Endoscopic Keyhole Approach for Intracranial Epidermoid

Abstract Objective In contemporary neurosurgical practice, keyhole endoscopic approach has established its role in various neurosurgical pathologies. Intracranial epidermoid is an ideal pathology for endoscopic keyhole approach as epidermoid is well encapsulated, extra-axial, avascular, and easily suckable. The objective of this study is to share our experience of endoscopic keyhole approach for intracranial epidermoids at various locations as a new minimally invasive neurosurgical approach to deal with these lesions. Materials and Methods We conducted a retrospective study on 26 patients who underwent keyhole pure endoscopic excision of intracranial epidermoid between July 2015 and December 2019. Patient's demographics, clinical features, radiological imaging, and postoperative complications were noted. Follow-up outcome of preoperative symptoms and postoperative complications were also analyzed. Results The mean age of the study population was 30.5 years with a mean follow-up of 30 months. The common presenting features were headache, hearing loss, and trigeminal neuralgic pain. Gross total resection was achieved in 73.1% cases, while near total resection and subtotal resection were achieved in 19.2 and 7.7% cases, respectively. In the follow-up, maximal improvement was seen in trigeminal neuralgic pain (83%) and headache (66.7%). Major postoperative complications were facial nerve paresis, lower cranial nerve paresis, and transient facial hypoesthesia, most of which improved over time. None of the patients required resurgery till date. Statistical Analysis Patients' data were analyzed using SPSS software version 23 (Statistical Package for Social Sciences, IBM, Chicago, United States). Conclusion This study demonstrates that with careful patient selection, endoscopic keyhole excision of epidermoid is a good alternative to conventional microsurgical excision with comparable surgical and functional outcomes.

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Combined Endoscopic and Exoscopic Resection of Intracranial Epidermoid Cysts

10.21203/rs.3.rs-980980/v1 ◽

2021 ◽

Author(s):

Li Chuzhong ◽

Li Zhenye ◽

Gui Songbai ◽

Zhao Peng ◽

Bai Jiwei ◽

...

Keyword(s):

Residual Tumor ◽

Subtotal Resection ◽

Total Resection ◽

Epidermoid Cysts ◽

Postoperative Hematoma ◽

Practical Experiences ◽

Intracranial Epidermoid ◽

Further Development ◽

Panoramic Views

Abstract Objective In the past ten years, a fully endoscopic technique has also been widely used. Exoscope has also been developed for microneurosurgery which offers quality image and convenient manipulation. This article aims at introducing an endoscopic-exoscopic technique for the resection of epidermoid cysts. Methods We retrospectively analyzed the patients with intracranial epidermoid cysts who received whole course combined endoscopic and exoscopic resection between 2017 and 2020 at our institution, to explore the benefit of combined endoscopic and exoscopic resection of intracranial epidermoid cysts and evaluated the clinical utility of endoscopic-exoscopic technique. Results A total of 17 patients were enrolled in the study. Of all patients, 6 patients (6/17, 35.3%) underwent total resection, 10 patients (10/17, 58.8%) underwent subtotal resection (residual capsule and/or) and 1 patients (1/17, 5.9%) underwent partial resection. Postoperative surgical complications were seen in 3 patients (3/17, 17.6%), including intracranial infection in 2 patients (2/17, 11.8%), and a delayed postoperative hematoma observed in the seventh day after operation for 1 patient (1/17, 5.9%), who was treated in a conservative manner and recovered smoothly from the hemorrhage. The median follow-up time was 33.3 months (range 14.5-54.5 months). During the follow-up period, there was no recurrence of the tumors that received total resection. 2 patients developed residual tumor regrowth but did not show any symptom therefore no further surgery was required. Conclusions Endoscopic-exoscopic technique is safe and efficient in the resection of intracranial epidermoid cysts with panoramic views and superior maneuverability. With further development and accumulation of practical experiences, the endoscopic-exoscopic technique can also be applied in the resection of other intracranial tumors.

