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At least 217 records · Page 12Linked to original sources
PubMed2000

Early arytenoid adduction for vagal paralysis after skull base surgery.

OBJECTIVES: To evaluate the efficacy of early arytenoid adduction in the management of vagal paralysis after skull base surgery. STUDY DESIGN: Retrospective evaluation at a tertiary care skull base center. METHODS: Aggressive surgical management of skull base lesions has become increasingly popular owing to advances in surgical technique and intraoperative monitoring. Temporary and permanent lower cranial neuropathies occur frequently, especially after the surgical management of lesions involving the vertebrobasilar system and the jugular foramen. An injury to the proximal vagus nerve is usually associated with dysphonia and swallowing dysfunction. An early arytenoid adduction has been employed in 26 patients with a vagal paralysis after skull base surgery. Most commonly, the neurosurgical patient underwent an arytenoid adduction under general anesthesia on postoperative day 2. RESULTS: Videostroboscopy after arytenoid adduction demonstrated 76% of patients had complete glottic closure. Of those with inadequate glottic closure, all demonstrated a well-medialized posterior glottis with a persistent anterior glottal gap. These patients were easily treated with a secondary type I thyroplasty under local anesthesia with sedation resulting in complete glottic closure. Despite excellent voice outcomes, 66% of these patients had dysphagia requiring enteral feedings for nutritional support. CONCLUSIONS: An early arytenoid adduction is an excellent medialization technique that can be performed safely in the early postoperative period under general anesthesia after skull base surgery.

Anesthesia, General↗
PubMed2001

The treatment of skull base meningiomas--combining surgery and radiosurgery.

While the operative results for treating skull base meningiomas have improved due to modern microsurgical techniques, surgery is still accompanied by a high morbidity rate. Over the last 6 years, we operated on 50 patients with intracranial meningiomas, 23 of which were skull-based lesions. Among these patients with skull base meningiomas, seven (30%) were treated with both surgery and radiosurgery. All patients received standard operative procedures. Five patients received subtotal resections and two patients received partial resections. No mortalities occurred in our series. Following the operations, the clinical status improved in six patients, while only one patient (with a tuberculum sellae meningioma) experienced deterioration of a preexisting visual disturbance. Radiosurgery was performed at a mean of 4.3 months after the operations. One patient was treated by a two-staged radiosurgery regimen in light of the patient's large tumour volume (57.5 cm(3)). The treatment volume of the series ranged from 0.3 to 29.6 cm(3)(mean 11.6 cm(3)), and the minimum dose for the tumours was from 8 Gy to 12 Gy (mean, 11.6 Gy). Tumour regression was observed in three patients (43%) during the follow up period for radiosurgery (mean: 28 months). No patients revealed tumour growth in the follow up period or suffered symptomatic radiation injury. The clinical status remained unchanged in each of the seven patients after radiosurgery. Although we treated only seven patients with skull base meningiomas using surgery combined with radiosurgery, and the follow up period has been short, we believe that such combination treatment may be a very useful option in selected patients.

Adult↗
PubMed1999

[Interdisciplinary surgical treatment of anterior skull base tumors].

OBJECTIVES: We present our clinical experiences regarding interdisciplinary surgical treatment of anterior skull base tumours and evaluate postoperative results. METHODS: Fifty-seven patients (25 male, 32 female) with benign and malignant neoplasms involving the anterior skull base were retrospectively reviewed. In all cases tumour resection was carried out by an interdisciplinary rhino-neuro-surgical skull base operating team. Forty-three of 57 patients (75.4%) underwent common transbasal tumour resection and 11 (19.3%) were operated on from an extended transbasal approach. An extensive transbasal approach for tumour resection was used in 3 patients (5.3%). Postoperative mortality and morbidity were evaluated over a period of 6 months. RESULTS: In all 57 patients a good access to the frontal fossa and the sinuses was achieved. By means of the transbasal approaches, one-step tumour removal was possible in all cases. Tumor diameter ranged fom 12 mm to 114 mm. Even tumours extending as far as the hard palate required no additional transfacial procedures. Surgical mortality was 3.5%. Permanent postoperative complications were noted in 4 cases (7.02%) and transient postoperative complications in 7 (12.28%). CONCLUSION: In dealing with anterior skull base tumours, interdisciplinary surgical procedures using transbasal approaches provide a satisfactory outcome at a low rate of postoperative complications. When transbasal approaches are applied, no additional transfacial skull base exposure using midfacial incisions is required.

