamous cell carcinoma of the temporal bone. We performed a retrospective chart review of 14 patients with cancer of the temporal bone who were provided initial treatment in our hospital from December 2001 to November 2008. Four patients with stage I tumors were treated by radiation therapy alone or with oral administration of S1. One patient with a stage II tumor was treated by radiation therapy concomitant with low dose docetaxel. Nine patients with stage IV tumors were treated by CCRT using the TPF regimen (docetaxel, cisplatin, and 5-fluorouracil). As an initial treatment, all patients but one were treated by radiation therapy with or witho... Skull Base journals http://www.medworm.com/rss/comments.php?id=4623373 Tue, 22 Mar 2011 00:00:00 +0100 4623373 http://www.medworm.com/index.php?rid=4623372&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275251 Skull BaseDOI: 10.1055/s-0031-1275251ABSTRACTWe reviewed the postoperative functional outcome following surgical resection of paragangliomas in patients with and without preoperative cranial nerve dysfunction. Patients who underwent surgical resections of head and neck paragangliomas were reviewed with functional outcomes defined as feeding tube and/or tracheostomy dependence, need for vocal cord medialization, and incidence of cerebral vascular accidents as primary end points. Secondary end points included pre- and postoperative function of lower cranial nerves and the impact of this dysfunction on long-term functional status. Sixty-one patients were identified: 27 with carotid paraganglioma (CP), 21 with jugular paraganglioma (JP), 8 with tympanic paragangliomas, 4 with vagal paraganglio... Skull Base journals http://www.medworm.com/rss/comments.php?id=4623372 Tue, 22 Mar 2011 00:00:00 +0100 4623372 http://www.medworm.com/index.php?rid=4783211&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275261 Skull BaseDOI: 10.1055/s-0031-1275261© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4783211 Mon, 21 Mar 2011 00:00:00 +0100 4783211 http://www.medworm.com/index.php?rid=4617199&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275252 Skull BaseDOI: 10.1055/s-0031-1275252ABSTRACTThe facial nerve is one of the most commonly injured cranial nerves. Once injured, the effects on form, function, and psyche are profound. We review the anatomy of the facial nerve from the brain stem to its terminal branches. We also discuss the physical exam findings of facial nerve injury at various levels. Finally, we describe various reconstructive options for reanimating the face and restoring both form and function.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4617199 Mon, 21 Mar 2011 00:00:00 +0100 4617199 http://www.medworm.com/index.php?rid=4617198&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275261 Skull BaseDOI: 10.1055/s-0031-1275261© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4617198 Mon, 21 Mar 2011 00:00:00 +0100 4617198 http://www.medworm.com/index.php?rid=4611677&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275255 This study aims to design an animal model of ICA injury during endonasal skull base surgery. Eight sheep underwent ICA isolation followed by arterial pressure monitoring and placement of a rapid infuser. The Sinus Model Otorhino Neuro Trainer (Pro Delphus, Pernambuco, Brazil) nasal model was then modified. A novel posterior sphenoid wall was created, allowing the artery to be placed within and fixed to the model in a watertight fashion. A diamond-tipped bur allowed surgical exposure of the carotid artery. A standardized injury was created endoscopically. The “two-surgeon technique” allowed local packing measures to be performed. Outcome measures were mean arterial pressure (MAP) following injury, resuscitation fluid volume, survival time, and total blood loss. Mean preinjury we... Skull Base journals http://www.medworm.com/rss/comments.php?id=4611677 Fri, 18 Mar 2011 00:00:00 +0100 4611677 http://www.medworm.com/index.php?rid=4601942&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275248 The objective of the present study is to elucidate the feasibility of surgical maneuvers under the side-viewing endoscope during skull base tumor removal. The study focused on 51 patients who underwent tumor removal with the assistance of a side-viewing endoscope. The side-viewing endoscope enabled visualization and removal of residual tumors obscured by the skull base bone, cranial nerves, and other vital structures after a microscopic procedure. If the surgical field is surrounded by the dura or skull base tissue, not only curettage of a tumor but also semisharp dissection and bipolar coagulation are shown to be feasible. In the subarachnoid space, however, the primary feasible surgical maneuver was suctioning of the tumor. The extent of skull base resection could be reduced in 25 cases ... Skull Base journals http://www.medworm.com/rss/comments.php?id=4601942 Wed, 16 Mar 2011 00:00:00 +0100 4601942 http://www.medworm.com/index.php?rid=4601941&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275256 We report the pathology and outcome of secondary skull base tumors in patients previously treated with external beam radiation for retinoblastoma (Rb). Rb patients are at increased risk of second head and neck primary malignancies due to early radiation exposure during treatment and loss of RB1 protein in genetic carriers. An institutional database was reviewed for patients with retinoblastoma who had previously received radiation therapy and subsequently developed skull base tumors. Seventeen patients met the selection criteria. The median age of Rb diagnosis was 12 months. Thirteen cases underwent enucleation in addition to radiation therapy as part of initial Rb treatment. A median of 19 years elapsed between the diagnosis of Rb and diagnosis of skull base malignancy. The most common tu... Skull Base journals http://www.medworm.com/rss/comments.php?id=4601941 Wed, 16 Mar 2011 00:00:00 +0100 4601941 http://www.medworm.com/index.php?rid=4601940&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275258 Skull BaseDOI: 10.1055/s-0031-1275258© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4601940 Wed, 16 Mar 2011 00:00:00 +0100 4601940 http://www.medworm.com/index.php?rid=4601939&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275254 We report a rare case of aspergilloma of the sella and parasellar region in a patient operated for acromegaly. A 30-year-old diabetic patient underwent two surgeries for a growth hormone-secreting pituitary adenoma, which included a transsphenoidal approach. During his last admission, magnetic resonance imaging revealed a heterogeneous mass in the sella, suprasellar region, sphenoid sinus, and cavernous sinus with multiple areas of necrosis. His presentation, surgical treatment, and response to antifungal therapy are discussed. The role of prior surgery and related comorbidities in developing the invasive granuloma are highlighted.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4601939 Wed, 16 Mar 2011 00:00:00 +0100 4601939 http://www.medworm.com/index.php?rid=4595956&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275246 We report a patient with an incidentally found right frontal sinus lesion. The patient underwent resection of the tumor via a right craniotomy. The histological diagnosis was consistent with a schwannoma. There has been no radiographic recurrence on 2-year follow-up.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4595956 Tue, 15 Mar 2011 00:00:00 +0100 4595956 http://www.medworm.com/index.php?rid=4595955&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275259 Skull BaseDOI: 10.1055/s-0031-1275259ABSTRACTSolitary fibrous tumors (SFTs) are uncommon neoplasms of mesenchymal origin that were first described as primary spindle-cell tumors of the pleura in 1931. Since then, infrequent case reports of extrapleural SFTs have been described including various subsites within the head and neck. Based on a review of the literature and a description of the endoscopic treatment of three patients with SFTs of the nasal cavity and ethmoid sinuses, the challenges associated with the management of sinonasal SFTs are discussed. Successful endoscopic resection was performed at a tertiary referral rhinology practice within a university center in three cases of sinonasal SFTs with no evidence of recurrence at 26, 35, and 49 months following resection. Summarized are... Skull Base journals http://www.medworm.com/rss/comments.php?id=4595955 Tue, 15 Mar 2011 00:00:00 +0100 4595955 http://www.medworm.com/index.php?rid=4595954&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275245 We report the first case of breast cancer metastases into left occipital condyle, which was biopsied successfully through radical extended mastoidectomy under computer-assisted intraoperative navigation. This access proved to be feasible and safe, and enough material could be obtained for histological examination. According to the result, optimal adjuvant treatment strategies could be planned.