Variability in the reported surgical techniques and methods for intercalary reconstruction following tumor resection

AbstractThe mandibular condyle is an integral structure in the temporomandibular joint (TMJ) serving not only as the hinge point for mandibular opening, but also facilitating mandibular growth and contributing to facial aesthetics. Significant compromise of the TMJ can be debilitating functionally, psychologically, and aesthetically. Reconstruction of the mandibular condyle is rarely straightforward. Multiple considerations must be accounted for when preparing for condylar reconstruction such as ensuring eradication of all chronically diseased or infected bone, proving clear oncologic margins following tumor resection, or achieving stability of the surrounding architecture in the setting of a traumatic injury. Today, there is not one single gold-standard reconstructive method or material; ongoing investigation and innovation continue to improve and transform condylar reconstruction. Herein, we review methods of condylar reconstruction focusing on autologous and alloplastic materials, surgical techniques, and recent technological advances.

Download Full-text

Lateral skull base malignancies

Neurosurgical FOCUS ◽

10.3171/foc.2002.12.5.9 ◽

2002 ◽

Vol 12 (5) ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Benjamin M. McGrew ◽

C. Gary Jackson ◽

Raquel A. Redtfeldt

Keyword(s):

Skull Base ◽

Postoperative Radiotherapy ◽

Survival Rates ◽

Tumor Resection ◽

Surgical Techniques ◽

Local Tumor Control ◽

Tumor Control ◽

Lateral Skull Base ◽

The Mean ◽

Poor Outcomes

Object Historically poor outcomes have been characteristic in patients with lateral skull base malignancies. As advances in skull base surgical techniques have been made, complete resection has increasingly been achieved. This has resulted in improved survival rates and local tumor control. Methods The authors performed a retrospective review of 95 patients treated for lateral skull base malignancies. The mean age of the patients was 49.4 years. There were 44 females and 51 males. The mean follow-up period was 50 months. Resection was performed in all patients, and postoperative radiotherapy was undertaken in 54% of the cases. Local disease control was maintained in 73% of the patients. Tumor involvement of the facial nerve and intracranial tumor extension did not jeopardize the rate of local control. Conclusions Despite the fact that technical advances in skull base surgery have resulted in a higher incidence of complete tumor resection and improved survival rates, a respect for the poor prognosis historically associated with lateral skull base malignancies should be maintained and treatment should be appropriately aggressive.

Download Full-text

Microvascular nose reconstruction after extended tumor resection.

Polish Journal of Surgery ◽

10.5604/01.3001.0014.1543 ◽

2020 ◽

Vol 92 (4) ◽

pp. 1-5

Author(s):

Łukasz Krakowczyk

Keyword(s):

Free Flap ◽

Reconstructive Surgery ◽

Tumor Resection ◽

Surgical Techniques ◽

Nasal Reconstruction ◽

Radial Forearm Free Flap ◽

Treatment Standards ◽

Anatomical Region ◽

Nasal Tumors ◽

Radial Forearm

Introduction: The nose is the central and probably the most important anatomical region of the face. Reconstructive surgery after tumor resection in this anatomical region requires from the surgeon knowledge of the anatomy, due to the three-dimensional shape and variety of tissues. Materials and methods: In the years 2010-2019, 48 patients were treated in the Oncological and Reconstructive Surgery Clinic for extended nasal tumors , who required the use of free microvascular flaps after resection for functional and aesthetic supply of anatomical structures of the nose. Results: In 48 patients, a total of 92 free microvascular flap were used for nasal reconstruction including: radial forearm free flap in 24 patients, radial forearm free flap with radial bone in 14 patients, auricle free flap in 16 patients, radial forearm free flap in combination with auricle free flap in 7 patients, double auricle free flap in 6 patients, radial forearm free flap in combination with double auricle free flap in 4 patients. Total necrosis of the free flap was noted in 4 cases, partial in 6 patients. Conclusions: Presented surgical techniques using the microvascular free flaps constitute a recognized method of treatment in the world and should be used in everyday surgeon practice. Discussion: In the reconstructive nose surgery after extended tumor resections due to cancer, there are no uniform treatment standards and algorithms . The surgeon is often dependent on his knowledge, skills and creative thinking . Presented results in this article allows to obtain optimal functional and aesthetic effects.

Download Full-text

Composite Mandibulectomy

Otolaryngology ◽

10.1177/0194599811435633 ◽

2012 ◽

Vol 146 (6) ◽

pp. 932-937 ◽

Cited By ~ 9

Author(s):

Douglas R. Sidell ◽

Tara Aghaloo ◽

Sotirios Tetradis ◽

Min Lee ◽

Olga Bezouglaia ◽

...