Adult↗
PubMed2005

The radical transbasal approach for resection of anterior and midline skull base lesions.

OBJECT: Craniofacial surgery can be performed to treat midline and anterior skull base lesions by creating a bicoronal scalp incision without the need for an additional transfacial procedure. Originally described as the transbasal approach, several modifications for further exposure of the skull base have been described. The authors present data on the application and outcomes of a modified transbasal approach. The radical transbasal approach consists of a bifrontal craniotomy and a frontoorbitonasal osteotomy. METHODS: Between 1992 and 2002, 41 patients (28 male and 13 female patients with a mean age of 38.3 years [range 7-77 years]) underwent 44 radical transbasal procedures. Twenty-three malignant and 18 benign lesions involving the midline skull base were treated. These cases were reviewed retrospectively. Gross-total resection of 30 lesions was achieved. Seven lesions were resected subtotally and six partially; one lesion was debulked. Complications occurred in 26 (59.1%) of the 44 operations and mostly consisted of cerebrospinal fluid leakage. The surgery-related mortality rate was 6.8% (three patients). Based on their pre- and postoperative Karnofsky Performance Scale scores, 86.4% of patients improved or remained the same. CONCLUSIONS: The radical transbasal approach increases the midline craniofacial corridor by allowing the globes to be safely retracted laterally. It also enhances exposure of the maxillary sinus from above. The morbidity and mortality rates associated with this procedure are high but consistent with the known rates for craniofacial surgery. This approach is best suited for the treatment of anterior skull base tumors that extend into the nasal cavity, orbit, ethmoid sinus, nasopharynx, and upper clivus. The approach may allow resection of tumors involving the maxillary sinus area without the need for an additional transfacial approach.

Adolescent↗
PubMed2003

Endoscopic repair of large skull base defects after powered sinus surgery.

OBJECTIVES: To evaluate the management of patients with large skull base defects (> 2 cm) and intracranial injury caused by powered endoscopic sinus surgery. Study design and setting All patients treated for postendoscopic sinus surgery skull base injury over a 4-year period were reviewed. RESULTS: Three patients with skull base defects greater than 2 cm in size and associated intracranial injury from powered ESS were identified. All patients presented with active cerebrospinal fluid leaks. CT scans showed intracranial injury and pathology reports revealed brain tissue removal. Using image-guided endoscopic techniques, all defects were addressed with multilayer repair. Closure was achieved in all patients on the first attempt, with an average follow-up of 27 months. CONCLUSIONS: The use of powered instrumentation along the skull base can be dangerous and can result in extensive skull base defects with associated loss of dura and gray matter. Large ethmoid roof defects and significant intracranial injury, however, are not absolute contraindications to endoscopic repair.

Adult↗
PubMed1996

Cisplatin-based neoadjuvant chemotherapy and combined resection for ethmoid sinus adenocarcinoma reaching and/or invading the skull base.

OBJECTIVE: To review our experience with cisplatin-based neoadjuvant chemotherapy before en bloc resection via a combined neurosurgical and transfacial approach for ethmoid sinus adenocarcinoma reaching and/or invading the skull base. DESIGN: Case series. SETTING: A tertiary care center and university teaching hospital. PATIENTS: Twenty-two patients with primary untreated ethmoid sinus adenocarcinoma reaching and/or invading the skull base consecutively treated between 1984 and 1992 with cisplatin-based neoadjuvant chemotherapy and combined neurosurgical and transfacial approach. MAIN OUTCOME MEASURES: Statistical analysis of survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor incidence based on the Kaplan-Meier actuarial method. Univariate analysis was performed to analyze the relationships between various factors, survival, and local recurrence. Clinical response, histological response, toxic effects of chemotherapy, and postoperative course were also reported. RESULTS: The Kaplan-Meier 3-year survival, local control, nodal recurrence, and distant metastasis estimates were 68.1%, 65.7%, 5.3%, and 10%, respectively. Metachronous second primary tumor was not encountered in our series. Survival was statistically more likely to be reduced in patients with intrasphenoidal tumor extent (P = .04) and local recurrence (P = .01). Local recurrence was statistically more likely in patients with intrasphenoidal tumor extent (P = .002) and no response to cisplatin-based neoadjuvant chemotherapy (P = .03). CONCLUSIONS: The results achieved suggest that cisplatin-based neoadjuvant chemotherapy before combined neurosurgical and transfacial approach should be further investigated for the treatment of ethmoid sinus adenocarcinoma reaching and/or invading the skull base.