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4595954 Tue, 15 Mar 2011 00:00:00 +0100 4595954 http://www.medworm.com/index.php?rid=4726264&cid=s_36598_16_f&fid=36598&url=https%3A%2F%2Fwww.thieme-connect.com%2Fejournals%2Ftoc%2Fsbs%2F104967%2Fgrouping%2F104038 Skull Base 2011; 02Article in Thieme eJournals:Table of contents  |  Congress (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4726264 Mon, 14 Feb 2011 00:00:00 +0100 4726264 http://www.medworm.com/index.php?rid=4327613&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270211 Skull BaseDOI: 10.1055/s-0030-1270211ABSTRACTThe major objectives in vestibular schwannoma (VS) surgery have evolved from reducing mortality to functional preservation of the facial nerve and hearing. Absence of fluid between the lateral end of the VS and the internal auditory canal fundus on magnetic resonance imaging (MRI) appeared to have a negative influence on hearing outcome. Our goal was to study the prognostic significance of fundus obliteration on facial nerve function after VS surgery in patients with clinically normal facial function. We performed a retrospective review in a tertiary referral neurotology unit or 110 consecutive patients with a surgically removed VS and normal preoperative facial nerve function. Facial nerve function was evaluated at 1 month and 1 year by using t... Skull Base journals http://www.medworm.com/rss/comments.php?id=4327613 Mon, 20 Dec 2010 00:00:00 +0100 4327613 http://www.medworm.com/index.php?rid=4019595&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1266762 Skull BaseDOI: 10.1055/s-0030-1266762ABSTRACTWe sought to determine the risk of tumor incisional recurrence in patients receiving surgery and postoperative radiation therapy for locally advanced sinonasal malignancies. Medical records for 70 patients newly diagnosed with nonmetastatic American Joint Committee on Cancer stage II to stage IV sinonasal malignancies between 1991 and 2003 were retrospectively reviewed. Patient demographics and tumor variables were recorded. All patients underwent upfront surgical resection with postoperative three-dimensional conformal proton beam radiotherapy. Recurrence and survival-related outcomes were recorded. Two patients with squamous cell carcinoma had pathologically confirmed tumor recurrence at the incision site. The actuarial risk of incisional recu... Skull Base journals http://www.medworm.com/rss/comments.php?id=4019595 Wed, 29 Sep 2010 23:00:00 +0100 4019595 http://www.medworm.com/index.php?rid=4019594&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1266761 We report a case of functional vagal paraganglioma to illustrate the biochemical and radiological imaging tests important in diagnosis and to highlight the importance of a multidisciplinary team approach to manage the preoperative, perioperative, and postoperative effects of catecholamine secretion from these tumors.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=4019594 Wed, 29 Sep 2010 23:00:00 +0100 4019594 http://www.medworm.com/index.php?rid=3974426&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1266763 Skull BaseDOI: 10.1055/s-0030-1266763ABSTRACTThe vascularized nasoseptal flap has become a principal reconstructive technique for the closure of endonasal skull base surgery defects. Despite its potential utility, there has been no report describing the use of the modern nasoseptal flap to repair traumatic cerebrospinal fluid (CSF) leaks and documenting the outcomes of this application. Specific concerns in skull base trauma include septal trauma with disruption of the flap pedicle, multiple leak sites, and issues surrounding persistent leaks after traumatic craniotomy. We performed a retrospective case series review of 14 patients who underwent nasoseptal flap closure of traumatic CSF leaks in a tertiary academic hospital. Main outcome measures include analysis of clinical outcome data. D... Skull Base journals http://www.medworm.com/rss/comments.php?id=3974426 Wed, 15 Sep 2010 23:00:00 +0100 3974426 http://www.medworm.com/index.php?rid=3966836&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1265825 The objective of this study is to determine the bony limits of the transnasal and transoral approaches to the anterior skull base. The data we present are meant to assist surgeons in preoperative planning for lesions of the sella, clivus, foramen magnum, and odontoid. Using precise measurements undertaken on 41 high-resolution computed tomography scans from patients at the University of Pennsylvania without any history of sinus or sellar pathology, we sought to define the bony limits of transoral and transnasal approaches. Direct measurements and calculated angles were used to assess the dimensions of the anterior skull base. Using our measurements, a transnasal approach can reach an average of 22.5 mm below the plane of the hard palate to the body of C2, and a transoral route can reach 38... Skull Base journals http://www.medworm.com/rss/comments.php?id=3966836 Mon, 13 Sep 2010 23:00:00 +0100 3966836 http://www.medworm.com/index.php?rid=3948278&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1265824 Skull BaseDOI: 10.1055/s-0030-1265824ABSTRACTEarly diagnosis of vestibular schwannoma (VS) has increased in recent years because of increased longevity and availability of magnetic resonance imaging (MRI). Initial conservative radiological surveillance is often requested by patients and physicians to establish whether these tumors are growing before embarking on intervention. Initial observation of at least 1 year in all small VS was therefore recommended by some authors. We evaluated our prospective skull base database of VSs that were managed with initial radiological surveillance to establish when this policy should be abandoned and what predicts future growth. Fifty-four consecutive patients with VS in our institution who were managed by initial yearly MRI scanning were studied. The MR... Skull Base journals http://www.medworm.com/rss/comments.php?id=3948278 Wed, 08 Sep 2010 23:00:00 +0100 3948278 http://www.medworm.com/index.php?rid=3948277&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1265823 We report one case with craniocervical neurenteric cyst that was excised by the far-lateral transcondylar (FLT) approach. A 43-year-old man presented with a history of recurrent episodes of mild neck pain and dysesthesia in his bilateral hands of 2 years' duration with rapid deterioration 3 weeks prior to admission. Magnetic resonance imaging (MRI) of the CCJ region revealed a well-defined intradural cystic lesion located ventral from the pontomedullary junction to C1 vertebra with medulla and C1 cord compression. This patient underwent total excision of the lesion via the FLT approach without any postoperative neurological deficits, and the histopathologic diagnosis was neurenteric cyst. Follow-up MRI has revealed no evidence of recurrence. The clinical features, imaging studies, and surg... Skull Base journals http://www.medworm.com/rss/comments.php?id=3948277 Wed, 08 Sep 2010 23:00:00 +0100 3948277 http://www.medworm.com/index.php?rid=3944283&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1265826 Skull BaseDOI: 10.1055/s-0030-1265826ABSTRACTDetailed descriptions of stepwise dural opening/removal for combined petrosal approach are presented. Following maximum bone work, the first dural incision was made along the undersurface of the temporal lobe parallel to the superior petrosal sinus. Posterior extension of the dural incision was made in a curved fashion, keeping away from the transverse-sigmoid junction and taking care to preserve the vein of Labbé. A second incision was made perpendicular to the first incision. After sectioning the superior petrosal sinus around the porus trigeminus, the incision was extended toward the posterior fossa dura in the middle fossa region. The tentorium was incised toward the incisura at a point just posterior to the entrance of the trochlear nerve.... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944283 Tue, 07 Sep 2010 23:00:00 +0100 3944283 http://www.medworm.com/index.php?rid=3944282&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1265821 Skull BaseDOI: 10.1055/s-0030-1265821ABSTRACTWe sought better understanding about the facial nerve anatomy in the rare inner ear Michel anomaly to help better define this aplasia and prevent potential complications in surgery on these patients. The data from computed tomography scans and magnetic resonance images of six Michel aplastic ears (three patients) were evaluated for a facial nerve course. Facial nerve course and anatomic landmarks were noted. Based on data obtained from this group of very rare patients, three different facial nerve anatomies were encountered. The first patient had normal-looking mastoid cells, normal middle ear ossicles, and a completely formed facial nerve canal through the middle ear. The second patient had pneumatized mastoid air cells despite an anomalous oss... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944282 Tue, 07 Sep 2010 23:00:00 +0100 3944282 http://www.medworm.com/index.php?rid=3944281&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1265822 Skull BaseDOI: 10.1055/s-0030-1265822ABSTRACTGiant cell reparative granuloma (GCRG) in the temporal bone of the skull base is a very rare benign osteolytic lesion. Here, we report two cases that were initially misdiagnosed according to the patients' histories, clinical symptoms, and brain imaging prior to surgery. One case had a history of resection of a middle cranial fossa meningioma. The other case had a history of otitis media and mastoiditis. Pathological examination of the surgical specimens led to the diagnosis of GCRG for both cases. Both patients recovered well after surgical removal of the lesion without radiotherapy. Follow-up for 2 years indicated no recurrence of GCRG. These two cases support the hypothesis that repairing responses of bone tissue to either trauma or inflammati... