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PubMed2004

Surgical strategies in the removal of malignant tumors and benign lesions of the anterior skull base.

The choice of surgical approaches to the tumors of the anterior skull base is determined by the location, dimensions of such lesions and their relations to the surrounding structures. Furthermore, the need for the reconstruction of the dura and skull base structures has an important influence on the decision about the surgical procedure. Transfacial approaches provide limited exposure, especially when tumors damage the floor of the anterior cranial fossa and involve the frontobasal dura and brain. Transcranial, craniofacial and subcranial approaches in particular may aid a surgeon in the removal of such lesions, and often these surgical procedures are the only beneficial methods. Our study comprised 15 patients. Transcranial approaches were used in ten cases. In five further cases, we adopted craniofacial or subcranial approaches. Total removal of these lesions was possible in 13 cases. Neither important complications nor death after surgery was observed except for two cases (craniofacial/subcranial approach) where the CSF leak and CNS infection were reported. We deem that the transcranial approach creates a good possibility for total removal of anterior skull base tumors, particularly of the benign lesions, and permits reconstruction of the skull base damaged by the tumor. However, in patients with large malignant tumors, the en bloc resection via the combined craniofacial/subcranial approach achieved better outcome.

Cranial Fossa, Anterior↗

PubMed1982

Clinically-directed CT in occult disease of the skull base involving foramen ovale.

Occult disease of the skull base may present as an isolated neurogenic symptom in the absence of physical signs or radiologic findings. It therefore often remains undiagnosed until advanced. Computed tomography (CT) provides the potential for diagnostic imaging far beyond conventional radiology. Not only do current generation scanners provide exquisite bone detail, they also provide the capability of soft tissue imaging. In the past year, we have matched the diagnostic problem of occult disease of the middle fossa skull base and its foramina with the potential diagnostic imaging solution of CT. Five patients were referred with possible occult middle fossa skull base disease--all had persistent unilateral facial paraesthesia in the distribution of one of the lower two trigeminal nerve divisions (V2 V3) as their only complaint; all had previously been extensively investigated (including axial CT); all remained undiagnosed. Utilizing clinically-directed CT (based on acoustic neuroma diagnostic index of suspicion and imaging experience), 2 of the 5 patients were found to have small mass lesions involving foramen ovale. This presentation will demonstrate our experience based on image-manipulated CT, actively monitored by both radiologist and otolaryngologist.

Adult↗

PubMed1991

[Clinical analysis of eight cases treated with lateral skull base surgery].

Eight cases were treated by lateral skull base surgery. Three benign tumors (2: paraganglioma, 1: neurinoma) originated from parapharyngeal space and infiltrated into jugular foramen, and five malignant tumors (3: squamous cell carcinoma, 1: adenoid cystic carcinoma, 1: rhabdomyosarcoma) involved the skull base. Preoperative magnetic resonance imaging gives information as to whether tumors invaded to cranial bone or not, and also permits deciding surgical procedures. Surgical management of mandibular bone was performed in five cases for complete tumor resection and sufficient surgical view; hemimandibulectomy was carried out in four malignant cases, who simultaneously underwent radical neck dissection, and one benign case underwent mandiblotomy. Ligation of sigmoid sinus was carried out in four cases (1; benign, 3; malignant) to control bleeding from large vessels. The skull base was reconstructed with myocutaneous flaps which were fixed by fibrin tissue adhesive. No significant surgical complications were not noted. There were no recurrence of benign tumor during 8-13 years follow up period. Malignant tumors, except one (rhabdomyosarcoma), had no local recurrence during follow up period (4 months-2 years). We emphasize that the progress in preoperative assessment, as well as in reconstructive surgical techniques, will assure more adequate indication of lateral skull surgery for malignant tumors.

Adult↗

PubMedDate not supplied

Non-Hodgkin lymphoma of the central skull base: MR manifestations.

