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At least 73 records · Page 4Linked to original sources
PubMed2004

Evolutions in the management of congenital intranasal skull base defects.

BACKGROUND: Congenital skull base defects have traditionally been treated via an intracranial approach. Recent advances in endoscopic management have made minimally invasive extracranial approaches feasible, with less morbidity. OBJECTIVE: To determine the success of endoscopic treatment of congenital cerebrospinal fluid leaks and encephaloceles. MAIN OUTCOME MEASURES: Retrospective review of congenital cerebrospinal fluid leaks and encephaloceles treated from January 1, 1992, to December 31, 2003. Data collected include demographic characteristics, presenting signs/symptoms, site of the skull base defect, surgical approach, repair technique, and clinical follow-up. RESULTS: Eight patients were treated via the endoscopic approach for congenital cerebrospinal fluid leaks and encephaloceles. The average age at presentation was 6 years (range, birth to 18 years). Three patients presented with meningitis (average age, 6 years), 4 had cerebrospinal fluid rhinorrhea, and 3 developed a nasal obstruction. Five defects originated at the foramen cecum, and 3 others involved the ethmoid roof/cribriform plate only. Our endoscopic approaches were successful on the first attempt, with a mean follow-up of 19 months. One patient experienced nasal stenosis postoperatively. CONCLUSIONS: Continuing progress in the surgical management of congenital skull base defects demonstrates that endoscopic repair is a successful alternative to traditional craniotomy approaches, with less morbidity. This technique requires meticulous preparation and precise grafting of the defect to avoid collateral damage to surrounding structures. While reduction in the risk of meningitis, intracranial complications, and facial growth abnormalities and alleviation of nasal obstruction necessitate the timely repair of these skull base defects, special considerations are discussed regarding the optimal timing of surgical intervention, operative working space, and exposure in a smaller nasal cavity.

Adolescent↗
PubMedDate not supplied

The evolving role of stereotactic radiosurgery for patients with skull base tumors.

Tumors located at the base of the skull are among the most difficult problems that neurosurgeons encounter. Management of patients with skull base tumors must take into account that complete tumor removal is not possible with acceptable morbidity in many patients. Therefore, radiation therapy and stereotactic radiosurgery are commonly performed. The use of radiosurgery for patients with skull base tumors has increased significantly over the past three decades and we now possess a better understanding of the expectations of skull base radiosurgery. For properly selected patients with benign tumors (meningiomas, schwannomas, glomus tumors), tumor control rates between 90 and 100% have been reported. Local control rates for chordomas and chondrosarcomas have ranged from 50 to 70%, but tumor growth adjacent to the treated area (marginal failure) remains a significant problem. Radiosurgery is also commonly performed for patients with malignant skull base tumors as a palliative treatment and symptom relief is common, especially for patients with facial pain related to their tumor. Follow-up beyond 10 years is still needed to better define long-term results of radiosurgery and the incidence of radiation-induced neoplasms after radiosurgery.

Humans↗
PubMed1999

[CT evaluation of the primary extracranial neoplastic diseases eroding the central skull base].

OBJECTIVE: To evaluate the central skull base erosion caused by primary extracranial mass lesions with CT. METHODS: Forty-nine patients (33 males and 16 females; mean, 40.2 years) suffered from the primary extracranial neoplastic diseases with middle skull base involvement were divided into two groups: group I (10 cases), primary osseous lesions of the central skull base and group II (39 cases), primary maxillofacial neoplasms. All lesions were confirmed histopathologically by surgery and biopsy. RESULTS: Four invasion patterns of the central skull base were identified on CT: I. resorption of the cortical bone (30 cases), including outer cortical margin destruction in 16 cases (group II lesions) and both inner and outer laminae resorption in 14 cases (4 group I lesions and 10 groups II lesions). II. ossification and thickening of the skull base (4 group I cases, all were fibrous dysplasia) III. erosive enlargement of the ovale and rotundam foramina (9 group II cases). IV. combined sclerosis and resorption of the skull base (6 cases, 2 group I lesions and 4 group II lesions). Involvement of the intracranial structures embraced the cavernous sinus (n = 12; group II lesions), temporal lobe (n = 11; 5 group I lesions and 6 group II lesions), and pituitary (n = 2, group II lesions). CT demonstrated the following central skull base structures were eroded: greater wing of sphenoid bone (n = 34), sphenoid body (n = 22), sphenoid process (n = 23), petrous bone (n = 15), and articular fossa of the temporal bone (n = 8). CONCLUSION: Osseous lesions originating from the central skull base have various CT manifestations. The cortical resorption of the central skull base may be regarded as a main pattern of bone erosion caused by primary maxillofacial neoplasms, and most of them have lesions involve the greater wing of sphenoid bone through the deeper maxillofacial spaces, such as the infratemporal, pterygopalatine and parapharyngeal spaces.

