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At least 199 records · Page 11Linked to original sources
PubMed1998

[Diagnosis and treatment of skull base metastasis].

OBJECTIVE: To study the diagnosis and surgical treatment of skull base metastases. METHODS: Clinical and radiological features, operative technique and postoperative complications of 15 cases of skull base metastases were discussed. RESULTS: Total resection was achieved in 13 cases, and subtotal resection in 2. 7 tumors were located in the anterior skull base. The main complication was CSF leakage. CONCLUSION: The preoperative diagnosis of skull base metastases is difficult, radical resection is effective, and postoperative complications are not uncommon.

Adenocarcinoma↗
PubMed1994

[3-D CT reconstruction of fractures of the skull base and the facial skeleton].

3-D reconstructions of the skull base, temporal bone, and skull fractures were compared to 2-D- CT to evaluate the diagnostic value in traumatized patients. 38 patients with 22 fractures of the facial skeleton (orbita, zygomatic, Le Fort), 12 temporal bone, and 4 skull fractures were investigated. Subjective grading was performed by two physicians (ENT/RAD) in respect of quality diagnostic validity and estimated clinical impact. The average image validity and quality were graded good. In the temporal bone the average information supplied by 3-D was of inferior value; here, the lack of information regarding the inner ear structures was responsible for the lack of clinical impact. In fractures of the facial skeleton and the skull base a good to very good image quality was seen and clinical relevance was high. 3-D CT is capable of demonstrating fractures, which is of little value in the temporal bone, but of high value in the skull base and the facial skeleton, especially if surfaces are involved or fragments are displaced.

Facial Bones↗
PubMed2005

[Skull base tumors].

Modern imaging techniques have great importance in the diagnosis and therapy of skull-base pathologies. Many of these lesions, especially in relation to their specific location, can be evaluated using CT and MR imaging. Tumors commonly found in the anterior skull base include carcinoma, rhabdomyosarcoma, esthesioneuroblastoma and meningioma. In the central cranial fossa, nasopharyngeal carcinoma, metastases, meningioma, pituitary adenoma and neurinoma have to be considered. The most common neoplasms of the posterior skull base, including the CP angle, are neurinoma, meningioma, nasopharyngeal carcinoma, chordoma and paraganglioma. One major task of imaging is the evaluation of the exact tumor extent as well as its relationship to the neighboring neurovascular structures. The purpose of this review is to recapitulate the most important anatomical landmarks of the skull base. The typical imaging findings of the most common tumors involving the skull base are also presented.

Cerebellopontine Angle↗
PubMed2004

Imaging of the nasopharynx and skull base.

The prerequisite for the correct diagnosis and accurate delineation of skull base lesions is familiarity with the complex anatomy of the skull base. Imaging plays a central role in the management of skull base disease because this region is often difficult to evaluate clinically. CT and MR imaging are complementary; they are often used together to demonstrate the full disease extent. This article focuses on the critical anatomy of the skull base and how this knowledge contributes to accurate disease assessment.

Journal Article↗
PubMed1995

Extended anterior subcranial approach for skull base tumors: long-term results.

The extended anterior subcranial approach differs significantly from more traditional surgical approaches to the skull base in that it allows a broad inferior access to the anterior skull base planes with tumor exposure from below rather than via the transfrontal route. The authors initially used the subcranial approach in 1978 for the treatment of high-velocity skull base trauma and certain craniofacial anomalies. In 1980 they expanded the indications to include the combined neurosurgical-otolaryngological resection of various skull base tumors. Osteotomy of the frontonasoorbital external skeletal frame provides optimum anterior access to the orbital and sphenoethmoidal planes as well as to the nasal and paranasal cavities while avoiding frontal lobe retraction and the external facial incisions characteristic of transcranial and transfacial approaches. The improved visualization of the anterior skull base and clival-sphenoidal region facilitates en bloc tumor removal, optic nerve decompression, exposure of the medial aspect of the cavernous sinus, and watertight realignment of the anterior cranial base dura. In this report the authors present their experience over the past 13 years with 104 patients who underwent operation via the extended subcranial approach. Because extensive frontal lobe manipulation and external facial incisions are avoided with this approach, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced. The extended anterior subcranial method is therefore an excellent alternative to traditional transfacial-transcranial skull base approaches for the removal of selected skull base tumors.

Adolescent↗
PubMed1998

Analysis of tumor recurrence following anterior skull base surgery.