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Sphenoorbital meningioma: surgical technique and outcome

Journal of Neurosurgery ◽

10.3171/2010.10.jns101128 ◽

2011 ◽

Vol 114 (5) ◽

pp. 1241-1249 ◽

Cited By ~ 37

Author(s):

Soichi Oya ◽

Burak Sade ◽

Joung H. Lee

Keyword(s):

Surgical Technique ◽

Visual Outcome ◽

Sphenoid Bone ◽

Wide Resection ◽

Tumor Control ◽

Subtotal Resection ◽

Total Resection ◽

Anterior Clinoid Process ◽

Orbital Wall

Object The aim of this study was to describe the surgical technique used for removal of sphenoorbital meningiomas in the authors' practice and to review the operative outcome. Methods Review of the senior author's practice between 1994 and 2009 revealed 39 patients (mean age 48 years) eligible for this study. Clinical presentation, surgical technique, postoperative outcome, and follow-up data are presented. Surgical technique is detailed, with an emphasis on aggressive removal consisting of drilling of the hypertrophied sphenoid bone, orbital wall, and anterior clinoid process, followed by tumor removal and a wide resection of the involved dura. A simple dural closure without reconstruction of the orbital roof or the lateral wall of the orbit is also described. Results Gross-total resection was achieved in 15 cases (38.5%), near-total resection with small residual in the cavernous sinus or periorbita in 20 cases (51.3%), and subtotal resection in 4 cases (10.3%). Postoperative complications included trigeminal hypesthesia in 9 patients, oculomotor palsy in 3 patients, and seizure in 2 patients. Seven patients had recurrence within the mean follow-up period of 40.7 months. Preoperative visual deficits were present in 21 patients (53.8%). Of these, 14 (66.7%) experienced visual recovery to normal levels postoperatively. Statistical analyses revealed preoperative severe visual deficit and sphenoid bone hypertrophy as an independent risk factor and an independent favorable factor, respectively, for a favorable visual outcome. Proptosis was resolved (≤ 2 mm) in 73.5% of the authors' patients. No patient had postoperative enophthalmos. Conclusions In the authors' practice, surgery for sphenoorbital meningiomas consists of resection of the orbital/sphenoid intraosseous, intraorbital, and intradural tumor components. The authors believe that aggressive removal of the orbital/sphenoid intraosseous tumor is critical for a favorable visual outcome and tumor control. Furthermore, satisfactory cosmetic results can be achieved with simple reconstruction techniques as described.

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Surgical Management of Intracranial Epidermoid Tumors—An Institutional Review of 234 Cases

Indian Journal of Neurosurgery ◽

10.1055/s-0039-1686962 ◽

2019 ◽

Vol 08 (01) ◽

pp. 025-033

Author(s):

Vernon Velho ◽

Anuj Bhide ◽

Harish Naik ◽

Nimesh Jain

Keyword(s):

Management Strategies ◽

Csf Leak ◽

Western India ◽

Total Excision ◽

Total Resection ◽

Complete Excision ◽

Common Location ◽

Adjacent Structures ◽

Intracranial Epidermoid

Abstract Aim To study the demographics, clinical profile, management strategies, and treatment outcomes of intracranial epidermoid lesions. Materials and Methods A single institutional retrospective analysis from a large institute in Western India was done of all patients operated for intracranial epidermoid tumors over a period of 20 years from January 1997 to January 2017. All patients were investigated with a contrast-enhanced computed tomography (CECT) as well as a magnetic resonance imaging (MRI), with a diffusion-weighted imaging to confirm diagnosis of epidermoid tumor. The presenting complaints and the demographics of all patients were recorded, and all patients underwent planned surgery, with or without a cerebrospinal fluid (CSF) diversion procedure as per requirement. Surgery ranged from a gross total resection to a near-total resection depending on the patient, location of the lesion, and involvement of adjacent structures. All patients underwent an immediate postoperative computed tomographic (CT) scan as well as a follow-up MRI. Patients were followed up to note clinical improvement as well as documentation of all complications. Results Total 234 patients of intracranial epidermoid tumors were operated upon in a 20-year span. Males predominated with a total number of 146 (62.4%). The most common age group was the fourth decade. The most common presentations were headache (118 patients) and neuralgia in the trigeminal distribution (82 patients). Infratentorial compartment was the most common location of the tumors (152 patients), with cerebellopontine angle being the predominant site in the posterior fossa (107 patients). Both supra- and infratentorial compartments were involved in 28 cases. Gross total excision could be achieved in 202 patients. Reoperation was required in 12 cases. The mean follow-up period was 68 months. The most common complication encountered was that of postoperative CSF leak (24 patients). We had eight cases of recurrence and six deaths in our series. Conclusion Epidermoid tumors can arise in virtually all intracranial locations. Gross total excision of the tumor is treatment of choice and can be curative for these benign lesions. Large lesions at presentation with involvement of multiple compartments can be difficult to manage and may require bicompartmental or second look surgery. Complete excision of the capsule with preservation of adjacent neuronal and vascular structures is of utmost importance to decrease postoperative morbidity and chances of recurrence. Perioperative steroids, avoidance of intraoperative spillage, and intraoperative endoscopic assistance are recommended in all cases.