Adolescent↗
PubMed2005

Sixth and tenth nerve palsy secondary to pseudomonas infection of the skull base.

PURPOSE: To describe skull base osteomyelitis, an uncommon complication of chronic otitis media in the post-antibiotic era, as a cause for diplopia. DESIGN: Case report. METHODS: The records of a patient with skull base osteomyelitis were reviewed. RESULTS: A patient presented with a sixth nerve palsy and tenth nerve palsy. Magnetic resonance imaging, bone scan, and gallium scan were helpful in establishing the diagnosis. Cultures grew Pseudomonas. The treatment required long-term intravenous antibiotics. CONCLUSIONS: Pseudomonas skull-based osteomyelitis can produce a sixth nerve palsy as a result of the involvement of the clivus. Although uncommon in the post-antibiotic era, early recognition, appropriate diagnostic testing, and aggressive systemic antibiotic treatment might prevent permanent neurologic sequel.

Abducens Nerve Diseases↗
PubMed2002

Chondrosarcoma of the skull base.

OBJECTIVES: Sarcomas of the skull base are challenging, potentially lethal tumors. Prognosis is considered poor. The present report reviews treatment options and presents a case of treatment with en bloc resection of the temporal bone and adjacent skull base. STUDY DESIGN: Single case report and literature review. RESULTS: Extensive skull base resection for chondrosarcoma can be performed successfully and may be curative. CONCLUSION: There is a role for en bloc resection of large areas of the skull base for treatment of chondrosarcoma. It appears that treatment combining surgery and radiation therapy is most likely to be effective.

Adult↗
PubMed1996

Update on skull base surgery.

The field of skull base surgery has changed significantly during the past decade. Various surgical approaches have been developed, which when used alone or in combination provide optimal exposure for the resection of a given lesion with minimal morbidity. This recent evolution in the field of skull base surgery has allowed the surgical management of larger lesions in previously inaccessible locations. Furthermore, techniques in the preoperative, intraoperative, and postoperative management of the intrapetrous internal carotid artery have circumvented many prior limitations of cranial base resections. The goals of this article are to provide an overview of the postlateral skull base approaches in use today, discuss the regions of the skull base that are accessible, and describe the state of the art in management of the intrapetrous internal carotid artery.

Carotid Artery, Internal↗
PubMed1989

Management of osteomyelitis of the skull base.

Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4-year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate antipseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol.

Aminoglycosides↗
PubMed2004

Porous polyethylene implant for cranioplasty and skull base reconstruction.

OBJECT: Cranial reconstruction after skull base surgery is important for restoration of function and cosmesis. The authors describe their experience with the Medpor porous polyethylene implant for cosmetic cranioplasty and reconstruction after skull base surgery. METHODS: Medpor, a biocompatible implant, is flexible and can be contoured to facilitate surgical reconstruction of small to medium (< 8 cm) convexity or cranial base defects resulting from a variety of skull base approaches. This method provides similar cosmetic results to standard alloplast cranioplasty while decreasing operating time. The porous nature of the material allows ingrowth of soft tissue and bone to increase implant strength and decrease the risk of infection. This material can also be used safely in reconstruction of the cranium and skull base adjacent to the paranasal sinuses. CONCLUSIONS: The authors have used the Medpor porous polyethylene implant in 611 standard cranial and skull base procedures and have achieved excellent cosmetic results and no implant-related complications.

Absorbable Implants↗
PubMed2003

[The subcranial approach for tumors involving the anterior skull base].

The technical approach for anterior skull base tumors has progressed considerably during the last decade. In the classical combined craniofacial resection (CFR) technique, anterior skull base lesions have been approached through bi-frontal craniotomy coupled with Weber-Ferguson and related modifications incisions. The purpose of this work is to present our experience with the subcranial approach for treatment of anterior skull base tumors. During the years 1994-2002, 64 patients underwent 72 procedures of anterior skull base tumor resection via the subcranial approach. The ages of the patients ranged from 2 to 81 years (mean 42 years). Twenty-nine cases involved malignant tumors (40%), and 43 cases involved benign tumors (60%). The most common benign pathology was meningioma (n = 12) and the most common malignant tumor was squamous cell carcinoma (n = 8). The principle skull base reconstruction procedure was performed using a multi-layered fascia: limited defects of the dura were reconstructed with the use of temporalis fascia, whereas reconstruction of large dural defects was performed using a multi-layered fascia lata sheath. Reconstruction of significant bony defects was achieved by utilizing a split calvarial bone graft, posterior sinus wall, or titanium mash covered with pericranial flap. Postoperative follow-up (26 months in average) revealed that 76% of the patients are without evidence of disease, 14% are alive with disease, 3% died of their diseases and 7% died of unrelated causes. Twenty-seven patients (44%) have suffered from anosmia following the operation. The rate of severe complications was 5.6%, and included meningitis (n = 2), cerebrospinal fluid rhinorrhea (n = 1) and tension pneumocephalus (n = 1). We conclude that the extirpation of anterior skull base tumors via the subcranial approach is simple, reproducible and reliable, and is associated with reasonable complication rates.