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944281 Tue, 07 Sep 2010 23:00:00 +0100 3944281 http://www.medworm.com/index.php?rid=3870139&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1263285 Skull BaseDOI: 10.1055/s-0030-1263285ABSTRACTThe indicators of poor outcome in giant intracranial aneurysms have been the subject of several studies in the literature. We conducted a retrospective analysis to evaluate the predictors of poor outcome in giant intracranial aneurysms. We studied consecutive cases with aneurysms admitted over a 9-year period in our institution. All the aneurysms were treated with clipping. Patient demographics, clinical profile, and aneurysm characteristics were evaluated in a multivariate analysis as probable indicators of Glasgow Outcome Scale (GOS) score. The outcome of the aneurysms (GOS score) was compared with the remaining non-giant aneurysms. A total of 41 giant and 348 non-giant aneurysms were identified in our series. In the multivariate analysis, the... Skull Base journals http://www.medworm.com/rss/comments.php?id=3870139 Tue, 17 Aug 2010 05:44:59 +0100 3870139 http://www.medworm.com/index.php?rid=3846549&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1263283 Skull BaseDOI: 10.1055/s-0030-1263283ABSTRACTWe sought to measure the anatomic dimensions of the crista galli in a consecutive series of patients undergoing the endoscopic transcribriform approach for anterior skull base tumors at a tertiary academic university hospital. We performed a retrospective chart review of patients undergoing purely endoscopic transcribriform surgery for sinonasal and skull base lesions. Main outcome measures included radiological dimensions of the crista galli. A total of 12 patients were identified and treated by the senior authors at the University of Pennsylvania. The average crista galli dimensions were 12.7 ± 2.4 mm (anterior-posterior) and 12.9 ± 2.5 mm (cranial-caudal dimension). Knowledge of the dimensions of the crista galli is ... Skull Base journals http://www.medworm.com/rss/comments.php?id=3846549 Tue, 10 Aug 2010 01:20:12 +0100 3846549 http://www.medworm.com/index.php?rid=3829196&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1263282 This study aims to contribute to the definition of the Dorello's canal and to the understanding of abducens vulnerability from an evolutionary perspective. The petroclival region and the Dorello's canal in particular were examined in a sample of 86 primate skulls. The sample contains 20 (common chimpanzee), 35 , 20 (orangoutan), and 11 (gibbon) skulls. Distance between the petrous apex and tip of the posterior clinoid process was measured using a 10-mm scale that was inserted into the endocranium. Complete absence of the Grüber ligament and an uninterrupted osseous circumference of the Dorello's canal (foramen) was demonstrated in all nonhuman primate species. Whatever the reason for the morphological difference between the human and ape Dorello's canal, it is without a doubt suggestive o... Skull Base journals http://www.medworm.com/rss/comments.php?id=3829196 Sat, 07 Aug 2010 05:50:51 +0100 3829196 http://www.medworm.com/index.php?rid=3829195&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1263281 Skull BaseDOI: 10.1055/s-0030-1263281ABSTRACTPostoperative cerebrospinal fluid (CSF) leakage is one of the most common and aggravating complications in transsphenoidal surgery. Although primary closure of the fistula would be the most desirable solution for an intraoperatively encountered CSF leak, it is difficult to achieve in such a deep and narrow operative field. In this article, the authors report endonasal endoscopic applications of no-penetrating titanium clips to repair a CSF fistula following tumor removal. The AnastoClip Vessel Closure System (VCS; LeMaitre Vascular, Boston, MA) was used for closure of a CSF fistula in endonasal transsphenoidal surgery. In all four patients, CSF leakage was successfully obliterated primarily with two to five clips. There was no postoperative CSF ... Skull Base journals http://www.medworm.com/rss/comments.php?id=3829195 Sat, 07 Aug 2010 05:50:51 +0100 3829195 http://www.medworm.com/index.php?rid=3829194&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1263284 We report a patient with an extradural dermoid cyst of the right parasellar region, causing right visual disturbance. Computed tomography revealed a hypodense mass lesion with rimlike calcification at the right parasellar region, accompanying marked erosion of the adjacent skull base. The tumor appeared as a heterogeneous intensity on magnetic resonance imaging and was surrounded by thin gadolinium enhancement without inner enhancement. The right optic nerve was compressed by the tumor. Surgical resection was successfully performed using a right frontotemporal extradural approach. The entire tumor was completely resided extradurally and was enclosed by saclike, stretched dura mater and extended deeply into the skull base. Histopathologic findings were consistent with the features of dermoi... Skull Base journals http://www.medworm.com/rss/comments.php?id=3829194 Sat, 07 Aug 2010 01:09:25 +0100 3829194 http://www.medworm.com/index.php?rid=3944288&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1263282 This study aims to contribute to the definition of the Dorello's canal and to the understanding of abducens vulnerability from an evolutionary perspective. The petroclival region and the Dorello's canal in particular were examined in a sample of 86 primate skulls. The sample contains 20 Pan troglodytes (common chimpanzee), 35 Gorilla gorilla, 20 Pongo pygmaeus (orangoutan), and 11 Hylobates moloch (gibbon) skulls. Distance between the petrous apex and tip of the posterior clinoid process was measured using a 10-mm scale that was inserted into the endocranium. Complete absence of the Grüber ligament and an uninterrupted osseous circumference of the Dorello's canal (foramen) was demonstrated in all nonhuman primate species. Whatever the reason for the morphological difference between the hu... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944288 Thu, 05 Aug 2010 23:00:00 +0100 3944288 http://www.medworm.com/index.php?rid=3944287&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1263281 Skull BaseDOI: 10.1055/s-0030-1263281ABSTRACTPostoperative cerebrospinal fluid (CSF) leakage is one of the most common and aggravating complications in transsphenoidal surgery. Although primary closure of the fistula would be the most desirable solution for an intraoperatively encountered CSF leak, it is difficult to achieve in such a deep and narrow operative field. In this article, the authors report endonasal endoscopic applications of no-penetrating titanium clips to repair a CSF fistula following tumor removal. The AnastoClip Vessel Closure System (VCS; LeMaitre Vascular, Boston, MA) was used for closure of a CSF fistula in endonasal transsphenoidal surgery. In all four patients, CSF leakage was successfully obliterated primarily with two to five clips. There was no postoperative CSF ... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944287 Thu, 05 Aug 2010 23:00:00 +0100 3944287 http://www.medworm.com/index.php?rid=3944286&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1263284 We report a patient with an extradural dermoid cyst of the right parasellar region, causing right visual disturbance. Computed tomography revealed a hypodense mass lesion with rimlike calcification at the right parasellar region, accompanying marked erosion of the adjacent skull base. The tumor appeared as a heterogeneous intensity on magnetic resonance imaging and was surrounded by thin gadolinium enhancement without inner enhancement. The right optic nerve was compressed by the tumor. Surgical resection was successfully performed using a right frontotemporal extradural approach. The entire tumor was completely resided extradurally and was enclosed by saclike, stretched dura mater and extended deeply into the skull base. Histopathologic findings were consistent with the features of dermoi... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944286 Thu, 05 Aug 2010 23:00:00 +0100 3944286 http://www.medworm.com/index.php?rid=3788162&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1262946 Skull BaseDOI: 10.1055/s-0030-1262946ABSTRACTThe restricted operative field, difficulty of obtaining proximal vascular control, and close relationship to important anatomic structures limit approaches to basilar apex aneurysms. We used a cadaveric model to compare three surgical transcavernous routes to the basilar apex in the neutral configuration. Five cadaveric heads were dissected and analyzed. Working areas and length of exposure provided by the transcavernous (TC) approach via pterional, orbitozygomatic, and temporopolar (TP) routes were measured along with assessment of anatomic variation for the basilar apex region. In the pterional TC and orbitozygomatic TC approaches, the mean length of exposure of the basilar artery measured 6.9 and 7.2 mm, respectively ( = NS). The ... Skull Base journals http://www.medworm.com/rss/comments.php?id=3788162 Tue, 27 Jul 2010 05:41:36 +0100 3788162 http://www.medworm.com/index.php?rid=3788161&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1262945 Skull BaseDOI: 10.1055/s-0030-1262945ABSTRACTWe systematically reviewed the literature concerning the anterior cranial fossa schwannomas to understand their pathogenesis, determine their origin, and standardize the terminology. We performed a MEDLINE, EMBASE, and Science Citation Index Expanded search of the literature; age, gender, clinical presentation, presence or absence of hyposmia, radiological features, and apparent origin were analyzed and tabulated. Cases in a context of neurofibromatosis and nasal schwannomas with intracranial extension were not included. Age varied between 14 and 63 years (mean = 30.9). There were 22 male and 11 female patients. The clinical presentation included seizures ( = 15), headache ( = 16), visual deficits ( =&#8... Skull Base journals http://www.medworm.com/rss/comments.php?id=3788161 Tue, 27 Jul 2010 01:21:06 +0100 3788161 http://www.medworm.com/index.php?rid=3944290&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1262946 Skull BaseDOI: 10.1055/s-0030-1262946ABSTRACTThe restricted operative field, difficulty of obtaining proximal vascular control, and close relationship to important anatomic structures limit approaches to basilar apex aneurysms. We used a cadaveric model to compare three surgical transcavernous routes to the basilar apex in the neutral configuration. Five cadaveric heads were dissected and analyzed. Working areas and length of exposure provided by the transcavernous (TC) approach via pterional, orbitozygomatic, and temporopolar (TP) routes were measured along with assessment of anatomic variation for the basilar apex region. In the pterional TC and orbitozygomatic TC approaches, the mean length of exposure of the basilar artery measured 6.9 and 7.2 mm, respectively (p = NS). The... