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Results for “Skull Base Neoplasms”

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At least 73 records · Page 4Linked to original sources

PubMed2002

Treatment of patients with spinal metastases from head and neck neoplasms.

BACKGROUND: Spinal metastases are uncommon in patients with advanced head and neck cancer. Treatment strategies in this patient group have not been defined. Although it has been established that neurologic dysfunction in patients with spinal metastases and cord compression constitutes an oncologic emergency, the role of surgical treatment remains controversial. OBJECTIVE: To clarify the treatment options in patients with head and neck cancer who develop spinal metastases. METHODS: The clinical course of patients seen at our institution with head and neck neoplasms and spinal metastases from January 1992 to January 2000 was reviewed. RESULTS: Eleven patients were identified. Nine developed spinal metastases more than 3 months after the diagnosis of advanced head and neck cancer. The other 2 presented with synchronous spinal involvement and skull base neoplasms. Patients without neurologic symptoms were offered intravenous steroids and palliative radiation. Patients with neurologic symptoms were treated with either intravenous steroids and radiation or surgical decompression and spinal fusion. In 1 patient, no improvement occurred within the first 2 days of radiotherapy, and the patient underwent surgical decompression. Patients with an unstable spine underwent surgical decompression and spinal fusion. Patients with a life expectancy of more than 6 months and neurologic symptoms were offered surgical therapy. In the 9 patients with advanced cancer, the average survival time was 3 months. Two of these patients have survived longer than 6 months. CONCLUSIONS: We propose that surgical decompression is a viable, justifiable option for selected patients with advanced head and neck cancer and spinal cord compression. Furthermore, we recommend surgical decompression as a first option in patients with an unstable bony spine and/or in whom survival is expected to be longer than 6 months. Finally, we propose a patient management algorithm in these cases.

Adult↗

PubMedDate not supplied

Sinonasal intestinal-type adenocarcinoma involvement of the paranasal sinuses.

We present a patient with a biopsy-proved sinonasal intestinal-type adenocarcinoma who presented with moderate confusion. He was found to have bifrontal hemorrhages, which to our knowledge has not been previously described in the literature for this entity. Intestinal-type adenocarcinoma should be in the differential diagnosis of aggressive lesions in the base of the skull with intracranial spread from the paranasal sinuses.

Adenocarcinoma↗

PubMed2000

Reconstruction of the orbital walls in surgery of the skull base for benign neoplasms.

Surgery for benign neoplasm extending into the orbital roof requires immediate reconstruction to avoid complications, which include transmission of the cerebral pulse to the globe, bulbar dystopia, diplopia, and fibrosis of the oculomotor muscles. Many alloplastic materials have been employed for such reconstruction, but currently most authors agree that autologous bone graft is the best option. Using calvarial bone in adults and split ribs in children, we have operated on eight patients for fibrous dysplasia (five cases), neurofibroma (two cases), or meningioma (one case). After a median follow-up period of two years and six months, good morphology of the orbit was maintained with no ocular symptoms.

Adolescent↗

PubMed1996

Resection of bilateral orbital and cranial base basal cell carcinoma with preservation of vision.

The surgical resection of skull base tumors often presents technically challenging problems and can result in major deformities. In planning the operation, each individual patient must be evaluated not only with respect to the extent of the disease, but also with respect to the functional losses, which may severely affect the patient's quality of life. The patient presented is an elderly woman with a malignant anterior skull base basal cell carcinoma and multiple recurrences. The tumor extended to the orbits bilaterally, resulting in blindness in the right eye. The objective was to resect the tumor from the skull base and the orbits, while preserving vision in the left eye. Utilizing intraoperative frozen sections, extensive tumor resection in the left orbit was accomplished without compromising vision. This was followed by the reconstruction of the eyelids and periorbital tissues. Exenteration of the right orbit, anterior craniectomy, and partial dural resection were also performed. Ten years later, the patient remains free of tumor recurrence and has good vision in her left eye.

Aged↗

PubMed2000

Endoscopic approaches to the cranial base: perspectives and realities.

We describe the development of transnasal endoscopic approaches to the cranial base in an interdisciplinary series of 103 patients, including 13 in the pediatric age group. Our aim was to define, with the aid of different case reports, the possibilities of endoscopic techniques in tumor resection, fistula repair, the treatment of mucoceles and meningoceles, and of combined intracranial and endoscopic approaches. The advantages of these minimally invasive approaches are panoramic visualization, rapidity and reduction of the cosmetic and functional disabilities in comparison with other conventional approaches, and a better capacity for identifying and developing key landmarks for surgery. On the other hand, endoscopic surgery requires an exsanguine operation field, technical improvements in instruments, and specific skills. Interdisciplinary collaboration in endoscopic approaches has proved useful in integrating experiences without overlap between fields, and in broadening possibilities: in our opinion endoscopic approaches will certainly be important in the future of cranial base surgery.

