Transoral and endoscope-assisted transoral approaches to resecting benign tumours of the parapharyngeal space located in the medial portion of the carotid sheaths and extending toward the skull base: our experience

2018 ◽  
Vol 132 (8) ◽  
pp. 748-752 ◽  
Author(s):  
Y Liu ◽  
H-J Yu ◽  
H-T Zhen
Keyword(s):  
Skull Base ◽  
Surgical Management ◽  
Parapharyngeal Space ◽  
Complete Resection ◽  
Transoral Approach ◽  
Surgical Approaches ◽  
Benign Tumours

AbstractObjectiveVarious surgical approaches have been described to remove tumours in the parapharyngeal space. This study investigated the feasibility of a transoral approach in the surgical management of parapharyngeal space benign tumours located in the medial portion of the carotid sheaths and extending toward the skull base.MethodsThirty-two patients were selected and underwent a transoral or an endoscope-assisted transoral approach in the surgical management of parapharyngeal space benign tumours located in the medial portion of the carotid sheaths. Medical photographs were used.ResultsAll patients underwent complete resection of their lesions via a transoral or endoscope-assisted transoral approach. None of the patients demonstrated residual or recurrent neoplasms, either clinically or radiographically, during their follow up.ConclusionBased on our studies, we assert that transoral and endoscope-assisted transoral approaches are suitable in managing parapharyngeal space benign tumours located in the medial portion of the carotid sheaths and extending toward the skull base.

Ventral Surgical Approaches to Craniovertebral Junction Chordomas

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A96-A103 ◽  
Author(s):  
Harminder Singh ◽  
James Harrop ◽  
Paul Schiffmacher ◽  
Marc Rosen ◽  
James Evans
Keyword(s):  
Surgical Management ◽  
Malignant Tumors ◽  
Craniovertebral Junction ◽  
Transoral Approach ◽  
Operative Approach ◽  
Surgical Approaches ◽  
Transnasal Approach ◽  
Neural Axis ◽  
Endoscopic Transnasal Approach

Abstract BACKGROUND Chordomas are primarily malignant tumors encountered at either end of the neural axis; the craniovertebral junction and the sacrococcygeal junction. In this article, we discuss the surgical management of craniovertebral junction chordomas. OBJECTIVE In this paper, we discuss the surgical management of craniovertebral junction chordomas. RESULTS The following approaches are illustrated: transoral-transpalatopharyngeal approach, high anterior cervical retropharyngeal approach, endoscopic transoral approach, and endoscopic transnasal approach. No single operative approach can be used for all craniovertebral chordomas. Therefore, the location of the tumor dictates which approach or approaches should be used.

scholarly journals Early Experience in Endoscopic Transoral Resection for Parapharyngeal Space Tumors

2018 ◽  
Vol 97 (4-5) ◽  
pp. E5-E9 ◽  
Author(s):  
Ling-zhao Meng ◽  
Qi Zhong ◽  
Ju-gao Fang ◽  
Hong-zhi Ma ◽  
Jian-hong Wang ◽  
...  
Keyword(s):  
Pleomorphic Adenoma ◽  
Parapharyngeal Space ◽  
Tissue Injury ◽  
Postoperative Radiotherapy ◽  
Malignant Lesion ◽  
Transoral Approach ◽  
Radiographic Evidence ◽  
Surgical Access ◽  
Transoral Resection

The purpose of this study was to investigate the feasibility, safety, and efficacy of the resection of parapharyngeal space (PPS) tumors via an endoscopic transoral approach. We reviewed 9 patients who were diagnosed with PPS tumors and who were treated with an endoscopic transoral approach. PPS tumors ranging from 2.5 to 6 cm were removed completely with no complications and excellent recovery (mean inpatient hospital stay: 6.89 days). Pathology was pleomorphic adenoma (n =7), schwannoma (n = 1) and malignant pleomorphic adenoma (n = 1). For the malignant lesion, the patient underwent postoperative radiotherapy (70 Gy). There was no radiographic evidence of recurrences, with mean follow-up of 11.22 months (range: 3 to 20). We conclude that resection of PPS tumors via an endoscopic transoral approach appears to be feasible, safe, and effective. Potential advantages of this approach include an excellent surgical view, rapid surgical access, less tissue injury, avoidance of external scar, fewer postoperative complications, and less morbidity.

scholarly journals Neurogenic Tumors of the Mediastinum: A Report of 60 Cases

2000 ◽  
Vol 7 (3) ◽  
pp. 261-265 ◽  
Author(s):  
Salih Topçu ◽  
Aysin Alper ◽  
Erkmen Gülhan ◽  
Osman Koçyigit ◽  
Irfan Tastepe ◽  
...  
Keyword(s):  
Complete Resection ◽  
Infants And Children ◽  
Malignant Tumours ◽  
Autonomic Ganglion ◽  
Term Survival ◽  
Nerve Sheath ◽  
Chest Disease ◽  
Benign Tumours