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944290 Sun, 25 Jul 2010 23:00:00 +0100 3944290 http://www.medworm.com/index.php?rid=3944289&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1262945 Skull BaseDOI: 10.1055/s-0030-1262945ABSTRACTWe systematically reviewed the literature concerning the anterior cranial fossa schwannomas to understand their pathogenesis, determine their origin, and standardize the terminology. We performed a MEDLINE, EMBASE, and Science Citation Index Expanded search of the literature; age, gender, clinical presentation, presence or absence of hyposmia, radiological features, and apparent origin were analyzed and tabulated. Cases in a context of neurofibromatosis and nasal schwannomas with intracranial extension were not included. Age varied between 14 and 63 years (mean = 30.9). There were 22 male and 11 female patients. The clinical presentation included seizures (n = 15), headache (n = 16), visual deficits (n =... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944289 Sun, 25 Jul 2010 23:00:00 +0100 3944289 http://www.medworm.com/index.php?rid=3735057&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261267 Skull BaseDOI: 10.1055/s-0030-1261267ABSTRACTWe sought to determine the extent of the frontal sinus by intraoperative transillumination through the superomedial orbital wall in a subcranial approach to the anterior skull base. After raising a bicoronal flap, the frontal sinus was transilluminated through the superomedial orbital wall with a fiber-optic light source, delineating the extent of the frontal sinus. The frontal sinus boundary was marked with a marker pen. A frontal sinus anterior wall osteotomy was performed with a sagittal saw, staying within the confines of the frontal sinus marking. A bone flap was removed, and the posterior wall was drilled out. The remaining procedure was performed in a standard fashion. At the end of the procedure, the bone flap was fixed with a titanium p... Skull Base journals http://www.medworm.com/rss/comments.php?id=3735057 Fri, 09 Jul 2010 05:38:13 +0100 3735057 http://www.medworm.com/index.php?rid=3735056&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261263 This study further characterizes the results of this technique with a larger patient cohort and longer-term follow-up. The design of this study is a retrospective chart review and the setting is an academic tertiary care referral center. Twenty-one patients with facial nerve paralysis from proximal nerve injury at the cerebellopontine angle underwent facial-hypoglossal neurorraphy with parotid release. Outcomes were assessed using the Repaired Facial Nerve Recovery Scale, questionnaires, and patient photographs. Of the 21 patients, 18 were successfully reinnervated to a score of a B or C on the recovery scale, which equates to good oral and ocular sphincter closure with minimal mass movement. The mean duration of paralysis between injury and repair was 12.1 months (range 0 to 36 months) wi... Skull Base journals http://www.medworm.com/rss/comments.php?id=3735056 Fri, 09 Jul 2010 05:38:13 +0100 3735056 http://www.medworm.com/index.php?rid=3735055&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261268 We report here the sixth case of anterior and lateral skull base defects presented in a single patient. Although rhinoliquorrhea and otoliquorrhea were reported separately in the literature, we postulated that the pathophysiology is the same for the whole skull base; obesity seems to contribute to the development of such primary spontaneous cerebrospinal fluid leak. Consequently, management is similar and regular follow-up is very important.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3735055 Thu, 08 Jul 2010 08:15:40 +0100 3735055 http://www.medworm.com/index.php?rid=3944293&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261267 Skull BaseDOI: 10.1055/s-0030-1261267ABSTRACTWe sought to determine the extent of the frontal sinus by intraoperative transillumination through the superomedial orbital wall in a subcranial approach to the anterior skull base. After raising a bicoronal flap, the frontal sinus was transilluminated through the superomedial orbital wall with a fiber-optic light source, delineating the extent of the frontal sinus. The frontal sinus boundary was marked with a marker pen. A frontal sinus anterior wall osteotomy was performed with a sagittal saw, staying within the confines of the frontal sinus marking. A bone flap was removed, and the posterior wall was drilled out. The remaining procedure was performed in a standard fashion. At the end of the procedure, the bone flap was fixed with a titanium p... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944293 Tue, 06 Jul 2010 23:00:00 +0100 3944293 http://www.medworm.com/index.php?rid=3944292&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261263 This study further characterizes the results of this technique with a larger patient cohort and longer-term follow-up. The design of this study is a retrospective chart review and the setting is an academic tertiary care referral center. Twenty-one patients with facial nerve paralysis from proximal nerve injury at the cerebellopontine angle underwent facial-hypoglossal neurorraphy with parotid release. Outcomes were assessed using the Repaired Facial Nerve Recovery Scale, questionnaires, and patient photographs. Of the 21 patients, 18 were successfully reinnervated to a score of a B or C on the recovery scale, which equates to good oral and ocular sphincter closure with minimal mass movement. The mean duration of paralysis between injury and repair was 12.1 months (range 0 to 36 months) wi... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944292 Tue, 06 Jul 2010 23:00:00 +0100 3944292 http://www.medworm.com/index.php?rid=3944291&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261268 We report here the sixth case of anterior and lateral skull base defects presented in a single patient. Although rhinoliquorrhea and otoliquorrhea were reported separately in the literature, we postulated that the pathophysiology is the same for the whole skull base; obesity seems to contribute to the development of such primary spontaneous cerebrospinal fluid leak. Consequently, management is similar and regular follow-up is very important.[...]© Thieme Medical PublishersArticle in Thieme eJournal:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3944291 Tue, 06 Jul 2010 23:00:00 +0100 3944291 http://www.medworm.com/index.php?rid=3697188&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261258 In this study, we describe the novel application of robotic surgery to the repair of dural defects in the skull base. A transmaxillary-transantral approach to the nasal cavity was performed bilaterally in a cadaveric model. Repair of the skull base defect was undertaken robotically. In this technical report, we demonstrate the feasibility of a suture-based technique for surgical reconstruction of the skull base with robotic assistance in a cadaveric model. In all cases, suture repair of dural defects was successfully performed with robotic-assisted technique. Although preliminary in nature, this study suggests that traditional suture techniques can be implemented in a confined surgical site with the use of robotic technology.[...]© Thieme Medical PublishersGet connected:Table of contents�... Skull Base journals http://www.medworm.com/rss/comments.php?id=3697188 Sat, 26 Jun 2010 01:14:13 +0100 3697188 http://www.medworm.com/index.php?rid=3688709&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1254406 This study reveals a reasonable rate of successful salvage of local esthesioneuroblastoma recurrence using surgery, radiation, or combined surgery and radiation.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3688709 Thu, 24 Jun 2010 05:37:38 +0100 3688709 http://www.medworm.com/index.php?rid=3688708&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1254404 We present the first known case of an intracerebral metastasis of a previously resected SNTCS.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3688708 Thu, 24 Jun 2010 05:37:38 +0100 3688708 http://www.medworm.com/index.php?rid=3688707&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261260 We present the first case of a coccidioidomycosis mycotic anterior inferior cerebellar artery (AICA) aneurysm that was clipped under hypothermic cardiac standstill in a pregnant acquired immunodeficiency syndrome (AIDS) patient. A 24-year-old pregnant AIDS patient presented with intraventricular hemorrhage and hydrocephalus. Angiography revealed an 8-mm basilar trunk aneurysm with the right AICA protruding from the side wall of the aneurysm. The patient underwent a retrosigmoid craniotomy and direct clipping of the aneurysm under hypothermic cardiac standstill. At presentation, the patient had a poor grade due to subarachnoid and intraventricular hemorrhage. Despite her large posterior circulation aneurysm in the setting of AIDS with extensive coccidioidomycosis meningitis, the lesion was ... Skull Base journals http://www.medworm.com/rss/comments.php?id=3688707 Thu, 24 Jun 2010 01:06:08 +0100 3688707 http://www.medworm.com/index.php?rid=3944296&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1254406 This study reveals a reasonable rate of successful salvage of local esthesioneuroblastoma recurrence using surgery, radiation, or combined surgery and radiation.