Adolescent↗

PubMed2003

Extranasal glial heterotopia: case report.

Glial heterotopia or the occurrence of isolated non-teratomatous extracranial glial tissue is rare. We report a neonate with extensive extranasal glial heterotopia involving the left buccopharyngeal region, palate and base of the skull and presenting with respiratory distress and a bleeding oral mass. A staged operative approach was adopted to excise the lesion. The literature on the subject is briefly reviewed.

Brain↗

PubMedDate not supplied

[Cutaneous spreading of a chordoma].

INTRODUCTION: Chordomas are rare extradural bone tumors arising from notochord remnants, the embryonic structure forming the original axis of the spine. They represent 0.1p. 100 of all intra-cranial tumors. The chordoma is a locally malignant cancer that tends to invade the surrounding tissues. Its localization in the skin is exceptional. OBSERVATION: A 56 year-old man developed a nut-sized vegetating nodule on the nasal groove. This lesion appeared a few months following surgery for a frontoglabellar relapse of a chordoma that had developed six years earlier at the base of the skull. DISCUSSION: We report this case because of the rareness of cutaneous involvement and the particular conditions in which it occurred. It may have been due to tumoral seeding during the previous surgical interventions.

Chordoma↗

PubMed1998

[Mandibular swing procedure for resection of pharyngeal and skull base tumors].

OBJECTIVE: To seek for a better approach for the resection of pharyngeal and skull base tumors. METHODS: The overall tumor distribution for the entire group was nasopharyngeal 2 cases, oropharyngeal 4, parapharyngeal space 5 and parapharyngeal infratemporal area 2 cases. All 13 cases of pharyngeal and skull base tumors had their tumors thoroughly resected via mandibular swing approaches. Five cases had retropharyngeal node dissections, 2 cases had unilateral modified radical neck dissections, 5 cases with defect oropharynx were reconstructed with the pectoralis major myocutaneous flap, 10 cases with malignant tumors had received adjutant radiotherapy after surgical procedures. RESULTS: Of the 13 cases, 10 were malignant, 3 were benign. The incision in 12 cases healed primarily, one case with malignant fibrocystic tumor got infective necrosis of pectoralis major myocutaneous flap, this case healed completely after more than two months. One case developed dysphagia postoperatively and was recovered by swallow training. One case had minimal occlusion disorder. All patients were followed up from 15 months to 3 years. Three cases with benign tumors achieved good clinical results and are living well. In the malignant group, one died of recurrence at 6 months postoperatively, one died of lung metastasis, 2 cases survived for 3 years, 2 for two years, 4 for one year. CONCLUSION: This procedure provides good exposure of the base of the skull, the pharynx and the parapharyngeal space as well as the clivus and upper cervical vertebrae; it allows dissection along the internal carotid artery and facilitates resection of the tumor en bloc. It provides operative safety and minimal morbidity.

Adolescent↗

PubMed2006

Long-term outcome of skull base surgery with microvascular reconstruction for malignant disease.

BACKGROUND: Successful resection of malignant skull base disease depends implicitly on the ability to reconstruct the resulting defects in the craniovisceral diaphragm, to support neural structures, and to prevent ascending intracranial infections. Microsurgery reliably achieves these objectives and has increased the scope of curative oncologic surgery. The authors assessed the reconstructive results and the long-term oncologic outcome of patients having skull base surgery with free tissue transfer. METHODS: A retrospective review of cases between 1989 and 2001 was undertaken. Demographics, histology, surgical management, complications, locoregional control, and survival were analyzed. RESULTS: Predominantly male patients (n = 53; 62 percent) with an average age of 60 years had microvascular reconstruction following oncologic surgery. There was a preponderance of cutaneous malignancies (56 percent), and most lesions involved the anterior skull base (53 percent). Tumors were mostly resected with a combined intracranial or extracranial approach, and reconstruction was undertaken with radial forearm, rectus abdominis, or latissimus dorsi flaps with 94 percent success. Complications occurred in 23 percent of patients, and no specific risk factors for developing intracranial complications were identified. Specifically, extensive reconstructions did not increase the complication rate. The 5-year locoregional control and survival rates were 74 percent and 60 percent, respectively. A positive resection margin significantly increased the risk of locoregional recurrence and worsened disease-specific survival on Cox regression. Survival was also influenced by grade of malignancy. CONCLUSIONS: Microsurgery is highly reliable for reconstructing defects resulting from oncologic resections of the cranial base. It can and should be undertaken using a small number of highly dependable flaps.