OBJECTIVE: The aim of this study was to demonstrate the MR characteristics of non-Hodgkin lymphoma of the skull base to help in the differential diagnosis of this neoplasm from other conditions. MATERIALS AND METHODS: MR of five patients, 7-64 years old, with pathologically proved lymphomas of the skull base were reviewed. Three cases had primary skull base lesions involving the sphenoid bone and the cavernous sinus. One case with a nasal cavity lesion involving the skull base and one with a relapsing skull base lesion of previously treated tonsillar lymphoma were included. RESULTS: The lesions had signal intensities that were similar to that of gray matter of brain on both T1- and T2-weighted imaging. Bilateral cavernous sinuses were involved with encasement of internal carotid arteries in every case. Postcontrast MR showed homogeneous enhancement of the tumor with dural infiltration along the planum sphenoidale, clivus, or tentorium. The clivus was destroyed or replaced by tumors in adult cases but in two children the clivus was preserved with intact sphenooccipital synchondrosis. In one case the tumor extended to the extracranial portion through the jugular foramen. CONCLUSION: The MR findings of a permeative lesion of the skull base, invasion of the cavernous sinus without arterial narrowing, infiltration along the dural surface, and an iso- or hypointensity with brain on T2-weighted imaging should suggest lymphoma.

Cavernous Sinus↗

PubMed2006

Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma.

OBJECTIVE: The objective of this study was to investigate the diagnosis and management of skull base osteoradionecrosis (ORN) after radiotherapy for nasopharyngeal carcinoma (NPC). METHODS: The general information, clinical manifestations, and treatment outcomes were retrospectively evaluated in 15 patients with skull base ORN after radiotherapy for NPC. RESULTS: The common symptoms of skull base ORN included foul odor, headache, and epistaxis. Endoscopic examination showed exposed bone or sequestration in the nasopharynx. The characteristic findings according to computed tomography included the following: bone was destroyed extensively and symmetrically or regionally; bone was exposed to the air cavity; sequestration can be observed; and small air bladder was present in the parenchyma. There were nine patients regional skull base ORN receiving surgery, two of whom died of postradiation temporal lobe necrosis and seven of whom survived for 2 to 7 years. Conservative treatments were provided to six patients, including five patients with extensive skull base ORN and one patient with regional ORN, among which three patients died of nasopharyngeal bleeding, one patient died of exhaustion, and two patients survived for 3 to 5 years. CONCLUSIONS: Clinical diagnosis of skull base ORN was based on symptoms, computed tomography, or magnetic resonance imaging and endoscopy. The final confirmation was according to pathologic examination. Surgery had the best effect. Extensive ORN accompanied by radiation brain damage or cranial nerves damage had poor prognosis. Nasopharyngeal bleeding and exhaustion were the main causes of death.

Endoscopy↗

PubMed2005

[Surgical approaches to the skull base neoplasms].

OBJECTIVE: To discuss the best surgical approach to the skull base neoplasms. METHODS: Retrospective analysis the 79 skull base neoplasms cases treated with surgical resection in Qilu hospital of Shandong university from 1992 to 2002. Eleven surgical approaches including midfacial degloving, frontal coronal discission, nasal eversion, maxillary swing, partial maxillary resection, total resection of orbit, mandibular swing, combination of front, temple, preauricular, post aureum, neck, and transoral approaches were used to resect the tumor which involved fossae pterygopalatine, paranasal sinuses, nasopharynx, antero, meso and posterobasilar region, lobi frontalis and lobi temporalis of cerebrum. RESULTS: Seventy-nine skull base neoplasms were totally removed and no one died from the operation. Although 5 cases complicated with cerebrospinal fluid leak and all recovered within 1 week, no serious cranium-cerebrum complication occurred. In 29 patients with benign tumor including 11 cases of meningioma, 3 cases of chondroma, 1 case of hemangio-meningioma, 1 case of cavernous hemangioma, 2 cases of osteodysplasia fibromas, 9 cases of neurofibroma, 1 case of glomus jugular tumor, 1 case of neurilemmoma, 19 have survived over 5 years and the longest one has survived over 8 years. For 50 patients with malignant tumor including 3 cases of well-differentiated squamous cell carcinoma, 17 cases of moderately differentiated squamous cell carcinoma, 11 cases of poorly differentiated squamous cell carcinoma, 1 case of undifferentiated carcinoma, 2 cases of chondrosarcoma, 5 cases of canceration of papilloma, 2 cases of adenocarcinoma, 1 case of esthesioneuroblastoma, 2 cases of malignant fibrohistiocytoma, 1 case of fibrosarcoma, 2 cases of malignant mixed tumour, 3 cases of sarcoma survival rates of 3 and 5 years were 59.2% (29/49), 38.5% (10/26) respectively. CONCLUSION: In order to resect the tumor completely and reduce the complication and malformation as far as possible, different surgical approaches must be designed according to the pathological changes characters and involved area,and the surgeon should select the shortest approach, avoid to damage the important neurovascular structure, and resect the tumor through the natural anatomy space by the shelter incision.