Keyword(s):

Animal Model ◽

Medical Center ◽

Tumor Resection ◽

Surgical Techniques ◽

Small Animal ◽

Postoperative Management ◽

Single Individual ◽

En Bloc ◽

Fracture Nonunion ◽

Anesthetic Complications

Objectives. Segmental mandibular defects can result after the treatment of various pathologic processes, including osteoradionecrosis, tumor resection, or fracture nonunion with sequestration. The variety of etiologies and the frequency of occurrence make the reconstruction of segmental mandibular defects a topic of significant interest. Despite these incentives, a well-established small-animal model of the segmental mandibulectomy, including composite resection, does not exist. The objective of this study is the creation of a reliable animal model that can be used to study the reconstruction of en bloc mandibular defects. Surgical techniques and an array of reconstructive options are described. Study design. Description of an animal model. Setting. Animal laboratory at a quaternary care university medical center. Methods. We present an Animal Research Oversight Committee–approved prospective analysis of survival operations in the rat model. A detailed, stepwise description of surgical technique and relevant intraoperative anatomy is presented. Postoperative management, early pitfalls, surgical complications, and future applications are discussed. Results. A total of 72 operations were performed by a single individual between July and October 2010. Two intraoperative and 9 postoperative complications were recognized. There were 6 orocutaneous fistulas, 2 abscesses, and 1 seroma. There were 4 fatalities, which were attributed to anesthetic complications (2, intraoperative), hematoma formation (1, postoperative), and foreign-body aspiration (1, postoperative). Conclusion. This novel animal model reliably replicates the en bloc segmental mandibular defects seen in our patient population and can be manipulated to achieve a wide variety of research objectives.

Download Full-text

Sacral tumor resection and the impact on pelvic incidence

Journal of Neurosurgery Spine ◽

10.3171/2010.9.spine09728 ◽

2011 ◽

Vol 14 (1) ◽

pp. 78-84 ◽

Cited By ~ 10

Author(s):

Oren N. Gottfried ◽

Ibrahim Omeis ◽

Vivek A. Mehta ◽

Can Solakoglu ◽

Ziya L. Gokaslan ◽

...

Keyword(s):

Pelvic Incidence ◽

Tumor Resection ◽

Surgical Techniques ◽

Clinical Importance ◽

Johns Hopkins Hospital ◽

En Bloc ◽

Sacral Tumor ◽

Si Joint ◽

The Impact ◽

Total Sacrectomy

Object Pelvic incidence (PI) directly regulates lumbar lordosis and is a key determinant of sagittal spinal balance in normal and diseased states. Pelvic incidence is defined as the angle between the line perpendicular to the S-1 endplate at its midpoint and the line connecting this point to a line bisecting the center of the femoral heads. It reflects an anatomical value that increases with growth during childhood but remains constant in adulthood. It is not altered by changes in patient position or after traditional lumbosacral spinal surgery. There are only 2 reports of PI being altered in adults, both in cases of sacral fractures resulting in lumbopelvic dissociation and sacroiliac (SI) joint instability. En bloc sacral amputation and sacrectomy are surgical techniques used for resection of certain bony malignancies of the sacrum. High, mid, and low sacral amputations result in preservation of some or the entire SI joint. Total sacrectomy results in complete disruption of the SI joint. The purpose of this study was to determine if PI is altered as a result of total or subtotal sacral resection. Methods The authors reviewed a series of 42 consecutive patients treated at The Johns Hopkins Hospital between 2004 and 2009 for sacral tumors with en bloc resection. The authors evaluated immediate pre- and postoperative images for modified pelvic incidence (mPI) using the L-5 inferior endplate, as the patients undergoing a total sacrectomy are missing the S-1 endplate postoperatively. The authors compared the results of total versus subtotal sacrectomies. Results Twenty-two patients had appropriate images to measure pre- and postoperative mPI; 17 patients had high, mid, or low sacral amputations with sparing of some or the entire SI joint, and 5 patients underwent a total sacrectomy, with complete SI disarticulation. The mean change in mPI was statistically different (p < 0.001) for patients undergoing subtotal versus those undergoing total sacrectomy (1.6° ± 0.9° vs 13.6° ± 4.9° [± SD]). There was no difference between patients who underwent a high sacral amputation (partial SI resection, mean 1.6°) and mid or low sacral amputation (SI completely intact, mean 1.6°). Conclusions The PI is altered during total sacrectomy due to complete disarticulation of the SI joint and discontinuity of the spine and pelvis, but it is not changed if any of the joint is preserved. Changes in PI influence spinopelvic balance and may have postoperative clinical importance. Thus, the authors encourage attention to spinopelvic alignment during lumbopelvic reconstruction and fixation after tumor resection. Long-term studies are needed to evaluate the impact of the change in PI on sagittal balance, pain, and ambulation after total sacrectomy.