Adenocarcinoma↗
PubMed1999

Early outcome and complications of the extended subcranial approach to the anterior skull base.

OBJECTIVES: To present the technique of the extended subcranial approach to the anterior skull base and to review the results in 55 patients who underwent the procedure. STUDY DESIGN: Retrospective review of the records of 55 patients who underwent the extended subcranial approach to the anterior skull base between 1994 and 1998 for the treatment of various neoplasms originating in the nasal cavity, nasopharynx, paranasal sinuses, orbit, or meninges, as well as for the repair of complex craniofacial trauma and/or cerebrospinal fluid (CSF) leak. Preoperative patient evaluation and the surgical technique are also reviewed. METHODS: Patient records were retrospectively reviewed and tabulated for age, sex, and indications for procedure, with special focus on early outcome and complications. RESULTS: Twenty-six patients underwent oncologic resections, 22 patients had reduction of complex fronto-naso-orbital and skull base fractures, and seven patients had repair of CSF leak. Significant complications in the oncologic group consisted of one hematoma requiring needle aspiration and two cases of temporary nontension pneumocephalus. In the fracture group, one patient died because of extensive intracerebral damage and multiorgan failure, and one patient had nontension pneumocephalus coupled with CSF leakage and one patient had temporary nontension pneumocephalus. The most common late complication in all three groups was anosmia. CONCLUSIONS: Based on their review, the authors conclude that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of various pathological conditions involving the anterior skull base.

Adolescent↗
PubMed1987

The diagnosis of skull base metastases by radionuclide bone scan.

The differential diagnosis of multiple cranial nerve palsies in patients with cancer includes meningeal infections, meningeal carcinomatosis, and skull base metastases. In distinguishing these, spinal fluid analysis and skull base tomography should be helpful in most cases. In circumstances when results of skull base tomography are negative, radionuclide bone scans can demonstrate metastatic disease in the base of the skull, and it should be obtained in all patients who are highly suspicious for having skull base metastasis with negative skull base tomography, including computed tomography (CT).

Aged↗
PubMed2000

Le Fort I osteotomy and skull base tumors: a pediatric experience.

BACKGROUND: The Le Fort I maxillary osteotomy approach for skull base tumor removal in the pediatric age group has not been widely discussed in the literature except for sporadic case reports and limited case series. OBJECTIVES: To review our experience with the Le Fort I osteotomy and to propose that it be used as an alternative approach because of its many advantages for the removal of tumors of the central skull base and paranasal sinuses. DESIGN: Case series. SETTING: Tertiary academic center. PATIENTS AND METHODS: A 5-year retrospective chart review of cases involving children who had undergone skull base tumor resection via the Le Fort I osteotomy approach. INTERVENTIONS: Skull base tumor removal via the Le Fort I osteotomy approach. MAIN OUTCOME MEASURES: Tumor type, location, and size; intraoperative and postoperative complications; and residual tumor and/or tumor recurrence associated with the surgical approach. RESULTS: Eleven patients (9 boys and 2 girls; mean age, 14.3 years) were identified through the chart review. The tumor types included 8 angiofibromas, 1 malignant fibrous histiocytoma, 1 giant cell tumor, and 1 cavernous hemangioma. All these lesions had extensive tumor growth into at least 1 of the following sites: pterygomaxillary space, sphenoidal sinus, and areas adjacent to the optic nerve, cavernous sinus, clivus, and anterior cranial fossa. The mean follow-up for this cohort was 12.8 months. No intraoperative complications were noted. Postoperative complications were reviewed with respect to the approach. To date, there have been no cases of residual tumor or tumor recurrence that can be attributed to the procedure. CONCLUSIONS: Our experience suggests that the Le Fort I osteotomy approach is a useful technique for the removal of extensive central skull base tumors and paranasal sinuses in the pediatric age group. It has distinct advantages over traditional anterior or lateral approaches, including a more direct line of vision and improved exposure and cosmesis.

Adolescent↗
PubMed2000

Skull-base invasion of nasopharyngeal carcinoma: magnetic resonance imaging findings and therapeutic implications.