Adult↗

PubMed1995

Neurofibromatosis of the skull base.

Neurofibromatosis of the skull base is a syndrome that may occur in an isolated fashion or as a component of Von Recklinghausen disease. This article discusses the clinical features of neurofibromatosis, diagnostic methods, and surgical treatment.

Adult↗

PubMed2001

Stereotactic proton beam therapy of skull base meningiomas.

PURPOSE: To review outcomes for patients with skull base meningiomas treated using the stereotactic proton beam at the National Accelerator Center (NAC), Republic of South Africa. METHODS AND MATERIALS: Since 1993, 27 patients with intracranial meningiomas have been treated stereotactically with protons at NAC. Of those, 23 were located on the skull base, were large or had complex shapes, and were treated with radical intent. Both stereotactic radiotherapy (SRT, 16 or more fractions) and hypofractionated stereotactic radiotherapy (HSRT, 3 fractions) were used. Eighteen patients underwent proton HSRT, while 5 patients were treated with SRT. The mean target volume for the HSRT group was 15.6 cm(3) (range 2.6-63 cm(3)). The mean ICRU reference dose was 20.3 cobalt Gray equivalent (CGyE), and the mean minimum planning target dose was 16.3 CGyE. The mean clinical and radiologic follow-up periods were 40 and 31 months respectively. The mean volume in the SRT group was 43.7 cm(3), with ICRU reference doses ranging from 54 CGyE in 27 fractions to 61.6 CGyE in 16 fractions. RESULTS: In the HSRT group, 16/18 (89%) of patients remained clinically stable or improved, while 2/18 (11%) deteriorated. Radiologic control was achieved in 88% of patients, while 2 patients had a marginal failure. Among the 5 SRT patients, 2 were clinically better, and 3 remained stable. All SRT patients achieved radiologic control. Three patients (13%), 2 of them in the HSRT group, suffered permanent neurologic deficits. Analyzing different dose/fractionation schedules, an alpha/beta value of 3.7 Gy for meningiomas is estimated. CONCLUSION: Proton irradiation is effective and safe in controlling large and complex-shaped skull base meningiomas.

Adult↗

PubMed2003

Plagiocephaly: morphometry of skull base asymmetry.

The aim of this study was to perform a morphometric analysis of the skull base to understand the mechanism of asymmetry between malformational and deformational plagiocephaly. Since 1988, we have carried out 102 CT scans with three-dimensional reconstruction of the endocranial side of the skull base. There were 20 cases of malformational plagiocephaly, consisting of 18 unicoronal synostoses (UCS) and two unilambdoid synostoses (ULS), and 82 cases of plagiocephaly without synostosis, made up of 60 cases of frontal plagiocephaly (FP) and 22 of occipital plagiocephaly (OP). The skull base asymmetry was analyzed in three ways: (1) the hemibases and the cranial fossa angles were compared with each other; (2) the structural asymmetry of the chondrocranium was calculated; and (3) the architectural asymmetry was measured in relation to the medio-labyrinthine plane. The skull base asymmetry of malformational plagiocephaly was located in the anterior and middle cranial fossae for UCS and in the posterior and middle cranial fossae for ULS. The asymmetry was the result of a localized structural anomaly of the chondrocranium. The asymmetry of deformational plagiocephaly corresponded to a distortion in relation to the medio-labyrinthine plane while the chondrocranium remained symmetric. The skull base asymmetry of malformational plagiocephaly is secondary to a localized malformation of the chondrocranium, and that of the deformational plagiocephaly is secondary to an architectural deformation.