Adolescent↗
PubMed1996

Pediatric neurotologic skull base surgery.

The objectives of neurotologic skull base surgery are complete resection of the lesion and high-grade function following surgery. There is a perception that these goals are more difficult to achieve in children than in adults. Skull base disease in children and adolescents is rare. Of the 292 skull base tumors treated from 1970 to 1995 by The Otology Group in Nashville, 15 were in patients 21 years of age or younger, with only 5 patients under 10 years old. In this retrospective study, the authors review these 15 cases and compare them to their adult series. The pathology encountered in the 15 young patients with skull base tumors included 8 glomus lesions and 4 schwannomas. In these patients, 13 tumors occurred sporadically, and 2 tumors were related to neurofibromatosis type 2. Advanced-stage disease and malignancy were prevalent in this younger patient group. All patients underwent excision of their skull base tumor, with one procedure considered a subtotal resection. As compared with an adult glomus tumor series, postoperative cranial nerve function and complication rates were generally worse in the young glomus patients. However, postoperative function and complications were consistent with the extensive procedures required for the treatment of advanced disease. Despite the advances that have been made in imaging and treatment modalities, this study illustrates the need for more timely diagnosis in younger patients with skull base tumors.

Adolescent↗
PubMed2006

Unusual tumors of the posterior fossa skull base.

Five unusual cases of posterior skull base tumors were treated through different skull base approaches. Two or more staged operations were required to achieve total or near-total excision and decompression of two extensive tumors. Total excision of an extensive en plaque meningioma of the foramen magnum that encircled the brain stem and cervical spinal cord could not be achieved through the extreme lateral and suboccipital craniectomy approach. However, the vital structures were decompressed and the patient's postoperative morbidity was acceptable. An extended middle fossa approach was required to excise a hemangiopericytoma of the middle and posterior fossae in a 12-year-old. Extension of the tumor into the posterior fossa precluded a retromastoid approach because the mass draped the lower cranial nerves posteriorly. Two men had undifferentiated adenocarcinomas involving the jugular foramen and middle to posterior fossa, respectively. The origin of one was renal in a 37-year-old man. A 63-year-old man survived 1.5 years after a good decompression of his extensive tumor and irradiation. The histological diagnosis of paraganglioma of the occipital bone was a surprise in a 25-year-old man with pure bony involvement. These cases indicate that the appropriate selection of skull base approaches and their combination can provide the needed access to achieve adequate excision or decompression of masses located in challenging anatomical regions of the skull base. Furthermore, good surgical excision improves palliation in radioresistant metastatic tumors of the skull base.

Journal Article↗
PubMed2004

Radial forearm free tissue transfer reduces complications in salvage skull base surgery.

OBJECTIVE: Patients who undergo skull base resection after prior surgery or radiation may be at high risk for complications when local flaps alone are used for reconstruction. To determine whether the complication rate could be reduced, fasciocutaneous free tissue transfer was used to reinforce the dural closure in patients who had prior skull base surgery or radiation. METHODS: This study is a case series of 20 patients (14 males, 6 females, aged 8-79 years of age with a mean of 47.7 years) from 1997 to 2001 who had prior skull base surgery or radiation, and underwent salvage skull base resection without large volume defects. All patients had a radial forearm free tissue transfer to reinforce the dural closure. Six patients had an osseous component to the forearm flap to provide vascularized bone to the orbital rim. RESULTS: The overall local complication rate was 35%. Three patients (15%) had major complications including 1 case of meningitis, 1 case of cerebrospinal fluid leak, and 1 case of a flap requiring venous salvage. There were no flap failures, 1 idiopathic median nerve palsy, and no pathologic radius bone fractures. CONCLUSION: Reconstruction with fasciocutaneous free tissue transfer for high-risk patients with low-volume dural defects following skull base resection can minimize the risk of major postoperative complications. EBM RATING: C.

