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At least 19 recordsLinked to original sources
PubMed1993

Cystic schwannoma of the sphenoid sinus and skull base.

Skull base and intracranial cystic schwannomas are rare tumors. To our knowledge, a cystic schwannoma involving the sphenoid sinus has not been previously reported. The location and fluid-filled nature of the lesion resulted in an erroneous preliminary diagnosis of a destructive sphenoid sinus mucocele. Endoscopic biopsy and decompression established the correct diagnosis and reversed a progressive visual loss until definitive surgical removal of the lesion was accomplished. Diagnostic evaluation, histologic findings and management strategies are discussed.

Humans↗
PubMed1993

Role of brachytherapy in the management of the skull base meningioma. Treatment of skull base meningiomas.

BACKGROUND: The treatment of primary and recurrent skull base meningiomas presents a formidable surgical problem. METHODS: Fifteen patients with primary and recurrent skull base meningiomas were treated by means of interstitial irradiation with iodine 125 (125I) seed implantation. The physical characteristics of 125I enabled the authors to administer a minimum tumor dose ranging from 100 to 500 Gy at a low dose rate of 0.05-0.25 Gy per hour. RESULTS: All 15 patients are alive at a median follow-up of 29 months. Of the 15 patients, 2 with calcification and 2 without calcification achieved only partial responses. The remaining 11 patients achieved a complete response. No early or late complications were observed. CONCLUSIONS: From these data, the authors conclude that interstitial irradiation with 125I seeds is an effective, safe, and simple method in the treatment of both recurrent and primary skull base meningiomas.

Adult↗
PubMed1994

Pituitary adenoma invading the skull base--a strategy for skull base surgery.

A strategy for surgical management, including the approach and preoperative evaluation, of pituitary adenoma invading the skull base is described. Preoperative evaluation requires a balloon occlusion test of the internal carotid artery (ICA) to determine tolerance to occlusion. Failure to tolerate occlusion indicates administration of brain protective agents and/or a bypass procedure before tumor removal. The transsphenoidal, pterional, orbitofrontomalar, and infratemporal fossa approaches are all suitable for various tumor locations. A combined orbitofrontomalar and extended frontal approach allows removal of tumor with extensive invasion and is suitable for bypass procedures. Preoperative evaluation of ICA occlusion can prevent development of hemodynamic stroke. We treated five patients with pituitary adenoma invading the skull base, including two primary and three recurrent cases. All symptoms improved, but temporary oculomotor nerve disturbance occurred in three patients and anosmia in one. Reoperations for recurrent pituitary adenomas were effective in reversing the symptoms. No hemodynamic stroke was seen postoperatively. These tumors, except for drug-responsive cases, are indicated for skull base surgery.

Adenoma↗
PubMed1997

Secondary craniofacial problems following skull base surgery.

Skull base wounds remain the most challenging that a skull base surgeon faces because of the unique and unforgiving requirements of the intracranial compartment. To successfully reconstruct these defects after complex exposure and radical resection around vital structures, a most conservative approach must be taken (i.e., one must choose the option that has the greatest chance to be successful, even if it means taking the extra time and effort of doing a free tissue transfer). Indeed, one can take no short cuts if the skull base would be left with a tenuous repair. Close postoperative surveillance of the patient for complications and maximal medical management is essential. Because of the difficulty of examining the hidden skull base wound postoperatively, surgeons must have a low threshold for re-exploration if a complication is suspected. As the first decade of the multidisciplinary skull base team approach passes, and long-term results are being assessed, the question of "is it worth it?" is fair. The reported series are showing increased survival rates and decreased complication rates. Therefore, the answer would appear to be "yes". The question is best answered, however, by the individual patient who previously had no hope for treatment of his or her deep-seated skull base tumor.

Adult↗
PubMed1984

Surgical reconstruction after extensive skull base surgery.

Skull base surgery is a rapidly expanding surgical subspecialty bringing together the sophisticated surgical skills of the neurotologist-head and neck surgeon and the neurosurgeon. Newly described surgical approaches to the skull base have made possible greater surgical ablation of the skull base region, resulting in large defects and thus heightening the need for reconstructing these regions. Prevention of cerebrospinal fluid leaks is the most important aspect of reconstruction and is achieved most readily when possible by dural patch grafts of fascia lata, coverage of the dura with soft tissue, and preservation of the soft tissue utilizing skin or split thickness skin grafts. Soft tissue may be in the form of free fascia lata grafts, pedicled galeal flaps, or local or regional skin flaps. Defects of the skull base larger than a few square centimeters are best reconstructed with local or regional skin flaps or musculocutaneous flaps. These flaps lend sufficient structural support so that bone support is not usually required. Subsequent cranioplasty, when necessary, can provide protection to those regions of the brain that are more susceptible to blunt trauma.

Cranial Fossa, Posterior↗
PubMed1997

Surgical treatment of anterior skull base tumours.

Skull base tumours represent a special challenge to surgeons due to the complex anatomy of the area. While small tumours are easy to remove, large lesions can pose complex situations. The most difficult aspects are not only the approach and removal, but specially the repair of the defects created by the resection of the tumour. We present here our experience with the surgical removal of tumours on the anterior skull base. To achieve a good approach, we resort to a bifrontal craniotomy including the cilliar arches. To obtain a skull base bone flap that can be used for repair at the end of the procedure, we remove the roof of the nose and a part of the medial wall and roof of both orbits. While the tumour is removed, the skull base bone flap is autoclaved to kill all tumoural cells. At the end of the procedure this bone flap is replaced, wrapped with a flap of pericranium. Provided no orbit needs to be emptied, no other flap is needed to reconstruct the area. One advantage is that the surgical cavity is not occluded with tissues, thus facilitating early identification of any recurrence. The area can be explored with the aid of an endoscope introduced into the nasal cavities through the nostrils, and in case of doubt, biopsies taken from all suspicious area. Our technique facilitates the repair of the surgical defect, and while not compromising the healing process it has a very low incidence of CSF leaks and infections.