OBJECTIVES:To analyze retrospectively 60 patients (13 infants and children, 47 adults - 21 men and 39 women) with mediastinal neurogenic tumours admitted to Atatürk Centre for Chest Disease and Chest Surgery, Ankara, Turkey between 1988 and 1999. This comprised 21.2% of 283 patients who had surgical operations for all mediastinal masses during the same period.PATIENTS AND METHODS:The patients ranged from four to 67 years of age. Thirteen patients were younger than 15 years and 47 were 15 years of age or older. Medical records were reviewed for demographic data, clinical presentation, diagnostic investigations, operative procedures, and tumour location and invasion. Postoperative morbidity and mortality were noted as well as long term follow-up. The clinical investigations included chest x-ray and computed tomography of the thorax in all patients, and spinal magnetic resonance imaging and bronchoscopical examination in some. Clinical variables were compared.RESULTS:The tumours had the following characteristics: 42 (70%) were nerve sheath tumours; 15 (25%) were autonomic ganglion tumours; two (3.6%) were paragangliomas; and one (1.4%) was a malignant peripheral neuroectodermal tumour (Askin's tumour). Nerve cell tumours comprised the majority of tumours in infants and children (nine of 13, 69%), whereas the nerve sheath tumours were most frequent in adults (39 of 47, 83%). There were 48 benign and 12 (20%) malignant tumours when all age groups were considered; the malignancy rate was 61.5% (eight of 13) in children and  8.5% (four of 47, P<0.05) in adults. All patients were operated via a posterolateral thoracotomy. Surgical resection of the tumour was complete in 56 of 60 patients (93.3%). Resection of malignant tumours was grossly incomplete in four cases (four of 12, 33.3%). All benign tumours were totally excised. There were two major complications (respiratory failure and pulmonary emboli) and 14 minor complications in the perioperative period. The mean follow-up period was five years and seven months. Tumours recurred in 5.3% (three of 56) of patients who had a complete resection initially. There were no late deaths related to benign tumours.CONCLUSIONS:Complete resection of tumours can be performed safely by a thoracotomy approach and is important for achieving satisfactory long term survival in most mediastinal neurogenic tumours.

Endoscopic surgical management of sinonasal inverted papilloma extending to the frontal sinuses

2016 ◽  
Vol 70 (6) ◽  
pp. 26-31 ◽  
Author(s):  
Yukiko Takahashi ◽  
Fumi Shoji ◽  
Yukio Katori ◽  
Hiroshi Hidaka ◽  
Naoya Noguchi ◽  
...  
Keyword(s):  
Surgical Management ◽  
Endoscopic Surgery ◽  
Late Complications ◽  
Inverted Papilloma ◽  
Surgical Approaches ◽  
Sinonasal Inverted Papilloma ◽  
Endoscopic Guidance ◽  
Frontal Sinuses ◽  
Draf Iii

Objective: Sinonasal inverted papilloma has been traditionally managed with external surgical approaches. Advances in imaging guidance systems, surgical instrumentation, and intraoperative multi-visualization have led to a gradual shift from external approaches to endoscopic surgery. However, for anatomical and technical reasons, endoscopic surgery of sinonasal inverted papilloma extending to the frontal sinuses is still challenging. Here, we present our experience in endoscopic surgical management of sinonasal inverted papilloma extending to one or both frontal sinuses. Methods: We present 10 cases of sinonasal inverted papilloma extending to the frontal sinuses and successfully removed by endoscopic median drainage (Draf III procedure) under endoscopic guidance without any additional external approach. Results: The whole cavity of the frontal sinuses was easily inspected at the end of the surgical procedure. No early or late complications were observed. No recurrence was identified after an average follow-up period of 39.5 months. Conclusion: Use of an endoscopic median drainage approach to manage sinonasal inverted papilloma extending to one or both frontal sinuses is feasible and seems effective.