Adolescent↗
PubMed1999

Application of skull base techniques to pediatric neurosurgery.

Techniques for skull base surgery have become well established over the last 10 years. Most of these techniques are used in adult patients for skull base tumors and neurovascular diseases. There are very few large series of pediatric patients in whom skull base approaches have been used, because of the rarity of these conditions. The authors would like to present a relatively large series of 26 pediatric patients who underwent skull base approaches for tumor resection. These tumors involved the anterior cranial base in 5 patients, the medial cranial skull base in 4 patients, and the posterior cranial base in 12 cases. Five patients had tumors that involved two or more fossae. The overall complication rate was 57%, which included temporary cranial nerve palsies, CSF leak and infection. Patients with permanent complications were 8 in number (37%). There was 1 postoperative death from pneumonia approximately 6 weeks after surgery. Complete tumor removal was achieved in 24 of the 26 patients. Skull base tumors in children are often extensive and present significant surgical challenges. Although complete tumor extirpation is the goal in most pediatric patients, this is often achieved only with some morbidity. This paper demonstrates the effectiveness of skull base approaches for these tumors and underscores the high stakes involved.

Adolescent↗
PubMed1993

[Surgery of the skull base tumor].

Surgery of the skull base tumor has been undertaken in 19 patients, 15 with anterior skull base tumor and 4 lateral skull base tumor. Among them, 16 cases had malignant tumors and 3 had benign tumors. The dura was exposed in 15 patients and resected in 5 patients due to tumor invasion. The dura and bony defects could be repaired with fascia lata, galea pericranial flaps and scalp flaps. Cautery was useful for treating minimally involved duras. Three out of 16 patients with malignant tumors were free of tumors for 4-14 years and 5 for 1.5-3 years postoperatively; 7 cases died of tumor recurrence.

Adult↗
PubMed1985

Osteoradionecrosis of the maxilla and skull base.

Osteoradionecrosis of the maxilla and base of skull are rare phenomena, usually seen after combined therapy for malignancies of the maxillary sinus. While the mandible is most commonly affected by osteoradionecrosis, the maxilla and skull base may also be affected when preoperative or postoperative radiotherapy is combined with surgery. Contributing factors may be: high radiation dosage delivered to the treatment volume (greater than 6000 rads), loss of tissue protective effects due to surgery, decreased vascularity caused by surgery and radiation, and proximity of a contaminated field. Onset of symptoms may vary. One patient presented 25 years after postoperative radiotherapy. Major symptoms were pain, trismus, and purulent discharge. The best diagnostic modality remains the history and physical exam, as the area is readily accessible. CT scans may be helpful in diagnosis and treatment planning. Therapy should follow time honored principles of local wound care. Home irrigations and hyperbaric therapy have been helpful in encouraging early sequestration and rapid healing.

Bone Diseases↗
PubMed1998

Use of free composite graft for a large defect in the anterior skull base.

Until recently, most skull base tumors, particularly those extending into the orbit or anterior or middle cranial fossa base, were excised incompletely because of the technical difficulty in performing en bloc resections. However, improved craniofacial surgical techniques, recent developments in technology and equipment, improved imaging techniques, interdisciplinary collaboration, and improved anesthetic techniques have enabled a wide range of attempts resulting in successful clinical outcome. We present a case of recurrent meningioma with intracranial and extracranial extension in which three previous operations left a large craniectomy defect in the frontal area as well as a frontal lobe defect. After removal of the tumor, we reconstructed the large defect using composite graft (free bone and fascia lata).

Adult↗
PubMed2002

Giant prolactinomas presenting as skull base tumors.

BACKGROUND: Prolactinomas invading the skull base are rare, and could easily be confused with skull base tumors of nonpituitary origin. CASE DESCRIPTION: We report a series of 4 cases of giant prolactinomas invading the skull base and presenting with atypical symptoms. Case 1 presented with a short history of headache and nasal obstruction. Case 2 presented with progressive hypoacusia, dizziness, and ophthalmoplegia. In Case 3, the patient developed rapid progressive visual failure and psychiatric symptoms. Case 4 presented with a 1-year history of headache and retrorbital pain. The diagnosis of prolactinoma was made on the basis of tumor immunohistochemistry and/or high plasma prolactin levels (range from 650-6,500 ng/mL). Medical treatment with the dopamine agonist cabergoline was given; it was effective in normalizing prolactin levels and inducing tumor shrinkage. CONCLUSION: Prolactin levels should be measured in all large skull base tumors involving the pituitary region before any surgery or inappropriate radiotherapy is performed.

Adult↗