[...]© Thieme Medical PublishersArticle in Thieme eJournal:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3944296 Tue, 22 Jun 2010 23:00:00 +0100 3944296 http://www.medworm.com/index.php?rid=3944295&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261260 We present the first case of a coccidioidomycosis mycotic anterior inferior cerebellar artery (AICA) aneurysm that was clipped under hypothermic cardiac standstill in a pregnant acquired immunodeficiency syndrome (AIDS) patient. A 24-year-old pregnant AIDS patient presented with intraventricular hemorrhage and hydrocephalus. Angiography revealed an 8-mm basilar trunk aneurysm with the right AICA protruding from the side wall of the aneurysm. The patient underwent a retrosigmoid craniotomy and direct clipping of the aneurysm under hypothermic cardiac standstill. At presentation, the patient had a poor grade due to subarachnoid and intraventricular hemorrhage. Despite her large posterior circulation aneurysm in the setting of AIDS with extensive coccidioidomycosis meningitis, the lesion was ... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944295 Tue, 22 Jun 2010 23:00:00 +0100 3944295 http://www.medworm.com/index.php?rid=3681477&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261265 We present a detailed case review and a perioperative management protocol with specific reference to skull base and neuroanatomy. We performed a retrospective chart review and analysis of outcomes and complications by approach and design and prospective employment of a perioperative management protocol in a major tertiary care referral hospital. We included patients undergoing endoscopic skull base approaches by the two senior surgeons from September 2005 to April 2009, selecting of transcranial/intracranial cases for detailed review. Our main outcome measures included perioperative morbidity, mortality, and complications; degree of resection; recurrence rate; and survival. Fifteen patients met study criteria. No perioperative mortality occurred. There were two major and four minor complic... Skull Base journals http://www.medworm.com/rss/comments.php?id=3681477 Tue, 22 Jun 2010 05:38:42 +0100 3681477 http://www.medworm.com/index.php?rid=3681476&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261257 This study aimed to establish the incidence of VS in patients with SSNHL, and we report several unusual cases among these patients. We reviewed retrospectively the charts and magnetic resonance imaging (MRI) findings of all adult patients who presented with SSNHL between 2002 and 2008. We utilized three-dimensional fast imaging with steady-state acquisition temporal MRI as a screening method. Of the 295 patients with SSNHL, VS was found in 12 (4%). All patients had intrameatal or small to medium-sized tumors. There were three cases with SSNHL in one ear and an incidental finding of intracanalicular VS in the contralateral ear. There were four cases of VS that showed good recovery from SSNHL with corticosteroid treatment. There were two cases that mimicked labyrinthitis with hearing loss an... Skull Base journals http://www.medworm.com/rss/comments.php?id=3681476 Tue, 22 Jun 2010 01:22:26 +0100 3681476 http://www.medworm.com/index.php?rid=3944298&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261265 We present a detailed case review and a perioperative management protocol with specific reference to skull base and neuroanatomy. We performed a retrospective chart review and analysis of outcomes and complications by approach and design and prospective employment of a perioperative management protocol in a major tertiary care referral hospital. We included patients undergoing endoscopic skull base approaches by the two senior surgeons from September 2005 to April 2009, selecting of transcranial/intracranial cases for detailed review. Our main outcome measures included perioperative morbidity, mortality, and complications; degree of resection; recurrence rate; and survival. Fifteen patients met study criteria. No perioperative mortality occurred. There were two major and four minor complic... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944298 Sun, 20 Jun 2010 23:00:00 +0100 3944298 http://www.medworm.com/index.php?rid=3944297&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261257 This study aimed to establish the incidence of VS in patients with SSNHL, and we report several unusual cases among these patients. We reviewed retrospectively the charts and magnetic resonance imaging (MRI) findings of all adult patients who presented with SSNHL between 2002 and 2008. We utilized three-dimensional fast imaging with steady-state acquisition temporal MRI as a screening method. Of the 295 patients with SSNHL, VS was found in 12 (4%). All patients had intrameatal or small to medium-sized tumors. There were three cases with SSNHL in one ear and an incidental finding of intracanalicular VS in the contralateral ear. There were four cases of VS that showed good recovery from SSNHL with corticosteroid treatment. There were two cases that mimicked labyrinthitis with hearing loss an... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944297 Sun, 20 Jun 2010 23:00:00 +0100 3944297 http://www.medworm.com/index.php?rid=3654016&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1253583 Skull BaseDOI: 10.1055/s-0030-1253583© Thieme Medical PublishersGet connected:Table of contents  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3654016 Sat, 12 Jun 2010 13:15:00 +0100 3654016 http://www.medworm.com/index.php?rid=3654015&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261270 Skull BaseDOI: 10.1055/s-0030-1261270ABSTRACTTranscranial motor evoked potential (MEP) for the facial nerve (facial MEP) has been recognized as a good method for quantitative monitoring of facial nerve function in skull base surgery. To improve the feasibility and safety of facial MEP monitoring, a peg-screw electrode and a “threshold-level” method were investigated. From 2007 to 2009, intraoperative facial MEP monitoring with the peg-screw electrode and threshold-level method was successfully achieved in 26 of 29 patients who underwent surgery for the posterior fossa extra-axial tumor. The relationship between the change in the facial MEP threshold level and the postoperative function of the facial nerve was analyzed in 23 patients who had no facial palsy preoperatively. There... Skull Base journals http://www.medworm.com/rss/comments.php?id=3654015 Sat, 12 Jun 2010 13:15:00 +0100 3654015 http://www.medworm.com/index.php?rid=3654014&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261262 Skull BaseDOI: 10.1055/s-0030-1261262ABSTRACTThe sphenoid bony landmarks are important for endoscopic orientation in skull base surgery but show a wide range of variations. We aimed to describe an instructional model for the endoscopic parasellar anatomy in sphenoid sinuses with ill-defined bony landmarks. Five preserved injected cadaveric heads and four sides of dry skulls were studied endoscopically via transethmoid, transsphenoidal approach. The parasellar region was exposed by drilling along the maxillary nerve (V2) canal [the length of the foramen rotundum (FR) between the middle cranial fossa and the pterygopalatine fossa]. This was achieved by drilling in the inferior part of the lateral wall of posterior ethmoids immediately above the sphenopalatine foramen. Cavernous V2 was traced... Skull Base journals http://www.medworm.com/rss/comments.php?id=3654014 Sat, 12 Jun 2010 13:15:00 +0100 3654014 http://www.medworm.com/index.php?rid=3654013&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261264 Skull BaseDOI: 10.1055/s-0030-1261264ABSTRACTOrganic foreign bodies of the skull base are an uncommon problem with the potential for serious morbidity that present complicated treatment dilemmas best managed by a multidisciplinary approach. A 58-year-old male presented to the emergency department with fevers and mental status changes and was found to have bacterial meningitis. Computed tomography of the sinuses revealed two adjacent defects of the ethmoid roof with associated soft tissue density concerning for an encephalocele. He had a remote history of a penetrating left maxilla injury with a stick 13 years earlier. An attempted endoscopic repair of the defects revealed a pulsating splinter of wood emanating from the ethmoid roof defect. Neurosurgery and infectious disease were consulted... Skull Base journals http://www.medworm.com/rss/comments.php?id=3654013 Sat, 12 Jun 2010 13:15:00 +0100 3654013 http://www.medworm.com/index.php?rid=3654012&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261261 Skull BaseDOI: 10.1055/s-0030-1261261ABSTRACTA basal encephalocele often shows an insidious clinical course. Only two cases of temporal lobe encephalocele accompanied with tension pneumocephalus have previously been reported. In this paper, we describe a case of lateral sphenoid sinus encephalocele presenting with intraventricular tension pneumocephalus. A 54-year-old man was referred to our institution presenting with intraventricular tension pneumocephalus. He had undergone ventriculoperitoneal shunt placement for postmeningitis hydrocephalus 3 months before this admission. Precise imaging examinations detected evidence suggestive of a lateral sphenoidal sinus recess encephalocele. Endoscopic transnasal approach was performed for surgical repair of the encephalocele. The encephalocele wa... Skull Base journals http://www.medworm.com/rss/comments.php?id=3654012 Sat, 12 Jun 2010 13:15:00 +0100 3654012 http://www.medworm.com/index.php?rid=3654011&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261269 We present a case of a purely infrasellar craniopharyngioma that initially presented as a sphenoid sinus mass. Craniopharyngiomas are usually located within the sella. Purely infrasellar craniopharyngiomas have only rarely been reported in the literature. A 25-year-old woman presented with 6-month history of progressive headaches. Initial neuroimaging revealed the presence of a sphenoid sinus mass. Initially, she underwent an endoscopic biopsy of the mass by our ENT service. Pathology was consistent with craniopharyngioma and she was referred to neurosurgery for further surgical management. She then underwent an endoscopic transsphenoidal approach for complete resection of the purely extracranial, infrasellar craniopharyngioma. The Rathke pouch arises from the roof of the primitive mouth a... Skull Base journals http://www.medworm.com/rss/comments.php?id=3654011 Sat, 12 Jun 2010 13:15:00 +0100 3654011 http://www.medworm.com/index.php?rid=3654010&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261266 We report a patient with a history of subtotal resection of a petroclival meningioma followed by gamma knife radiosurgery who presented with sudden neurological deterioration following intratumoral hemorrhage after 4 asymptomatic years. The patient underwent early resection of this atypical meningioma and evacuation of hematoma via a retrosigmoid transpetrosal approach and had rapid neurological improvement.