Download Full-text

Lateral Approach to Anterolateral Tumors at the Foramen Magnum: Factors Determining Surgical Procedure

Operative Neurosurgery ◽

10.1227/01.neu.0000156796.28536.6d ◽

2005 ◽

Vol 56 (suppl_4) ◽

pp. ONS-324-ONS-336 ◽

Cited By ~ 23

Author(s):

Nevo S. Margalit ◽

Jonathan B. Lesser ◽

Michael Singer ◽

Chandranath Sen

Keyword(s):

Vertebral Artery ◽

Tumor Resection ◽

Surgical Techniques ◽

Foramen Magnum ◽

Lateral Approach ◽

Occipital Condyle ◽

Transverse Foramen ◽

Glomus Tumors ◽

Far Lateral Approach ◽

Operative Notes

Abstract OBJECTIVE: We discuss and evaluate surgical strategies and results in 42 patients with a variety of tumors involving the anterior and anterolateral foramen magnum and present factors affecting the degree of resection and patient outcomes. We describe our surgical techniques for resection of these tumors via the lateral approach, including consideration for occipital condylar resection and vertebral artery management. METHODS: A retrospective analysis was performed of 42 surgically treated patients with tumors involving the anterior and anterolateral foramen magnum. Patients received treatment between 1991 and 2002; patients’ files, operative notes, and pre- and postoperative imaging studies were used for the analysis. RESULTS: The female-to-male ratio was 28:14. Mean patient age was 47 years. Pathological entities comprised 18 meningiomas, 12 chordomas, 3 glomus tumors, 3 schwannomas, and 6 miscellaneous tumors. We mobilized the vertebral artery at the dural entry point in all patients with meningiomas. The vertebral artery was mobilized at the C1 transverse foramen for the majority of extradural tumors. Partial condyle resection was performed in eight meningiomas and five extradural tumors. Complete condyle resection was required in 12 cases, including 9 chordomas, 2 carcinomas, and 1 bone-invading pituitary adenoma. Thirteen patients required occipitocervical fusion after tumor resection. CONCLUSION: In anterior or anterolaterally located foramen magnum tumors, we think the extreme lateral or far lateral approach affords significant advantages. Vertebral artery mobilization and occipital condyle resection may be needed depending on the extent and location of the foramen magnum tumor and its specific pathological characteristics. Tumor invading the occipital condyle or significant condylar resection may cause occipitocervical instability and require fusion.

Download Full-text

Minimally invasive lumbar intradural extramedullary tumor resection

Neurosurgical FOCUS ◽

10.3171/2012.v2.focus12158 ◽

2012 ◽

Vol 33 (Suppl1) ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Brian Lee ◽

Patrick C. Hsieh

Keyword(s):

Minimally Invasive ◽

Tumor Resection ◽

Surgical Techniques ◽

Csf Leak ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Extramedullary Tumor ◽

Intradural Extramedullary ◽

Dural Opening ◽

Invasive Techniques

Intradural, extramedullary schwannomas have long been treated with open midline incision, laminectomy, and dural opening to expose and resect the lesion. While this technique is well established, today new surgical techniques can be utilized to perform the same procedure while minimizing pain, size of incision, and trauma to adjacent tissues. In cases of intradural surgery, minimally invasive surgery limits the degree of soft tissue disruption. As a result, there is significant decreased dead space within the surgical cavity that may decrease the rate of CSF leak complications. Minimally invasive techniques have continuously improved over the years and have reached a point where they can be used for intradural surgeries. In this case presentation, we demonstrate a minimally invasive approach to the lumbar spine with resection of an intradural schwannoma. Surgical techniques and the nuances of the minimally invasive approach to intradural tumors compared to the standard open procedure will be discussed. The video can be found here: http://youtu.be/XXrvAIq_H48.

Download Full-text

Intraoperative magnetic resonance imaging–assisted transsphenoidal pituitary surgery in patients with acromegaly

Neurosurgical FOCUS ◽

10.3171/2010.7.focus10164 ◽

2010 ◽

Vol 29 (4) ◽

pp. E9 ◽

Cited By ~ 32

Author(s):

David Bellut ◽

Martin Hlavica ◽

Christoph Schmid ◽

René L. Bernays

Keyword(s):

Pituitary Adenomas ◽

High Field ◽

Remission Rate ◽

Tumor Resection ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Residual Tumor ◽