In order to elucidate the predictive factors for tumor recurrence following skull base surgery and the significance of salvage surgery in cases of recurrence, we retrospectively surveyed the incidence, site, and time of local recurrences in 20 patients who underwent either anterior or anterolateral skull base surgery for malignant tumors invading the anterior cranial fossa between 1989 and 1995 at the University of Tokyo Hospital. Nineteen patients underwent total resections of malignancies, with recurrences and/or metastases occurring in 13. Local recurrences occurred at the skull base in 5 patients (group A), outside the skull base in 4 patients (group B), and in both locations in 2 patients (group C). The mean time interval between surgery and recurrence was 29 months in group A, and 4.2 months in groups B and C. The local recurrence-free rates were 51% at 1 year and 34% at 5 years. Both brain and/or dural invasion and a microscopic positive surgical margin were proven to be predictive factors for tumor recurrences. The 3-year local recurrence-free rate was 20% in patients with dural invasions and 83% in those without. The incidence of recurrence-free patients was 79% in cases with negative margins, with no patient being recurrence-free in positive cases. All recurrences found more than 6 months after the initial surgery resulted in patients being salvaged successfully by a second operation.

Adolescent↗
PubMed2005

Frontal skull base surgery combined with endonasal endoscopic sinus surgery.

BACKGROUND: Postoperative infection remains a serious complication after radical resection of anterior skull base lesions because intracranial, nasal, and paranasal cavities are opened during surgery. To prevent complications from postoperative infection, we combined endonasal endoscopic sinus surgery (ESS) with the frontal transbasal approach in patients with skull base lesions. METHODS: Patients (n = 16) with anterior skull base lesions extending to the paranasal or nasal cavity underwent surgical resection via the frontal transbasal approach. After removal of the lesion via the transcranial approach, enlargement of the ostium or sinusotomy was performed bilaterally using our endonasal ESS procedure. The main purpose of ESS is the establishment of a wide drainage route to avoid dead space and postoperative infection. Furthermore, we confirmed the absence of residual lesion and leakage of cerebrospinal fluid (CSF), endoscopically. RESULTS: The frontal transbasal approach combined with endonasal ESS was performed in 16 patients with frontal skull base lesions. There were 8 malignant tumors, 6 benign tumors, and 2 mucoceles. Although 11 patients had preoperative active paranasal sinusitis, most frequently at the ethmoid sinus, none experienced postoperative infection. There was no complication related to ESS procedure. Furthermore, leakage of CSF and extracranial residual tumor were not found. CONCLUSION: Endonasal ESS after frontal skull base surgery is a highly useful technique for preventing postoperative infection, especially for the cases with large skull base tumors extending into other regions involving the paranasal sinuses or nasal cavity and with active paranasal sinusitis.

Adolescent↗
PubMed1992

Surgical treatment of tumours of the skull base.

OBJECTIVE: To describe the special features of surgical removal of tumours of the skull base and to review a series of patients treated for skull base tumours. DESIGN: A retrospective review of patients followed up for between six months and six years. SETTING: A unit specialising in surgery of the skull base at a tertiary referral centre. PATIENTS: Sixty-six patients with skull base tumours were referred to the unit between February 1984 and December 1989. INTERVENTIONS: Fifty-six of the patients underwent complete or partial surgical removal of the tumour. Radiotherapy was used as primary treatment in 10 patients, for tumour recurrence in four patients and as adjuvant postoperative treatment in 10 patients. RESULTS: In the majority of patients the tumours were benign and have been controlled or are considered cured. Of the seven patients with malignant tumours five have died and two are long-term survivors (one has multiple metastases). Three patients with histologically "benign" tumours died of multiple metastases. There have been a total of 10 deaths in the series but only one occurred in the perioperative period. Cranial nerve palsy was the major postoperative complication. CONCLUSION: Modern microsurgical techniques and modern anaesthesia and intensive care skills lead to a cure in many patients with skull base tumours previously considered inoperable.

Follow-Up Studies↗
PubMed2006

[Using of titanium mesh for the reconstruction of skull base defect].