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3654010 Sat, 12 Jun 2010 13:15:00 +0100 3654010 http://www.medworm.com/index.php?rid=3654009&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1261259 We present a rare case of a 50-year-old female patient with symptomatic high mega jugular bulb requiring surgery. We review her medical file, preoperative and postoperative imaging, audiograms, and surgical report. High jugular bulb was diagnosed with computed tomography and magnetic resonance imaging. Symptoms of facial nerve palsy and headache were abolished after surgical procedure. Headache and facial nerve palsy can be caused by high mega jugular bulb. Surgery is indicated in such symptomatic cases and leads to relief of signs and symptoms of disease.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3654009 Sat, 12 Jun 2010 01:13:17 +0100 3654009 http://www.medworm.com/index.php?rid=3944305&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261270 Skull BaseDOI: 10.1055/s-0030-1261270ABSTRACTTranscranial motor evoked potential (MEP) for the facial nerve (facial MEP) has been recognized as a good method for quantitative monitoring of facial nerve function in skull base surgery. To improve the feasibility and safety of facial MEP monitoring, a peg-screw electrode and a “threshold-level” method were investigated. From 2007 to 2009, intraoperative facial MEP monitoring with the peg-screw electrode and threshold-level method was successfully achieved in 26 of 29 patients who underwent surgery for the posterior fossa extra-axial tumor. The relationship between the change in the facial MEP threshold level and the postoperative function of the facial nerve was analyzed in 23 patients who had no facial palsy preoperatively. There... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944305 Thu, 10 Jun 2010 23:00:00 +0100 3944305 http://www.medworm.com/index.php?rid=3944304&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261262 Skull BaseDOI: 10.1055/s-0030-1261262ABSTRACTThe sphenoid bony landmarks are important for endoscopic orientation in skull base surgery but show a wide range of variations. We aimed to describe an instructional model for the endoscopic parasellar anatomy in sphenoid sinuses with ill-defined bony landmarks. Five preserved injected cadaveric heads and four sides of dry skulls were studied endoscopically via transethmoid, transsphenoidal approach. The parasellar region was exposed by drilling along the maxillary nerve (V2) canal [the length of the foramen rotundum (FR) between the middle cranial fossa and the pterygopalatine fossa]. This was achieved by drilling in the inferior part of the lateral wall of posterior ethmoids immediately above the sphenopalatine foramen. Cavernous V2 was traced... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944304 Thu, 10 Jun 2010 23:00:00 +0100 3944304 http://www.medworm.com/index.php?rid=3944303&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261264 Skull BaseDOI: 10.1055/s-0030-1261264ABSTRACTOrganic foreign bodies of the skull base are an uncommon problem with the potential for serious morbidity that present complicated treatment dilemmas best managed by a multidisciplinary approach. A 58-year-old male presented to the emergency department with fevers and mental status changes and was found to have bacterial meningitis. Computed tomography of the sinuses revealed two adjacent defects of the ethmoid roof with associated soft tissue density concerning for an encephalocele. He had a remote history of a penetrating left maxilla injury with a stick 13 years earlier. An attempted endoscopic repair of the defects revealed a pulsating splinter of wood emanating from the ethmoid roof defect. Neurosurgery and infectious disease were consulted... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944303 Thu, 10 Jun 2010 23:00:00 +0100 3944303 http://www.medworm.com/index.php?rid=3944302&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261261 Skull BaseDOI: 10.1055/s-0030-1261261ABSTRACTA basal encephalocele often shows an insidious clinical course. Only two cases of temporal lobe encephalocele accompanied with tension pneumocephalus have previously been reported. In this paper, we describe a case of lateral sphenoid sinus encephalocele presenting with intraventricular tension pneumocephalus. A 54-year-old man was referred to our institution presenting with intraventricular tension pneumocephalus. He had undergone ventriculoperitoneal shunt placement for postmeningitis hydrocephalus 3 months before this admission. Precise imaging examinations detected evidence suggestive of a lateral sphenoidal sinus recess encephalocele. Endoscopic transnasal approach was performed for surgical repair of the encephalocele. The encephalocele wa... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944302 Thu, 10 Jun 2010 23:00:00 +0100 3944302 http://www.medworm.com/index.php?rid=3944301&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261269 We present a case of a purely infrasellar craniopharyngioma that initially presented as a sphenoid sinus mass. Craniopharyngiomas are usually located within the sella. Purely infrasellar craniopharyngiomas have only rarely been reported in the literature. A 25-year-old woman presented with 6-month history of progressive headaches. Initial neuroimaging revealed the presence of a sphenoid sinus mass. Initially, she underwent an endoscopic biopsy of the mass by our ENT service. Pathology was consistent with craniopharyngioma and she was referred to neurosurgery for further surgical management. She then underwent an endoscopic transsphenoidal approach for complete resection of the purely extracranial, infrasellar craniopharyngioma. The Rathke pouch arises from the roof of the primitive mouth a... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944301 Thu, 10 Jun 2010 23:00:00 +0100 3944301 http://www.medworm.com/index.php?rid=3944300&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261266 We report a patient with a history of subtotal resection of a petroclival meningioma followed by gamma knife radiosurgery who presented with sudden neurological deterioration following intratumoral hemorrhage after 4 asymptomatic years. The patient underwent early resection of this atypical meningioma and evacuation of hematoma via a retrosigmoid transpetrosal approach and had rapid neurological improvement.[...]© Thieme Medical PublishersArticle in Thieme eJournal:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3944300 Thu, 10 Jun 2010 23:00:00 +0100 3944300 http://www.medworm.com/index.php?rid=3944299&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1261259 We present a rare case of a 50-year-old female patient with symptomatic high mega jugular bulb requiring surgery. We review her medical file, preoperative and postoperative imaging, audiograms, and surgical report. High jugular bulb was diagnosed with computed tomography and magnetic resonance imaging. Symptoms of facial nerve palsy and headache were abolished after surgical procedure. Headache and facial nerve palsy can be caused by high mega jugular bulb. Surgery is indicated in such symptomatic cases and leads to relief of signs and symptoms of disease.[...]© Thieme Medical PublishersArticle in Thieme eJournal:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3944299 Thu, 10 Jun 2010 23:00:00 +0100 3944299 http://www.medworm.com/index.php?rid=3565080&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1254405 This article investigates the possibility for the distal superficial temporal artery (STA) to proximal posterior cerebral artery (PCA) direct bypass by subtemporal oblique posterior transzygomatic approach. Five adult cadaveric specimens were dissected. Cadeveric dissection protocol was approved by the Research Ethics Committee. A preauricular vertical skin incision was made, the trunk of STA was identified, and bifurcation, frontal, and parietal branches of the STA were followed distally. Posterior zygomatic arch osteotomy and microcraniotomy were then performed, and the dura was opened. The temporal lobe was retracted, interpeduncular and ambient cisterns were opened, and the P2 segment of the PCA was exposed. Parietal branch of STA and P2 segment of the PCA was anastomosed. The average ... Skull Base journals http://www.medworm.com/rss/comments.php?id=3565080 Sat, 15 May 2010 13:10:51 +0100 3565080 http://www.medworm.com/index.php?rid=3565079&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1254403 We report a case of intracerebral frontal abscess in continuity with the anterior skull base in a 53-year-old immunocompromised female with invasive rhino-orbital aspergillosis. An aperture was created by drilling the anterior skull base during endonasal sinus surgery, and the abscess was drained through its lower pole. The aperture was left open after surgery to ensure complete abscess drainage. Follow-up at 8 months revealed no cerebrospinal fluid leak or meningitis, and no abscess recurrence. This case validates the feasibility of endonasal trans-ethmoidal drainage of intracranial abscesses.