Analysis of Variance↗

PubMed1992

Solitary plasmacytoma of the skull base.

Plasmacytomas involving the skull base are rare lesions that may be well advanced by the time of diagnosis. Because of their anatomic site they may produce a variety of signs and symptoms, some of which may be vague, often resulting in delays in presentation and in appropriate investigations. We present such a patient, discuss the diagnosis and management, and give a review of the literature.

Diplopia↗

PubMed2000

Education and information needs identified by patients and key family members prior to surgery for a skull base neoplasm: implications for practice.

Many patients with extensive skull base neoplasms poorly understand the nature of their problems. Therefore, education of patients and family members is an important component of care. Research has established the benefits of pre-operative education for other types of surgery and information seeking as an important method of coping. Yet in 184 references on skull base surgery (1996-1999), no case-based or research data that examined education and information needs prior to hospitalization for surgery was found. The investigators present findings from Phase 1 of a descriptive research study designed to determine the education and information needs perceived by patients and family members at their initial visit to the neurosurgeon and on admission to hospital. Data was collected, using interviews and a questionnaire, from 18 patients with skull base neoplasms and 15 key family members. The study findings provide insight into the experience of patients and families during a time period (prehospitalization) that has not been explored. Results indicate that key education needs of participants are related to the brain tumour and surgery. Findings reveal patient participants in contrast to family members had little in the way of information needs. Underlying and impacting the education and information needs is the theme of 'Hearing the News'. Relevance of the results to nursing practice in the pre-operative phase is addressed.

Adult↗

PubMedDate not supplied

Low-grade fibrosarcoma of the anterior skull base: endoscopic resection and repair.

BACKGROUND: Fibrosarcomas of the paranasal sinuses and skull base are uncommon tumors. Traditionally, "open approach" surgery remains the mainstay for treatment of choice for these tumors. METHODS: A 49-year-old man underwent resection of a right anterior skull base fibrosarcoma using the endoscopic approach. RESULTS: Close follow-up using both endoscopic and imaging methods over a period of four years has revealed a well-healed skull base with no evidence of recurrence. CONCLUSION: Significant resistance exists at present for such a technique to deal with malignant diseases of the head and neck but results from advanced centers continue to prove that this may be a technique worth mastering and improving on.

Bone Transplantation↗

PubMed1990

[Experimental study of Gore-Tex in the treatment of the skull base].

Fractures of the skull base are frequently accompanied by dural injuries. Lyophilized dura mater is very suitable for dural reconstruction at the level of the smooth convex posterior wall of the frontal sinus but surgery in the region of the sphinoid tectum and lateral to the falx cerebri is difficult. The Gore-Tex patch is very soft and comfortable. Vascular prostheses are manufactured from this material and have been implanted successfully for years. This material was subjected to a check of histocompatibility in animal experiments by intracranial implantation as a replacement for lyophilized dura mater. Lyodura is replaced by granulations of collagenous tissue. Gore-Tex is incorporated with fibroblastic and osteoblastic penetration. This alloplastic material should only be used under specific conditions.

Animals↗

PubMed1988

High activity iodine 125 endocurietherapy for recurrent skull base tumors.

Experience with endocurietherapy of skull base tumors is reviewed. We present our cases of recurrent pituitary hemangiopericytoma, radiation-induced recurrent meningioma, recurrent clival chordoma, recurrent nasopharyngeal cancer involving the cavernous sinus, and recurrent parotid carcinoma of the skull base which were all successfully retreated with high-activity 125iodine (I-125) permanent implantation.

Adenocarcinoma↗

PubMed2006

[The study of 11 cases of chordoma in the skull base or neck].