OBJECTIVE: The purpose of this study is to evaluate the possibility and surgical principle of titanium mesh used for the reconstruction of skull base bone defect. METHODS: The clinical data of 11 patients with defect of skull base bone repaired with titanium mesh were retrospectively analysed. RESULTS: Among 11 patients, there were 6 patients with skull base tumor, 3 patients with fibrosis hyperplasia, 2 patients with encephalomeningocele. The surgical approach included craniofacial approach in 7 patients, transfrontal and extended transfrontal approach in 3 patients, trans-midface approach in 1 patient. The anterior and lateral skull base was repaired in 2 patients, anterior and middle skull base and sellar repaired in 6 patients, anterior skull base and orbital floor repaired in 3 patients. In early postoperative period, there were 3 patients with intracranial pneumatosis, but without symptom, and 1 patient with transient cerebrospinal leakage. Following-up for average 14.4 months, there was no titanium mesh displacement and intracranial infection in all patients. CONCLUSIONS: The titanium mesh used for the repair of skull base bone defect was both possible and safe.

Adolescent↗
PubMed2006

Skull base chordomas: management and results.

Growth patterns of skull base chordomas are related to important neurovascular structures. Local invasiveness results in "clinically malignant" behavior. A high rate of transient neurological deficits occurs following radical surgery. At our institution, the principle of radical removal is not followed at any price. This study compared the results of our management with recent series. Eleven patients, five females and six males aged 24-65 years (mean 41 years), underwent removal of skull base chordoma with size one <3 cm, five 3-5 cm, and five >5 cm. Mostly, standard operative approaches were chosen. All patients underwent postoperative radiotherapy. Resection was subtotal/partial in seven patients and total in four with no mortality. Neurological deterioration occurred due to transient cranial nerve deficits in six patients. Temporary surgical morbidity (including cranial nerve deficits) was observed in seven patients. Median Karnofsky performance status score improved compared to preoperative (80), early postoperative (70), and latest assessment (90) (median 36 months). Five patients underwent reoperation due to tumor recurrence after 4-48 months (mean 24 months). Most patients undergoing removal of skull base chordomas suffer from transient neurological deficits which are mainly nonsignificant as the patients return to preoperative functional status. The apparently high rate of incomplete tumor resection (64%) reflects the infiltrative behavior and relationship with neurovascular structures. The operative strategy should not be excessively aggressive at any price, but rather take into account the options of radiotherapy and observation of residual tumor.

Adult↗
PubMed2002

Neural conservation in skull base surgery.

Surgical treatment of lesions of the skull base carries significant risk to the functioning of the cerebral hemispheres, the brain stem and the cranial nerves. This risk is due both, to problems associated with maintaining an adequate blood flow while exposing and removing the tumor and to direct or indirect trauma to the brain, perineural tissues and cranial nerves. These risks may be reduced if information about possible implications of surgical maneuvers on the cerebral blood flow and on the function of the patients central nervous system and cranial nerves is available and can be monitored during surgery of the skull base. The use of electromyographic neuromonitoring for the facial nerve and of BERA-monitoring for the auditory nerve have been described and are now standard methods to achieve these goals. In acoustic tumors in the last several years beside preservation of the function of the facial nerve hearing preservation especially in small tumors has been one of the primary goals in acoustic neuroma surgery. Computer assisted surgery and intraoperative imaging for lateral skull base surgery are still in their infancy but promise to allow further improvement of neural conservation.

Brain↗
PubMedDate not supplied

Endoscopic skull base surgery II: a new animal model for surgery of the posterior fossa.

The field of skull base surgery has been influenced by a general philosophy that currently exists in modern surgical practice favoring less invasive means of managing surgical disease. Adapting techniques developed by general surgeons and other surgical subspecialists, skull base surgeons are now experimenting with endoscopy to resect tumors, manage vascular lesions, and manipulate critical intracranial structures. Lesions formerly requiring significant soft tissue dissection and craniotomy for exposure are now potentially amenable to treatment via a keyhole approach. As in other surgical specialties, however, a reliable animal model is necessary for experimentation with and development of new endoscopic techniques in the skull base. The swine provides just such a model, primarily due to craniofacial and skull base relationships that are analogous to humans. We have focused on the posterior skull base of the swine in this experiment: Via a retrosigmoid craniotomy we opened the dura of the posterior fossa and used endoscopes to visualize and manipulate the critical structures in this area. The cerebellum and midbrain were appreciated, as were cranial nerves V, VII, VIII, IX, X, and XI. Blood vessels on the surface of the midbrain were also identified. This experience further supports the use of the swine as an appropriate animal model for endoscopic skull base surgery.

Animals↗
PubMed2003

Two occult skull base malformations causing recurrent meningitis in a child: a case report.