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Intracranial nonvestibular neurinomas: Young neurosurgeons’ experience

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0039-1700320 ◽

2014 ◽

Vol 05 (03) ◽

pp. 231-243

Author(s):

Forhad Hossain Chowdhury ◽

Mohammod R. Haque ◽

Khandkar A. Kawsar ◽

Mainul H. Sarker ◽

Mahmudul Hasan ◽

...

Keyword(s):

Vagus Nerve ◽

Cranial Nerve ◽

Cranial Nerves ◽

Craniovertebral Junction ◽

Jugular Foramen ◽

Clinical Profile ◽

Clinical Feature ◽

Subtotal Resection ◽

Total Resection

ABSTRACT Background and Objectives: Neurinoma arising from other than nonvestibular cranial nerves is less prevalent. Here we present our experiences regarding the clinical profile, investigations, microneurosurgical management, and the outcome of nonvestibular cranial nerve neurinomas. Materials and Methods: From January 2005 to December 2011, the recorded documents of operated nonvestibular intracranial neurinomas were retrospectively studied for clinical profile, investigations, microneurosurgical management, complications, follow-up, and outcomes. Results: The average follow-up was 24.5 months. Total number of cases was 30, with age ranging from 9 to 60 years. Sixteen cases were males and 14 were females. Nonvestibular cranial nerve schwannomas most commonly originated from trigeminal nerve followed by glossopharyngeal+/vagus nerve. There were three abducent nerve schwannomas that are very rare. There was no trochlear nerve schwannoma. Two glossopharyngeal+/vagus nerve schwannomas extended into the neck through jugular foramen and one extended into the upper cervical spinal canal. Involved nerve dysfunction was a common clinical feature except in trigeminal neurinomas where facial pain was a common feature. Aiming for no new neurodeficit, total resection of the tumor was done in 24 cases, and near-total resection or gross total resection or subtotal resection was done in 6 cases. Preoperative symptoms improved or disappeared in 25 cases. New persistent deficit occurred in 3 cases. Two patients died postoperatively. There was no recurrence of tumor till the last follow-up. Conclusion: Nonvestibular schwannomas are far less common, but curable benign lesions. Surgical approach to the skull base and craniovertebral junction is a often complex and lengthy procedure associated with chances of significant morbidity. But early diagnosis, proper investigations, and evaluation, along with appropriate decision making and surgical planning with microsurgical techniques are the essential factors that can result in optimum outcome.

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Imaging Evaluation of Modified Poppen Approach for Microsurgical Removal of Pineal Lesions

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2020.3020 ◽

2020 ◽

Vol 10 (6) ◽

pp. 1352-1358

Author(s):

Chuandong Cheng ◽

Jinlong Wu ◽

Xiaoyu Ru ◽

Ying Ji

Keyword(s):