Imaging Results ◽

Duration Of Surgery

Object Acromegaly is a rare disease, usually caused by a growth hormone (GH)–producing pituitary adenoma. If untreated, severe cardiovascular, metabolic, cosmetic, and orthopedic disturbances will result. Surgery is generally recommended as the first-line treatment. Transsphenoidal surgical techniques were recently extended by the introduction of intraoperative MR (iMR) imaging. In the present study, the contribution of ultra-low-field (0.15-T) iMR imaging to tumor resection, complication avoidance, and endocrinological and neurological outcome was analyzed. Methods A series of 39 consecutive transsphenoidal iMR imaging–guided (using the PoleStar N20 device) surgical procedures performed between September 2005 and August 2009 for GH-producing pituitary adenomas was retrospectively analyzed. In addition to the patients' clinical data, the following criteria were evaluated independently: duration of surgery; length of hospital stay; endocrinological parameters; results of neurological examinations; and pre-, post-, and intraoperative MR imaging results. Results Thirty-seven patients with acromegaly underwent 39 transsphenoidal surgeries for pituitary adenomas. During a median follow-up period of 30 months (range 9–56 months), the remission rate was 73.5% in 34 patients with primary surgery and 20% in 5 cases with previous surgery; overall the remission rate was 66.7%. There were no serious postoperative complications. Detection of tumor remnant on iMR imaging led to a 5.1% increase in remission rate. Conclusions In this largest study to date of GH-producing pituitary adenomas in which iMR imaging–guided transsphenoidal surgery was analyzed, the results suggest that this method is a highly effective and safe treatment modality, even compared with previously published surgical series in which high-field iMR imaging was used. Limitations of iMR imaging are the detection of small residual tumor in the cavernous sinus and persisting disease that could not be observed, even on diagnostic high-field follow-up MR images. This points to a general limitation regarding remission rates that can be achieved using iMR imaging. Nevertheless, iMR imaging led to an increase of the remission rate in this study.

Download Full-text

Cranial chordomas: results of radical excision

Neurosurgical FOCUS ◽

10.3171/foc.2001.10.3.4 ◽

2001 ◽

Vol 10 (3) ◽

pp. 1-7 ◽

Cited By ~ 32

Author(s):

Chandranath Sen ◽

Aymara Triana

Keyword(s):

Skull Base ◽

Cranial Nerve ◽

Recurrent Disease ◽

Postoperative Radiotherapy ◽

Tumor Resection ◽

Surgical Techniques ◽

Residual Tumor ◽

Radical Excision ◽

Proton Beam Irradiation ◽

Csf Leakage

Object The authors analyze their experience with the treatment of 29 patients who underwent radical excision of skull base chordomas. Methods Modern skull base surgical techniques were used in all patients who were treated between August 1991 and July 2000. The degree of tumor resection was gauged according to intraoperative inspection and postoperative high-resolution imaging findings. There were 21 patients with primary disease and eight with recurrent disease. Total resection was accomplished in 18 patients. Five patients had undergone radiotherapy prior to the present surgery, and an additional eight patients underwent postoperative radiotherapy. There were no surgery-related deaths. In five patients who died of the disease, surgery and radiotherapy had failed to effect a cure. Two of the remaining patients are alive with recurrent disease, and there is questionable evidence of recurrence in another patient. All 24 patients are functioning independently. Cranial nerve impairment was the most common postoperative deficit, followed by cerebrospinal fluid (CSF) leakage and infection. Conclusions The use of skull base techiniques in radical surgery provides an opportunity to excise the tumor and the involved bone. In most cases the procedure-related cranial nerve deficits improve over time. The complications of CSF leakage and infection can be minimized and are preventable. Proton beam irradiation is an excellent adjuvant treatment but is reserved for patients with definite tumor recurrence or residual tumor that can be identified on the imaging studies.

Download Full-text

Squamous cell carcinoma of the pterygopalatine fossa - A case report

Romanian Journal of Rhinology ◽

10.1515/rjr-2016-0020 ◽

2016 ◽

Vol 6 (23) ◽

pp. 173-176

Author(s):

Vlad Budu ◽

Mihail Tusaliu ◽

Alexandru Coman ◽

Ioan Bulescu

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Tumor Resection ◽

Surgical Techniques ◽

Pterygopalatine Fossa ◽

Transnasal Approach ◽

Selective Embolization ◽

Maxillary Nerve ◽

Anatomical Space

Abstract The pterygopalatine fossa is an inverted pyramid-shaped space of the viscerocranium, protected by bony structures. Surgical access to this anatomical space is difficult, especially for tumor resection. There are numerous open surgical techniques for accessing this space, but nowadays, minimally-invasive endoscopic approaches are preferred in order to increase postoperative quality of life and reduce postoperative morbidities.The tumors of the pterygopalatine fossa can be benign or malignant, and can occur primarily in the fossa or as secondary extensions from the surrounding regions through the multiple canals and foramina in its walls. Squamous cell carcinomas of this space have been described to appear as extensions from the nasopharynx, the paranasal sinuses or through perineural extension from the cutaneous branches of the maxillary nerve.In this paper the authors present a rare case of squamous cell carcinoma of the pterygopalatine fossa, which was excised in an endoscopic transnasal approach after preoperative selective embolization.

Download Full-text