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3565079 Sat, 15 May 2010 01:01:40 +0100 3565079 http://www.medworm.com/index.php?rid=3944306&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1254405 This article investigates the possibility for the distal superficial temporal artery (STA) to proximal posterior cerebral artery (PCA) direct bypass by subtemporal oblique posterior transzygomatic approach. Five adult cadaveric specimens were dissected. Cadeveric dissection protocol was approved by the Research Ethics Committee. A preauricular vertical skin incision was made, the trunk of STA was identified, and bifurcation, frontal, and parietal branches of the STA were followed distally. Posterior zygomatic arch osteotomy and microcraniotomy were then performed, and the dura was opened. The temporal lobe was retracted, interpeduncular and ambient cisterns were opened, and the P2 segment of the PCA was exposed. Parietal branch of STA and P2 segment of the PCA was anastomosed. The average ... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944306 Thu, 13 May 2010 23:00:00 +0100 3944306 http://www.medworm.com/index.php?rid=3553904&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1253573 Skull BaseDOI: 10.1055/s-0030-1253573ABSTRACTAs endoscopic skull base resections have advanced, appropriate reconstruction has become paramount. The reconstructive options for the skull base include both avascular and vascular grafts. We review these and provide an algorithm for endoscopic skull base reconstruction. One hundred and sixty-six skull base dural defects, reconstructed with an endonasal vascular flap, were examined. As an adjunct, avascular reconstruction techniques are discussed to illustrate all options for endonasal skull base reconstruction. Cerebrospinal fluid (CSF) leak rates are also discussed. Small CSF leaks may be successfully repaired with various avascular grafting techniques. Endoscopic endonasal approaches (EEAs) to the skull base often have larger dural defects w... Skull Base journals http://www.medworm.com/rss/comments.php?id=3553904 Wed, 12 May 2010 01:04:27 +0100 3553904 http://www.medworm.com/index.php?rid=3550294&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1253582 Skull BaseDOI: 10.1055/s-0030-1253582ABSTRACT Endoscopic endonasal skull base surgery is a growing field in which the nasal corridors are used to address skull base lesions. Whether the middle turbinates must be removed for adequate exposure is controversial and not well addressed in the literature. This is a prospective, observational study of 163 consecutive cases of purely endoscopic endonasal transsphenoidal surgeries performed at a single tertiary care institution. The primary study outcome measurement is the feasibility of middle turbinate preservation in endoscopic transsphenoidal skull base surgery. The pathologies included 99 pituitary tumors, 15 craniopharyngiomas, 11 meningiomas, 11 Rathke's cleft cysts, 7 encephaloceles, 5 cerebrospinal fluid leak repairs, 9 clival chordomas, a... Skull Base journals http://www.medworm.com/rss/comments.php?id=3550294 Tue, 11 May 2010 13:31:51 +0100 3550294 http://www.medworm.com/index.php?rid=3550293&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1253575 The objectives are to evaluate the applicability of the Pittsburgh staging system (PSS) (designed for primary temporal bone malignancies) to advanced periauricular cutaneous malignancies with temporal bone involvement and to study treatment outcomes and prognostic factors predicting recurrence-free survival. Ten patients with advanced periauricular cutaneous malignancy with temporal bone involvement were identified. Patients with primary temporal bone or parotid gland malignancies were excluded. All patients were clinically T4 at presentation by the American Joint Committee on Cancer (AJCC) staging system. Using Pittsburgh staging, six were T1 (stage I) and four were T4 (stage III). The mean follow-up was 13.6 months (3 to 24 months). Patients with basal cell carcinoma were managed with wi... Skull Base journals http://www.medworm.com/rss/comments.php?id=3550293 Tue, 11 May 2010 13:31:51 +0100 3550293 http://www.medworm.com/index.php?rid=3550292&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1253574 We describe two cases in which the endoscopic transsphenoidal approach was used to manage this lesion. The design of this study is as a review of new endoscopic approaches. The setting of the study is a tertiary referral unit in a London teaching hospital. Case 1: A 53-year-old man diagnosed with bilateral cholesterol granulomas of the petrous apices. Case 2: A 32-year-old woman diagnosed with a right-sided cholesterol granuloma of the petrous apex. The main outcome measures were symptom resolution and postoperative complications. An endoscopic transsphenoidal approach was used in the first case. In the second case, the lesion was approached through the nasopharynx, an approach that has not been described previously. Both patients' symptoms resolved and no complications occurred. Transsphe... Skull Base journals http://www.medworm.com/rss/comments.php?id=3550292 Tue, 11 May 2010 01:13:26 +0100 3550292 http://www.medworm.com/index.php?rid=3944307&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1253573 Skull BaseDOI: 10.1055/s-0030-1253573ABSTRACTAs endoscopic skull base resections have advanced, appropriate reconstruction has become paramount. The reconstructive options for the skull base include both avascular and vascular grafts. We review these and provide an algorithm for endoscopic skull base reconstruction. One hundred and sixty-six skull base dural defects, reconstructed with an endonasal vascular flap, were examined. As an adjunct, avascular reconstruction techniques are discussed to illustrate all options for endonasal skull base reconstruction. Cerebrospinal fluid (CSF) leak rates are also discussed. Small CSF leaks may be successfully repaired with various avascular grafting techniques. Endoscopic endonasal approaches (EEAs) to the skull base often have larger dural defects w... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944307 Mon, 10 May 2010 23:00:00 +0100 3944307 http://www.medworm.com/index.php?rid=3944308&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1253575 The objectives are to evaluate the applicability of the Pittsburgh staging system (PSS) (designed for primary temporal bone malignancies) to advanced periauricular cutaneous malignancies with temporal bone involvement and to study treatment outcomes and prognostic factors predicting recurrence-free survival. Ten patients with advanced periauricular cutaneous malignancy with temporal bone involvement were identified. Patients with primary temporal bone or parotid gland malignancies were excluded. All patients were clinically T4 at presentation by the American Joint Committee on Cancer (AJCC) staging system. Using Pittsburgh staging, six were T1 (stage I) and four were T4 (stage III). The mean follow-up was 13.6 months (3 to 24 months). Patients with basal cell carcinoma were managed with wi... Skull Base journals http://www.medworm.com/rss/comments.php?id=3944308 Sun, 09 May 2010 23:00:00 +0100 3944308 http://www.medworm.com/index.php?rid=3516821&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1253580 We report a retropharyngeal ganglioneuroma with an unusual clinical presentation of neck stiffness and pain. A 42-year-old woman presented with incapacitating neck pain, neck stiffness, right upper extremity weakness, as well as dysphagia. Neurological workup was normal. Imaging revealed a hyperdense, ill-defined, diffuse right retropharyngeal mass suggestive of a possible nerve sheath tumor with no communication with the cervical spine. Surgical removal was uneventful and associated with a postoperative Horner's syndrome. In follow-up, dysphagia and neck symptoms improved. Retropharyngeal ganglioneuromas can occur in a wide age range of patients. Surgical excision via a cervical approach offers definitive therapy but may be associated with an iatrogenic Horner's syndrome for which the pat... Skull Base journals http://www.medworm.com/rss/comments.php?id=3516821 Fri, 30 Apr 2010 01:11:13 +0100 3516821 http://www.medworm.com/index.php?rid=3513005&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1253579 We present an unusual case of a clinically silent corticotropic adenoma of the pituitary gland that underwent cystic degeneration following recurrence after transsphenoidal surgery and radiation therapy. The patient underwent left frontotemporal craniotomy with resection of the suprasellar mass and decompression of the left optic nerve. Postoperative magnetic resonance imaging demonstrated no further optic chiasm or nerve compression. Patients with clinically silent ACTH-secreting tumors should be monitored for aggressive tumor behavior and may require closer follow-up than those patients harboring other nonfunctional tumors.