Endonasal Endoscopic Management of Frontal Sinus Cerebrospinal Fluid Leak

2017 ◽  
Vol 31 (6) ◽  
pp. 406-411 ◽  
Author(s):  
Javaneh Jahanshahi ◽  
Mehdi Zeinalizadeh ◽  
Hasan Reza Mohammadi ◽  
Seyed Mousa Sadrehosseini
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Frontal Sinus ◽  
Surgical Approaches ◽  
Endoscopic Management ◽  
Graft Material ◽  
Endoscopic Repair ◽  
Skull Base Reconstruction ◽  
Csf Rhinorrhea

Background A frontal sinus leak is uncommon and is seen in ∼15% of cases of patients with cerebrospinal fluid (CSF) rhinorrhea. Now, endonasal endoscopic techniques have been reported to reconstruct skull base defects in the frontal sinus with a favorable outcome. Objective To review our experience in the repair of frontal sinus CSF leaks through an endonasal endoscopic approach. Methods Twenty-four patients with a frontal sinus leak who underwent endonasal endoscopic repair entered the study. Clinical presentation, location, frontal sinusotomy, graft material, follow-up, and frontal sinus status were evaluated. Results Among >100 cases of surgically repaired CST rhinorrhea, the frontal sinus was the site of the leak in 24 patients (mean age, 28.9 years; mean follow-up, 22 months). The etiology consisted of spontaneous leak and traumatic leak; whereas patients with skull base reconstruction after removal of tumor were excluded. Surgical approaches included Draf IIb, Draf III, Draf IIa in 20, 3, and 1 patients, respectively. Tree autografts as two-layer inlay fat–muscle and onlay fascia lata were used in the majority of patients. A success rate was achieved in 95.83% of the patients. Conclusion Endonasal endoscopic repair of a frontal sinus leak was a successful procedure, with a low failure rate and minimal morbidity.

Technical Note: Extreme Lateral Supracerebellar Approach for Resection of Superior Cerebellar Peduncle Arteriovenous Malformations

2021 ◽  
Author(s):  
Georgios Klironomos ◽  
Amrit K Chiluwal ◽  
Amir R Dehdashti
Keyword(s):  
Arteriovenous Malformations ◽  
External Ventricular Drainage ◽  
Technical Note ◽  
Complete Resection ◽  
Surgical Approaches ◽  
Superior Cerebellar Peduncle ◽  
The Mean ◽  
Cerebellar Peduncle ◽  
Intraoperative Rupture

Abstract BACKGROUND The surgical approaches to the region of the cerebello-mesencephalic sulcus and superior cerebellar peduncle (SCP) remain a neurosurgical challenge. OBJECTIVE To present the use of the extreme lateral supracerebellar infratentorial (SC-IT) approach to treat arteriovenous malformations (AVMs) of the SCP, which is a different entity compared to brainstem AVMs METHODS We treated 4 patients with SCP AVMs in the last 5 yr at our institution. The mean age was 49.7 yr. The average nidus size was 2.12 cm. Of those, 3 patients presented with hemorrhage and 1 with headache and tinnitus. Extreme lateral SC-IT approach was used in all cases. RESULTS Complete resection was achieved in all cases as verified with postoperative angiogram. In 1 case, intraoperative rupture with intraventricular hemorrhage was encountered, and the patient required temporary external ventricular drainage. There was no permanent complication or neurological deficit. The modified Rankin Scale (at discharge or follow-up) was less than 2 in all cases. CONCLUSION The AVMs located primarily in the SCP are distinct compared to brainstem AVMs, and their management should be different. Extreme lateral SC-IT approach should be considered as a viable alternative surgical approach for resection of these AVMs, and excellent surgical results can be achieved.

The neurosurgical management of sinonasal malignancies involving the anterior skull base: a 28-year experience at The MD Anderson Cancer Center

2021 ◽  
pp. 1-9
Author(s):  
Gautam U. Mehta ◽  
Joel Z. Passer ◽  
Shaan M. Raza ◽  
Betty Y. S. Kim ◽  
Shirley Y. Su ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Management ◽  
Anterior Skull Base ◽  
Brain Invasion ◽  
Lumbar Drain ◽  
Sinonasal Malignancies ◽  
Stage Disease ◽  
Over Time