Adolescent↗

PubMed2004

Chondrosarcomas of the base of the skull in Ollier's disease or Maffucci's syndrome--three case reports and review of the literature.

Ollier's disease is a rare disease characterized by constitutional bone dysplasia with multiple enchondromas. The combination of haemangioma and chondromatoses is known as Maffucci's syndrome. Malignant degeneration of bone dysplasia into chondrosarcoma is a well-known complication, but a lesion of the base of the skull is exceptional. It is a slowly growing low-grade malignant tumour. Three new cases of chondrosarcoma of the base of the skull occurring in one patient with Marfucci's syndrome and two patients with Ollier's disease are reported and these cases are discussed in the light of the literature. A multidisciplinary approach, comprising surgery and radiotherapy, achieved good results.

Adult↗

PubMed2005

[Metastasis of rectal adenocarcinoma to the skull base and paranasal sinuses, with unusual clinical symptoms].

INTRODUCTION: The isolated distant metastasis of digestive tract adenocarcinoma, to the head and neck region is very rare. Also, the VI cranial nerve paralysis, present, as an isolated symptom of the disease, in this case is very rare. MATERIAL AND METHODS: The diagnosis in 71 years female patient was based on CT, endoscopic examination and biopsy, and pathologic examination, with immunohistochemical differentiation between primary intestinal type adenocarcinoma of paranasal sinuses, and metastasis of adenocarcinoma from digestive tract. RESULTS: The immunohistochemical staining (CEA +, CK20 +, CK7 -, ChrA -, NSE -) proved the diagnosis. The colonoscopy revealed asymptomatic primary tumor in colon. The palliative Rtg-therapy was not commenced due to deterioration of general condition of patient. The patient died 2 months after diagnosis was established. CONCLUSIONS: The importance of differential diagnosis between the primary intestinal type adenocarcinoma in the upper respiratory tract and metastases of adenocarcinoma from digestive tract to head and neck region is crucial, due to entirely different type of treatment planning in both situations.

Adenocarcinoma↗

PubMedDate not supplied

[Cerebral metastasis].

INTRODUCTION: Cancer and its metastatic complications are one of the most important types of disease due to their high morbidity and mortality (nearly 100%). In spite of the blood-brain barrier, the brain is one of the main targets. Paradoxically, the incidence of cerebral metastases (CM) has increased due to the progress of medical science. The clinical features of CM are particularly seen in otoneurophthalmology (ONO). OBJECTIVE: To review the pathophysiology, etiology, prognosis, complementary tests and clinical features of the CM, particularly the findings of most importance in ONO. MATERIAL AND METHODS: Data on MC was obtained from MEDLINE and Cancerlit for the period 1991 to 2000. The cases of CM seen in three hospitals of different communities and levels of healthcare are also reviewed. RESULTS: The CM are mainly situated in the cortical and juxtacortical zones, causing seizures which together with headache and mental and focal motor syndromes, make up the main clinical findings. Cancer of the lung and breast are the main causes of CM, whilst cancer of the prostate metastasizes more to the base of the skull and spinal coverings. Melanoma has the greatest tendency to metastasize. In spite of surgery, radiotherapy and chemotherapy the average survival with CM is three months. CONCLUSIONS: CM is a diagnosis which should be considered in patients of middle age or older. The lung is the most usual site of origin. In spite of the dreadful prognosis, the doctor plays a decisive part in both aggressive and palliative measures.

Adult↗

PubMed1996

Intraosseous carcinoma arising from mandibular ameloblastoma with progressive invasion and pulmonary metastasis.

A 60-year-old woman, who had undergone curettage of a mandibular ameloblastoma about 20 years before, presented with recurrence of an ameloblastoma in the mandibular symphysis. This tumor was removed by a marginal resection. About 2 years later, the tumor recurred in the right mandibular ramus, and the patient underwent right mandibulectomy. About 6 months later, the tumor again recurred. Radical resection was performed, but invasion of the infraorbital region and cranial base was noted. An anterior craniotomy was then performed and the lesion removed. Histologically, proliferation of squamous cells associated with atypia was seen, and ameloblastic features were no longer observed. Metastasis to the lung was noted 1 year later.

Ameloblastoma↗

PubMed2000

Chemotherapy for esthesioneuroblastomas.

Esthesioneuroblastoma can be regarded as a chemosensitive tumor based on multiple reports of response to treatment. Neoadjuvant therapy is seldom curative, however, and may be of no benefit in some patients. Individuals who respond to preoperative therapy have a greater chance of long-term disease-free survival. Platinum-based therapy has been the mainstay of treatment. Toxicity has been mild, and treatment failures have been treated with postoperative chemotherapy with or without bone marrow transplantation. Given the small number of cases of esthesioneuroblastoma diagnosed annually, it is unlikely that any consensus on this issue is forthcoming. Either post- or presurgical treatment of advanced stage or recurrent disease has become the standard of care, however.