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3513005 Thu, 29 Apr 2010 13:18:56 +0100 3513005 http://www.medworm.com/index.php?rid=3513004&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1253576 We present the case of a young adult who had combined operative/Gamma knife treatment for a benign vestibular schwannoma, followed by further surgery 2 years later. He represented 10 years after original diagnosis with facial numbness and ataxia, MRI showing gross tumor recurrence. After radical resection, histology showed malignant transformation to a malignant peripheral nerve sheath tumor. Within 3 months there was rapid, aggressive recurrence with brainstem compression, requiring further surgery for brainstem decompression. Histology confirmed further de-differentiation to an anaplastic sarcoma. While awaiting radiotherapy the tumor recurred again, the patient succumbing. The patient had no features of neurofibromatosis type 2. In the literature there are 13 other cases of malignant ve... Skull Base journals http://www.medworm.com/rss/comments.php?id=3513004 Thu, 29 Apr 2010 01:10:53 +0100 3513004 http://www.medworm.com/index.php?rid=3509345&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1253577 The objective is to correlate the intracavernous internal carotid artery (ICA) with the position of the intracavernous neural structures. The cavernous sinuses of nine injected cadaveric heads were dissected bilaterally. As measured on computed tomographic angiograms from 100 adults, anatomical relationships and measurements of intracavernous ICA and neural structures were studied and correlated to the intracavernous ICA curvature. Intracavernous ICAs were classified as normal and redundant. The meningohypophyseal trunk (MHT) of normal ICAs appeared to be closely related to the abducens nerve compared with redundant ICAs (5.5 ± 2.1 mm versus 10.0 ± 2.5 mm, respectively;  = 0.001). The position of the inferolateral trunk (ILT) varied along the horizonta... Skull Base journals http://www.medworm.com/rss/comments.php?id=3509345 Wed, 28 Apr 2010 13:37:56 +0100 3509345 http://www.medworm.com/index.php?rid=3509344&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1253581 Skull BaseDOI: 10.1055/s-0030-1253581ABSTRACTSkull base surgery has evolved to a point that its focus is now shifting to outcome analysis. To do so for petroclival meningiomas is difficult. The rarity of the tumor, different treatment philosophies, and variations in reporting complicate the outcome analysis. With this limitation in mind, we analyzed the literature on this disease and report the combined outcomes in a unified fashion in hopes that it will serve as a starting point for further prospective analysis. Data was extracted from all available reports on MEDLINE/PubMed published in English. All studies were retrospective and uncontrolled. The majority of studies represent the experience of a single surgeon at a single institution. Of the 19 studies with detailed demographic and outc... Skull Base journals http://www.medworm.com/rss/comments.php?id=3509344 Wed, 28 Apr 2010 13:37:56 +0100 3509344 http://www.medworm.com/index.php?rid=3509343&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1253578 Skull BaseDOI: 10.1055/s-0030-1253578ABSTRACTTherapeutic parent artery occlusion has been routinely utilized for management of some intracranial aneurysms. One possible long-term complication of this procedure is “de novo” formation of aneurysms. The purpose of this paper is to estimate the incidence of de novo aneurysm formation, the time period between occlusion and formation, and the most common sites of formation. A PubMed search was performed for all articles between 1970 and 2008 reporting cases of both therapeutic carotid occlusion and de novo cerebral aneurysms. The 20 papers reviewed reported 187 patients having undergone therapeutic carotid occlusion. Of the 163 patients reported in complete-case series, seven developed new aneurysms (4.3%). Thirty-six total new aneur... Skull Base journals http://www.medworm.com/rss/comments.php?id=3509343 Wed, 28 Apr 2010 01:17:21 +0100 3509343 http://www.medworm.com/index.php?rid=3384211&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1251508 Skull BaseDOI: 10.1055/s-0030-1251508ABSTRACTEndoscopic repair of spinal fluid leaks is a commonly performed procedure with low morbidity. However, this is the first report of cerebrovasospasm, following endoscopic repair of a cerebrospinal fluid (CSF) leak. A 51-year-old woman underwent endoscopic repair of a spontaneous CSF leak. She subsequently developed symptomatic cerebrovasospasm on postoperative day 3. This was successfully treated with intraarterial verapamil infusion.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Skull Base) Skull Base journals http://www.medworm.com/rss/comments.php?id=3384211 Sat, 20 Mar 2010 03:21:11 +0100 3384211 http://www.medworm.com/index.php?rid=3360777&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1249249 Skull BaseDOI: 10.1055/s-0030-1249249ABSTRACTCerebrospinal fluid leaks of the temporal bone are rare, often occult, and sometimes challenging to localize and repair. This is a retrospective study of eight patients with spontaneous cerebrospinal fluid leak and six patients with cerebrospinal fluid leak or encephalocele discovered during chronic ear surgery who were treated in a tertiary medical center over a 5-year period. All received preoperative temporal bone computed tomography, and six also underwent magnetic resonance imaging, one computed tomography cisternography, and one radionuclide cisternography. All patients initially underwent a transmastoid surgical approach. Additional exposure was necessary in three patients; two underwent middle fossa craniotomy and another required minicr... Skull Base journals http://www.medworm.com/rss/comments.php?id=3360777 Sat, 13 Mar 2010 14:19:55 +0100 3360777 http://www.medworm.com/index.php?rid=3360776&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1249574 Skull BaseDOI: 10.1055/s-0030-1249574ABSTRACTPostoperative temporalis muscle atrophy from injury to the neurovascular supply can cause significant cosmetic disfigurement, and avoidance of electrocautery use has become a common practice in minimizing this outcome. We attempted to quantify the effects of electrocautery on temporalis atrophy by retrospectively reviewing postoperative magnetic resonance images in patients having undergone an orbital frontal craniotomy. We reviewed medical records and compared volumetric measurements of the temporalis muscle in 25 patients using the contralateral temporalis muscle as an internal control. The mean size of the nonsurgical temporalis muscle was 24.6 cm as compared with 23.6 cm on the operated side. The difference of 1.0 cm was not statistically si... Skull Base journals http://www.medworm.com/rss/comments.php?id=3360776 Sat, 13 Mar 2010 14:19:55 +0100 3360776 http://www.medworm.com/index.php?rid=3360775&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1249573 Skull BaseDOI: 10.1055/s-0030-1249573ABSTRACTThe purpose of this report is to present indications and risks of endoscopic transsphenoidal approach to treat petrous apex cholesteatoma. This is a retrospective analysis of two cases of petrous apex cholesteatoma presenting with double vision who underwent an endoscopic transsphenoidal approach at Lariboisiere Hospital, Paris, France. Control of the lesion was satisfactory in both cases. However, a minor pontic stroke resulted in transient hemiparesis in the case with dehiscent dura around the petrous apex cholesteatoma. To our knowledge, there are the first cases of petrous apex cholesteatoma reported to be removed by an endoscopic transsphenoidal approach, using image guidance system, with minimal morbidity.[...]© Thieme Medical PublishersG... Skull Base journals http://www.medworm.com/rss/comments.php?id=3360775 Sat, 13 Mar 2010 03:17:37 +0100 3360775 http://www.medworm.com/index.php?rid=3356011&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1249571 Skull BaseDOI: 10.1055/s-0030-1249571ABSTRACTWe quantitatively compared relative merits of lateral approaches to the pontomesencephalic junction (PMJ): anterior petrosectomy, subtemporal transtentorial, posterior petrosectomy, and retrosigmoid transtentorial. In dissected cadaveric heads, lengths of exposure were measured anteriorly from CN V along the pontomesencephalic sulcus (PMS); posterosuperiorly along the lateral mesencephalic sulcus (LMS); and posteroinferiorly along the interpeduncular sulcus (IPS). Subtemporal transtentorial approach provided best anterior exposure along the PMS (23.8 ± 4.5 mm). Posterosuperior exposures were comparable for all approaches except anterior petrosectomy (limited). Posteroinferior exposure was most with subtemporal transtentorial approac... Skull Base journals http://www.medworm.com/rss/comments.php?id=3356011 Fri, 12 Mar 2010 14:22:12 +0100 3356011 http://www.medworm.com/index.php?rid=3356010&cid=s_36598_16_f&fid=36598&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0030-1249248 Skull BaseDOI: 10.1055/s-0030-1249248ABSTRACTTo assess the severity and evolution of sinonasal symptoms in patients following endoscopic anterior skull base surgery to define the typical postoperative course. Design: Cross sectional study. Participants include 69 patients who underwent endoscopic skull base surgery by a dual surgeon team (otolaryngologist and neurosurgeon) from January 2008 to August 2009. Main outcome measures: Sinonasal Outcomes Test (SNOT)-20 survey scores at preoperative and at three postoperative time points. An ordinal logistic regression model was used to analyze the data, summarizing the relationship between the outcome (SNOT score) and the predictor (time point) using an odds ratio. Scores for the symptoms of need to blow nose, sneezing, runny nose, postnasal disc... Skull Base journals http://www.medworm.com/rss/comments.php?id=3356010 Fri, 12 Mar 2010 14:22:12 +0100 3356010