OBJECTIVE: To study the clinical manifestation, histopathological types, radiological characteristics, surgical methods and the prospective efficacy of chordoma in the skull base and neck. METHOD: Analyzed the characteristics about eleven patients with chordoma in the skull base or neck that we had treated in our department from 1985 to 2003 and introduced a case of a huge chordoma in the neck. All of the patients were treated by surgery. RESULT: The clinical manifestations of chordoma in the neck or skull base were complex. The first symptoms included the mass in the neck, rhinocleisis, visuognosis fall, tinnitus, hearing loss, and damages of brain nerves. Eight cases were the typical chordoma and the other three were the cartilaginiform chordoma. The dilatant image of parenchyma was the feature in CT scan and the images often had clear confines. The cervical vertebra and the skull base were damaged in the most of the cases. Four patients (4/11) recrudesced in two years after the surgery, and eight of eleven were living more than five years after the surgery. CONCLUSION: The clinical manifestations of chordoma in the neck or skull base were complex. The cervical vertebra and the skull base were often damaged in the most of the cases. Surgery is an effective method on chordoma. The surgery path should be selected according

Adult↗

PubMed2003

Management of osteomyelitis of the anterior skull base and craniovertebral junction.

OBJECTIVES: The study goals were to determine the patient demographics, identify predisposing factors, and determine efficacy of treatment for nonotologic osteomyelitis of the skull base and craniovertebral junction. STUDY DESIGN: All patients with a biopsy-proven diagnosis of osteomyelitis of the skull base treated by the author from 1997 through 2001 were retrospectively evaluated. RESULTS: Six patients were identified on review. The average age at presentation was 56.7 years (age range, 38 to 70 years), and all except one patient had an underlying immunocompromising condition (diabetes mellitus, human immunodeficiency virus infection, steroid use). Most presented with neurologic deficits associated with a destructive lesion of the osseous skull base. Aggressive debridement of involved bone enabled through the use of broad field standard skull base approaches was associated with clinical resolution of symptoms in each case. Systemic antibacterial/antifungal therapy and medical optimization remain important adjuncts in the treatment of this group of patients. CONCLUSION: The diagnosis of this entity may be difficult to discern from neoplastic involvement of the skull base. Standard skull base approaches are useful for both the diagnosis and the treatment of nonotologic osteomyelitis.

Adult↗

PubMed2005

Subcranial approach in the surgical treatment of anterior skull base trauma.

Fractures of the anterior skull base, because of the region's anatomical relationships, are readily complicated by neurological damage to the brain or cranial nerves. This review highlights the use of a subcranial approach in the operative treatment of injuries of the anterior skull base and compares it to the more traditional neurosurgical transcranial approach. The extended anterior subcranial approach takes advantage of the specific features of injuries in this region and allows direct access to the central anterior cranial base in order to repair fractures, close CSF fistulae and relieve of optic nerve compression. It avoids extensive frontal lobe manipulation. The success of the approach in achieving the aims of surgery with low morbidity is reviewed.

Brain Injuries↗

PubMed2001

Identification of isochromosome 1q as a recurring chromosome aberration in skull base chordomas: a new marker for aggressive tumors?

OBJECT: The authors conducted a study of 22 skull base chordomas. METHODS: A series of 22 skull base chordomas was analyzed with G banding. Subsequently, metaphase cells obtained from three tumors were reexamined using multicolor spectral karyotyping. Clonal chromosome aberrations were identified in 11 cases, all of which were recurrent tumors. Three tumors showed a remarkable similarity in cytogenetic features, and these features appear to characterize a recurring combination of nonrandom chromosome aberrations, including isochromosome 1q, gain of chromosome 7, and monosomy for chromosomes 3, 4, 10,13, and 18. Isochromosome 1q was identified as the sole recurring structural chromosome rearrangement in these tumors. The pattern of chromosome loss reported in the progression of lumbosacral chordoma also appears to be true of skull base chordomas with the additional findings of isochromosome 1q, gain of chromosome 7, and loss of chromosome 18. CONCLUSIONS: Skull base chordomas characterized by isochromosome 1q and monosomy 13 provide support for the concept of the loss of putative tumor suppressor loci on 1p and 13q and aggressive tumor behavior.

Adolescent↗