Adult↗

PubMed1988

3-D CT for cranial facial and laryngeal surgery.

Three-dimensional imaging is a new digital technology which interpolates two-dimensional computer tomography information to render a "life-like" anatomic display of the diagnostic information. We have found that this new methodology significantly improves the assessment and therapy of patients undergoing surgical procedures of the head and neck. The technique has been used in cranial-facial and laryngeal pathology, and in preoperative planning of tumor resection, particularly skull-base neoplasms. The use of three-dimensional computer tomography improves the display of the location and volume of pathology and affords accurate therapeutic and surgical planning. The choice and extent of surgery is better defined, and precise bone removal can be performed. In reconstructive surgery, an accurate prefabricated model of the bony defect can be made to aid reconstruction. Representative cases demonstrating the use of three-dimensional computer tomography in head and neck surgery, and its benefits in saving operative time and improving the postoperative result, will be discussed.

Child, Preschool↗

PubMed1996

Fronto-ethmoidal and orbital osteomas with intracranial extension. Report of two cases.

Osteomas involving the anterior cranial base are quite rare lesions. Intracranial and orbital extension of these tumors, causing neurological and ophthalmological symptoms and signs is a rare event. Two such cases are reported. In the first one, the tumor arose from the frontal sinus and extended upward to the medial and superior wall of the right orbital cavity and the lower part of the right frontal convexity. In the second case the osteoma arose from the left orbital roof and extended to the lower part of the homolateral frontal convexity and the splenoid wing. After the operation the symptoms disappeared and the cosmetic deficits were corrected. Skull-films, CT and MR well define the bony extension and the displacement of the orbital and intracranial structures. Indications to the surgery include progressive ophthalmologic and neurologic signs and significant cosmetic deformations. The surgical techniques and the postoperative complications are briefly discussed.

Adult↗

PubMed2006

[Cranial nerve palsies due to skull base metastases in patients with prostate cancer: a report of two cases].

Two patients with prostate cancer showed cranial nerve palsies due to skull base metastases. Case 1: A 64-year-old man had prostate cancer (T4 N0 M1, Gleason score 7, prostate-specific antigen [PSA] level 372 ng/mL) with multiple bone metastases. Seventy-seven months after initiation of therapy, he had an articulation disorder and palsy of the left side of the tongue, with 12th cranial nerve palsy. Case 2: A 75-year-old man had a prostate cancer (T3b N0 M1, Gleason score 7, PSA level 177 ng/mL) with multiple bone metastases. Sixty-six months after initiation of therapy, he had hearing loss, noise in the right ear, and dizziness, with 8th cranial nerve deficits. Magnetic resonance imaging showed low intensity in the clivus in both cases, and all over the skull in case 2. The first patient was treated with radiation therapy and intravenous steroids at an early date. His symptoms improved.

Adenocarcinoma↗

PubMed2002

Bilateral third and unilateral sixth nerve palsies as early presenting signs of metastatic prostatic carcinoma.

PURPOSE: To report four cases of cranial nerve palsy, which presented to the ophthalmologist as the only or one of the earliest manifestations of prostatic carcinoma. This is an infrequent complication of metastatic prostatic carcinoma usually only occurring late in the disease process in those with a history of prostatic carcinoma. METHODS: The case records of four patients with a history of a cranial nerve palsy who attended the ophthalmology department and who had a recent or subsequent diagnosis of prostatic carcinoma were reviewed. RESULTS: Diplopia caused by lesions affecting the third and sixth nerves sometimes in association with sensory symptoms may be a manifestation of metastatic prostatic carcinoma. These findings are consistent with base of the skull metastases from the condition. Two patients are still alive 54 months and 12 months after the diagnosis. One of the patients died 13 months after the diagnosis of prostatic carcinoma was made and the other died 21 months after the diagnosis from an unrelated hypertensive brain haemorrhage. CONCLUSIONS: Any patient presenting with diplopia must have an adequate past medical history taken and in an elderly gentleman this should include symptoms of prostatic disease. If indicated urological referral and measurement of prostate specific antigen may be performed. In patients whose cranial nerve palsy is complicated by other sensory signs or those in whom no sign of recovery occurs in 2 months, a contrast CT scan asking for bone windows to be included may be helpful in delineating any pathology. Radiotherapy may be useful for the treatment of metastatic prostatic carcinoma causing cranial nerve palsies with some patients experiencing either complete or partial resolution of their symptoms. The effect of newer hormonal agents or chemotherapy on this aspect of the disease is not well documented in current literature.

Abducens Nerve Diseases↗