Occult malformations of the skull base are rare anomalies, but can cause severe complications such as meningitis. Detailed skull base investigations for detecting cerebrospinal fluid fistulas or celes are often not initiated until after a history of recurrent meningitis. We present a child first seen at the age of 12 with recurrent episodes of bacterial meningitis since early childhood, requiring antibiotic prophylaxis for years. High-resolution computed tomography revealed a chronic sinusitis and a bony defect on the right olfactory groove, while magnetic resonance imaging and CT-cisternography indicated no cerebrospinal fluid fistula or cele at that time. Endonasal surgery for chronic sinusitis was performed with a confirmed bony defect on the right olfactory groove and an olfactory fibre without its sleeve-like dura prolongation running into an adjacent ethmoidal cell, necessitating that it be covered. In the absence of any antibiotics a new episode of meningitis occurred 5 years after surgery. CT-cisternography and magnetic resonance imaging were repeated, now indicating a transclival bony defect with a meningocele in its proximal part, most probably presenting a canalis basilaris medianus. Endonasal surgery confirmed this bony defect after adenoidectomy, and closure was accomplished. No further meningitis has been observed for 2 years. Congenital skull base defects may be difficult to detect, but sufficient surgical closure after their precise delineation is mandatory to prevent infectious endocranial complications. The presence of more than one developmental skull base defect should be considered during careful radiological skull base evaluation, which has to include the clivus in order not to overlook rare basilar malformations.

Child↗
PubMed2001

A multidisciplinary team approach to skull base chondrosarcomas.

OBJECT: The authors review their experience with treating skull base chondrosarcomas, which are much rarer than skull base chordomas and differ from them in prognosis and treatment. METHODS: Seventeen patients (12 male and five female patients) with histologically verified chondrosarcomas were followed up prospectively over a 12-year period. The mean age at presentation was 35.9 years. Most patients presented with cranial nerve palsies. Seven had undergone surgery prior to referral to the authors' unit. All underwent maximum surgical cytoreduction by the most direct surgical approach; only the two patients harboring the mesenchymal variant underwent radiotherapy. CONCLUSIONS: One patient died of a pulmonary embolus; the patients harboring mesenchymal chondrosarcomas died at 20 and 36 months, respectively, after treatment. Of the remaining patients, 93% were alive 5 years postsurgery and had a projected 10-year survival rate of 84% (mean survival time 9.3 years). These data emphasize the very slow progression of this tumor compared with skull base chordoma.

Adolescent↗
PubMed1995

Skull base approaches for posterior circulation aneurysms.

With the emergence of skull base surgery, surgical approaches have been developed and redefined, providing surgeons with accessible avenues to difficult lesions of the cranial base. Although the majority of lesions to which these techniques have been applied have been for tumors, we find that these skull base approaches can equally provide access to difficult vascular lesions, especially complex aneurysms of the posterior circulation. In this report three different skull base approaches were used in four patients for the treatment of posterior circulation aneurysms. A cranio-orbital-zygomatic approach was used for the acute stage of a ruptured basilar tip artery anenrysm and for a giant posterior cerebral artery aneurysm. A petrosal approach was used for a ruptured basilar trunk aneurysm, and the transcondylar approach was used for a vertebral artery aneurysm. Each approach provides a wide field and excellent exposure of vital structures with minimal brain retraction. Neck clipping of the aneurysms was successfully achieved in all cases. We believe that our skull base approaches facilitate the surgical treatment of posterior circulation aneurysms.

Journal Article↗
PubMed1998

Lateral skull-base surgery--a review of recent advances in surgical approaches.

OBJECTIVE: The expanding field of lateral skull-base surgery is reviewed. The rapid evolution of this subspecialty of otolaryngology--head and neck surgery has occurred subsequent to the primary postgraduate training of many practitioners of our specialty. Furthermore, it can be difficult for many resident physicians to acquire concise, up-to-date references pertaining to this area of subspecialization. This article is designed to provide a succinct, up-to-date review of the field of lateral skull-base surgery. MATERIALS AND METHODS: The current literature is reviewed. RESULTS: Lateral skull-base surgery is a rapidly evolving discipline involving neurologists and neurosurgeons in the resection of complex lesions of the skull base that had previously been difficult or impossible to adequately access. Otolaryngologists,via the subspecialty of neurotology, have been leaders in developing and applying the different lateral skull-base approaches. CONCLUSIONS: This article categorizes the various lateral skull-base approaches, outlines the principles of the surgical exposures, and discusses the indications for their use.

Craniotomy↗