Adolescent↗
PubMed1982

A new measure of growth efficiency: skull base height.

Skull base height increases significantly with better nutrition and health conditions, as seen in comparing 163 nineteenth to twentieth century dissecting-room skeletons (Terry Collection) with 237 modern American middle-class adults (forensic and willed skeletons). The increase parallels the change in pelvic inlet depth index, known to respond sensitively to nutrition, and in stature, and is over six times greater than the general skull size change. Skull base height (porion-basion) is easy to measure with depth gauge and sliding caliper, or by subtraction, and is in adult a sensitive indicator of childhood growth stress.

Age Determination by Skeleton↗
PubMedDate not supplied

Evaluation of skull base erosion in nasopharyngeal carcinoma: comparison of plain radiography and computed tomography.

Over a period of 16 months, a total of 175 patients with newly diagnosed nasopharyngeal carcinoma (NPC) were evaluated with plain radiography and computed tomography (CT) of nasopharynx and base of skull. 54 of 175 patients (30.9%) had CT evidence of skull base erosion. Plain radiography failed to demonstrate the skull base erosion in 22 of 54 patients (40.7%) and underestimated the extent of bony involvement in another 21 patients (38.9%). In 14 of 54 patients (25.9%), there was also false suspicion of bony erosion in the plain films in one or more regions of the skull base which was not substantiated by CT and subsequent clinical course. The present study shows that plain radiography lacks sensitivity and specificity in detecting skull base erosion by NPC. CT evaluation of NPC patients should include thin CT sections of base of skull for detection of subtle bone erosion, and this would allow better decision concerning the shielding of the pituitary-hypothalamic axis during radiotherapy for improvement in therapeutic ratio. For the investigation of individuals highly suspicious of harboring NPC, even when the plain radiography is negative, CT should still be performed as this may give the only clue to the presence of a small submucosally spreading NPC.

Humans↗
PubMed1995

Computer-assisted image-guided surgery in pediatric skull-base procedures.

Skull-base surgery is characterized by the variety of important neural and vascular structures within a narrow operating field. Although preoperative imaging by computed tomography (CT) and magnetic resonance imaging (MRI) and the use of microsurgical techniques have improved intraoperative orientation, a large number of complications still are caused by localization problems. Especially in pediatric skull-base surgery, maximum localization accuracy during surgery is required. The authors developed a localizing system based on tomographic imaging (such as CT or MRI) to achieve safer surgery by providing highly accurate location information. The preliminary successful experience in the use of the Aachen computer-assisted surgery device for pediatric skull-base surgery (14 cases) is presented. Indication include juvenile angiofibroma of the nasopharynx, infectious and tumorous diseases of the paranasal sinuses, orbital tumors, foreign bodies, and intracranial abscess formation.

Adolescent↗
PubMed1985

Rare tumors of the skull base and temporal bone.

Skull base surgery has advanced significantly in the last decade. Neuro-otologists and neurosurgeons are working together to apply their combined expertise to totally remove skull base lesions with minimal additional neurologic deficit. Standard approaches have been developed for the more common lesions of the skull base, such as the glomus jugular tumor. Rare tumors of the skull base can be removed using the standard skull base surgery techniques. However, there are specific problems with some of these tumors. This article will describe four types of unusual skull base tumors: hyalinized chemodactoma, giant cell tumor of the bone, papillary adenoma of the middle ear, and ganglioneuroma. The unique properties of these tumors and the surgical approach to their removal will be presented and illustrated by case reports.

Adult↗
PubMed1991

Complications of skull base surgery.

As skull base resections have increased in complexity and magnitude, so have the complications associated with the procedures. In this paper, we have reviewed the major complications of skull base surgery, including CSF leak, bleeding, stroke, meningitis, cranial nerve deficits and recurrent disease. This report summarizes the factors that lead to these complications, as well as measures to prevent them. We have also discussed our approach to the management of these complications, with particular emphasis on CSF leak and vagal nerve paralysis.

Head and Neck Neoplasms↗
PubMed1996

Management of malignant schwannomas of the paranasal sinuses and anterior skull base.

The evolution of skull base surgery has facilitated the extirpation of previously unresectable tumors. As experience with skull base surgery increases, the feasibility of resection and long-term outcomes is becoming apparent for the more common lesions. Neoplasms such as malignant schwannomas are rare and, therefore, defy single-institution analysis. The treatment and four-year follow-up of a malignant paranasal sinus and anterior skull base schwannoma is described. Analysis of the literature confirms the low incidence of this tumor and supports the efficacy of skull base surgery in its treatment.

Aged↗
PubMed1986

Chondrosarcoma of the skull base.

Chondrosarcoma of the skull base is an uncommon neoplasm that comprises 0.15% of all intracranial tumors and 6% of skull base lesions. Compression of vital neurologic structures by tumor expansion as well as the histologic characteristics contribute to the malignant potential of these neoplasms. Tumor recurrence has been associated with incomplete resection in this traditionally surgically inaccessible region. This review of five cases of chondrosarcoma of the skull base examines the surgical approaches to resection in a chronologic fashion to emphasize that total gross resection of these lesions has become possible through the evolution of lateral skull base techniques. The difficulty in pathologic diagnosis and the efficacy of postoperative radiotherapy in enhancing survival are also addressed.

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↗
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↗
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↗