PURPOSE: To evaluate the value of skull-base abnormality on MRI for predicting local recurrence in nasopharyngeal carcinoma. MATERIALS AND METHODS: Between November 1988 and February 1997, 48 patients with NPC were examined with both MRI (1.5 T) and CT prior to radiation therapy. T classification (1987 UICC) based on physical examination and CT findings were T1 in 3 cases, T2 in 22, T3 in 9, and T4 in 14. On MRI, low-intensity tissue with Gd enhancement in the marrow of the skull was considered to be a suspicious finding of skull-base invasion. CT simulation was performed in all patients. The total dose to the primary tumor was 60-75 Gy (mean, 67 Gy). The mean follow-up period was 42 months. RESULTS: All 14 T4 patients had abnormal tissue in the marrow of the skull base on MRI. Thirty-eight percent (13 of 34) of T1-3 patients were suspected to have skull-base invasion based on MRI (0% for T1, 27% [6 of 22] for T2, and 78% [7 of 9] for T3). The 5-year local control rate was significantly different between T1-3 and T4 tumors (97% vs. 69%, p < 0.025) but was not different by the presence of the MRI abnormality in the skull base. CONCLUSION: Skull-base invasion suspected solely by MRI does not relate to local recurrence provided that careful treatment planning is performed with the aid of MRI and CT simulator.

Bone Marrow Examination↗
PubMed1995

Posterior skull base transfacial approaches.

Transfacial approaches to the midline skull base provide direct access for resection of complex lesions. The transfrontal nasal-orbital and transmaxillary (Levels III and V) approaches have become the "work horses" of our skull base team, in that either alone or in combination, they provide access to most parts of the anterior skull base and clivus. The flexibility offered by the ability to select a Level I or Level II approach in place of a Level III approach, or a Level VI approach in place of a Level V approach, however, greatly enhances the individualization of treatment strategy. The overlapping exposure shared by these techniques provides flexibility in the choice of surgical exposure and allows multiple factors to be considered, including tumor location and size.

Adolescent↗
PubMed2005

Neurotologic skull base surgery in pediatric patients.

OBJECTIVE: Innovations in diagnosis, surgical techniques, and perioperative care have dramatically improved outcomes in lateral skull base procedures in recent years. There is a belief, however, that children with skull base tumors have yet to benefit from these technological and procedural advances. The purpose of this study is to provide a clinical review of neurotologic skull base surgery in the pediatric population. STUDY DESIGN: Retrospective case review. SETTING: Private practice tertiary referral center. PATIENTS: Eighty-nine pediatric patients undergoing 115 neurotologic procedures for lateral skull base tumors from July 1992 to September 2003. MAIN OUTCOME MEASURES: Initial clinical presentation, tumor type, pre- and postoperative hearing and facial nerve status, treatment course, complications, and functional outcomes. RESULTS: The majority of tumors in this series were vestibular schwannomas, and 65 patients were diagnosed with neurofibromatosis Type 2. Surgical approaches included 70 middle fossa, 40 translabyrinthine, 2 transcochlear, 2 infratemporal fossa, and 1 retrosigmoid craniotomy. Complete tumor removal was accomplished in the majority of cases (97%), with good preservation of facial nerve function (House-Brackmann Grade I or II) in 80% of patients. In patients undergoing middle fossa surgery for hearing preservation, measurable hearing was preserved in 61.4% of cases. The incidence of complications was low. CONCLUSION: With advances in diagnostic procedures and use of current neurotologic techniques, pediatric patients may undergo successful treatment of lateral skull base tumors, with good functional outcomes and minimal morbidity.

Adolescent↗
PubMed2005

Laser surface registration for lateral skull base surgery.

OBJECTIVE: Logistics in the run-up to computer-assisted lateral skull base intervention can be reduced by markerless registration methods. So far, only the facial skin surface but not the skin surface that was near to the lateral skull base was used for markerless patient registration. The present study was designed to evaluate whether the auricles may serve as an accurate spatial reference for markerless patient registration in image-guided lateral skull base surgery. STUDY DESIGN: In a prospective clinical study, the precision of markerless patient registration was checked by using periauricular evaluation markers and additional distant oral evaluation markers that served as targets for the infrared pointer of a navigation system. Ten patients with cranial tumors, bony malformations, or foreign bodies who were planned for image-guided surgery were selected. Markerless patient registration was performed by laser-scanning with the SSN++ navigation system. RESULTS: Based on the auricle, a high accuracy (mean target detection error tde = 0.9 mm +/- s = 0.3 mm) was achieved in markerless patient registration as long as the auricle was not deformed during CT imaging or during laser scanning. However, the conventional CT acquisition with a head support caused temporary auricular deformations in half of the patients, which made a precise laser-scan registration impossible. CONCLUSIONS: Automated laser registration of the auricle reduces the logistical input in connection with computer-assisted lateral skull base surgery, ensuring the accuracy that has been achieved up to now with marker-based methods. Constantly good results can be achieved if the head support of the computer tomograph has an appropriate opening at the level of the auricles in order to avoid auricular deformations during CT acquisition.