OBJECTIVE Sinonasal malignancies that extend to the anterior skull base frequently require neurosurgical intervention. The development of techniques for craniofacial resection revolutionized the management of these neoplasms, but modern and long-term data are lacking, particularly those related to the incorporation of endoscopic techniques and novel adjuvant chemotherapeutics into management schema. The present study was performed to better define the utility of surgical management and to determine factors related to outcome. METHODS Patients who underwent surgery between 1993 and 2020 were included in this retrospective cohort study. Only patients with greater than 6 months of clinical and radiological follow-up were included. Outcome measures included progression, survival, and treatment-related complications. RESULTS Two hundred twenty-five patients were included. The mean clinical follow-up was 6.5 years. The most common histological diagnosis was olfactory neuroblastoma (33%). Overall, metastatic disease and brain invasion were present in 8% and 19% of patients, respectively, at the time of surgery. A lumbar drain was used in 54% of patients. When stratified by decade, higher-stage disease at surgery became more frequent over time (15% of patients had metastatic disease in the 3rd decade of the study period vs 4% in the 1st decade). Despite the inclusion of patients with progressively higher-stage disease, median overall survival (OS) remained stable in each decade at approximately 10 years (p = 0.16). OS was significantly worse in patients with brain invasion (p = 0.006) or metastasis at the time of surgery (p = 0.014). Complications occurred after 28% of operations, but typically resulted in no long-term negative sequelae. Use of a lumbar drain was a significant predictor of complications (p = 0.02). Permanent ophthalmological disabilities were observed after 4% of surgical procedures. One patient died during the perioperative period. Finally, major complications (Clavien-Dindo grade ≥ IIIb) decreased from 27% of patients in the 1st decade to 10% in the 3rd decade (p = 0.007). CONCLUSIONS The surgical management of sinonasal malignancies with anterior skull base involvement is effective and generally safe. Surgical management, however, is only one facet of the overall multimodal management paradigms created to optimize patient outcomes. Survival outcomes have remained stable despite more extensive disease at surgery in patients who have presented in recent decades. The safety of such surgery has improved over time owing to the incorporation of endoscopic surgical techniques and the avoidance of lumbar spinal drainage with open resection.

Glomangiopericytoma (sinonasal-type haemangiopericytoma)

2012 ◽  
Vol 126 (10) ◽  
pp. 1069-1072 ◽  
Author(s):  
J C Oosthuizen ◽  
S Kennedy ◽  
C Timon
Keyword(s):  
Skull Base ◽  
Endoscopic Resection ◽  
Clinical Presentation ◽  
Endoscopic Examination ◽  
Complete Resection ◽  
Anterior Skull Base ◽  
Surgical Approaches ◽  
Open Approach ◽  
Successful Management ◽  
Histopathological Features

AbstractBackground:Glomangiopericytoma is a rare sinonasal tumour of perivascular myoid phenotype, which accounts for less than 1 per cent of all sinonasal tumours.Objective:Discussion of the clinical presentation, histopathological features and advances in the management of sinonasal and skull base glomangiopericytoma.Case report:A 32-year-old woman presented with worsening nasal obstruction, anosmia, severe frontal headaches and right-sided proptosis. Radiographic and endoscopic examination revealed a right-sided, vascular mass involving the nasal cavity, paranasal sinuses and anterior skull base. Histopathological features were consistent with a glomangiopericytoma. Complete endoscopic resection with free margins was achieved.Conclusion:Glomangiopericytomas are rare, vascular, sinonasal tumours. Successful management depends on complete resection, traditionally achieved via an open approach. However, recent advances in endoscopic surgical approaches have enabled complete endoscopic resection of these tumours, minimising morbidity and facilitating subsequent surveillance of the operative site.

Surgical Treatment of Intracardiac-Extending Intravenous Leiomyomatosis: A Single Center Experience

2016 ◽  
Vol 19 (3) ◽  
pp. 094
Author(s):  
Yang Li ◽  
Nan Yang ◽  
Long Lu ◽  
Fengxia Ma ◽  
Jianmin Yao
Keyword(s):  
Surgical Management ◽  
Circulatory Arrest ◽  
Pelvic Mass ◽  
Complete Removal ◽  
Complete Resection ◽  
Intravenous Leiomyomatosis ◽  
Hospital Data ◽  
Single Center Experience ◽  
Few Data

<strong>Background:</strong> Few data were known on surgical management of intracardiac-extending in patients with intravenous leiomyomatosis (IVL).<br /><strong>Methods:</strong> From June 2007 to December 2014, six women (mean age, 39.3 ± 7.5 years; range, 24-55 years) with intracardiac-extending IVL were treated surgically at our hospital. Data were obtained from medical and pathological records, including characteristics of patients, surgical management, and follow-up. <br /><strong>Results:</strong> Surgery was performed successfully in all patients. Of 6 patients, 4 underwent one-stage operation and 2 underwent two-stage procedures. Circulatory arrest with hypothermia was used for a cardiotomy combined with venotomy in <br />5 patients. Complete resection was done in 5 patients. There were no perioperative deaths or complications in any of the patients. Hospital stay was 11.2 ± 2.9 days (range 7-15 days). All patients were followed-up for a mean of 41.0 ± 19.1 months (range, 17-69 months) after surgery. A recurrence of pelvic mass was found in 1 patient, but no symptoms or intravenous mass were reported. No obstruction occurred in any patient with a venotomy.<br /><strong>Conclusion:</strong> Surgery is a better therapy for IVL and complete removal has favorable outcomes.

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