Adult↗
PubMed2004

[Surgical treatment of transcranial middle cranial fossa-lateral skull base malignant tumor].

OBJECTIVE: To evaluate the surgical method of transcranial middle cranial fossa-lateral skull base malignant tumor. METHODS: Sixteen patients with transcranial middle cranial fossa-lateral skull base malignant tumors were treated by three surgical methods. (1) Postauricular "C" form incision, combined with subtotal resection of temporal bone and high lateral neck approach to resect tumors located in middle cranial fossa, lateral skull base, and parotid region. (2) Temporal side "tungue" form incision, middle cranial fossa approach to resect tumors inside and outside the skull. (3) Temporal-auricular-mandible swing approach to resect tumors in parapharyngeal-infratemporal fossa-middle cranial fossa. Thirteen of the 16 cases received radiotherapy postoperatively. RESULTS: After operation, 11 of the 16 cases survived more than three years, five cases died within three years. Three-year-survival rate was 69%. CONCLUSIONS: Our results showed that the three surgical methods adopted could fully expose the internal and external skull lesion to remove the extensive malignant tumors. For late stage malignant tumors of the skull base, it should be treated aggressively by combination of surgical therapy and postoperative radiotherapy.

Adult↗
PubMed2005

Could transcranial endoscopy represent an alternative to craniotomy in skull base surgery?

Craniofacial malformations and upper third facial tumor surgical management is currently performed by skull base osteotomies to allow skeleton mobilization or tumor removal. Craniotomies and retraction of frontal lobes allow wide exposure of anterior skull base. In the last decades, in keeping with the trend to perform less invasive surgical approaches, several authors reported endoscopic approaches for selected cases of skull base surgery, such as closure of cerebrospinal fluid leaks and transethmoidal and trans-sphenoidal approaches for pituitary surgery. Recent experience with transnasal endoscopic procedures improved both techniques and outcomes and became more common. The authors present a cadaver study of combined transfacial transcranial endoscopic approach to skull base. Such an approach used with minimally invasive surgery principles could represent, in selected cases (both for neoplastic lesions and malformations), an alternative to traditional anterior cranial fossa surgical approaches by wide craniotomies.

Cadaver↗
PubMed1997

Use of vertical median forehead flap in the reconstruction of the anterior skull base: report of two cases.

Improvements in reconstruction of the skull base have made craniofacial surgery safe. Reconstruction of the anterior skull base must provide a seal between the cranial cavity and upper respiratory tract, as well as offer structural support for the brain. A wide variety of local flaps have been designed. The choice of flap in individual cases depends on the location and size of the defect. We report a reconstructive technique for the anterior skull base with vertical median forehead flaps which we used to treat two patients, one patient with adenocarcinoma and the other with leiomyosarcoma. Both were lesions of the ethmoid sinuses and nasal cavity.

Adenocarcinoma↗
PubMed1999

Pure extradural approach for skull base lesions.

Lesions in the parasellar and paracavernous regions can be removed by various skull base approaches involving basal osteotomies. A major complication of intradural skull base approaches is CSF leak and associated meningitis. We have managed 5 patients with skull base lesions with a pure extradural approach using wide basal osteotomies. The operative techniques are described.

Adolescent↗
PubMed2005

Closure of complex lateral skull base defects.

OBJECTIVE: To discuss surgical reconstructive options and complications in patients with extensive lateral skull base defects. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Eligibility criteria included patients seen between July 1999 and July 2003 with malignant neoplasms of the lateral skull base requiring surgical therapy, with resultant surgical defect not amenable to primary closure. INTERVENTION: Surgical extirpation of malignant skull base neoplasm requiring free tissue transfer or rotational flap closure. MAIN OUTCOME MEASURE: Closure and healing of surgical defect, intraoperative and postoperative complications, patient survival. RESULTS: There were 11 patients, 8 males and 3 females, with an average age of 65 years. Eight patients required trapezius flap reconstruction, whereas one patient required temporalis rotational flap closure, and two patients required rectus abdominus free tissue transfers. There was one perioperative death secondary to cardiac disease. There were no immediate wound complications. One patient developed a delayed partial trapezius flap failure successfully treated with a rectus abdominus flap. CONCLUSIONS: The trapezius rotational flap is a reliable means of closing complex lateral skull base defects with minimal morbidity.

Abdominal Muscles↗