Postoperative Complications ◽

Clinical Data ◽

Tumor Resection ◽

Occipital Lobe ◽

Pineal Region ◽

Subtotal Resection ◽

Image Evaluation ◽

Imaging Evaluation ◽

Anatomical Relationship

Objective: The pineal region is deep, and anatomical relationship is complex. Imaging evaluation can effectively guide all kind of neurosurgery. The aim of this study was to explore the value of image evaluation in pineal region microsurgery via modified Poppen approach. Methods: From January 2008 to December 2017, the imaging and clinical data form 62 patients received microsurgery of pineal lesions via the modified Poppen approach at our Hospital were reviewed. The incidences of postoperative complications were compared between the patients with differences in lesion diameter, tentorial angle and preoperative hydrocephalus. Result: According to the data from image evaluation, all the pineal lesions was removed through modified Poppen approach, with total tumor resection in 48 cases, subtotal resection in 10 cases, and partial resection in 4 cases. After 3 to 12 months follow-up, the complication was found in 13 cases (21.0%), including hemianopia (2 cases), occipital lobe contusion (7 cases), monoparesis (2 cases), intracranial infection (2 cases). The incidences of postoperative hemianopia and monoparesis for patients with a lesion > 4.5 cm were significantly higher than those with a lesion ≤ 4.5 cm (P < 0.05). The incidence of postoperative hemianopia for the patients with a tentorial angle > 60° was significantly higher than for those with a tentorial angle ≤ 60° (P < 0.05). Conclusion: Imaging evaluation is useful for microsurgical removal and prediction of complication for modified Poppen approach of pineal lesions.

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CRB modification to retromandibular approach for management of subcondylar fractures.

International Journal of Medical and Surgical Sciences ◽

10.32457/ijmss.2019.026 ◽

2019 ◽

Vol 6 (3) ◽

pp. 84-87

Author(s):

Chandrashekhar Bande ◽

Krishna Kurawar ◽

Ashish Maheshkar ◽

Ankita Bhagat ◽

Manu Goel

Keyword(s):

Postoperative Complications ◽

Facial Nerve ◽

Internal Fixation ◽

Open Reduction ◽

Good Alternative ◽

Surgical Access ◽

Subcondylar Fracture ◽

Ease Of Access ◽

Scar Mark

The aim of this study was to evaluate the efficacy of CRB modification of retromandibular approach to gain surgical access for open reduction and internal fixation of mandibular subcondylar fractures. A total number of 264 sustained extra-capsular subcondylar fractures from 230 patients were selected for the study over the period of 5 years. Evaluation of intraoperative accessibility, postoperative facial nerve function, postoperative complications and scar was carried out. All the patients were treated using CRB Curvilinear approach. Patient follow up was recorded for 1 year on a regular interval basis. Symptoms of postoperative facial nerve injury were seen in 2 patients which recovered with time, postoperative complications were not encountered in any case and minimum scar mark hidden in the cervical skin crease. Hence open reduction and internal fixation for Subcondylar fracture of mandible by using the CRB modification of retromandibular approach is a good alternative for other conventional approaches in having ease of access, ease of fixation, reduced incidences of injury to facial nerve and its branches with good aesthetic outcome.

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Clinical Outcomes Following Dose-Escalated Proton Therapy for Skull-Base Chordoma

International Journal of Particle Therapy ◽

10.14338/ijpt-20-00066.1 ◽

2021 ◽

Vol 8 (1) ◽

pp. 179-188

Author(s):

Adam L. Holtzman ◽

Ronny L. Rotondo ◽

Michael S. Rutenberg ◽

Daniel J. Indelicato ◽

Alexandra De Leo ◽

...

Keyword(s):

Overall Survival ◽

Skull Base ◽

Local Control ◽

Subtotal Resection ◽

High Dose ◽

Disease Specific Survival ◽

Total Resection ◽

Skull Base Chordoma ◽

Disease Specific

Abstract Purpose To evaluate the effectiveness of external-beam proton therapy (PT) on local control and survival in patients with skull-base chordoma. Materials and Methods We reviewed the medical records of patients with skull-base chordoma treated with definitive or adjuvant high-dose PT and updated their follow-up when feasible. We assessed overall survival, disease-specific survival, local control, and freedom from distant metastasis. Radiotherapy toxicities were scored using the Common Terminology Criteria for Adverse Events, version 4.0. Results A total 112 patients were analyzed, of whom 105 (94%) received PT and 7 (6%) received combined proton-photon therapy between 2007 and 2019. Eighty-seven patients (78%) underwent a subtotal resection, 22 (20%) a gross total resection, and 3 (3%) a biopsy alone. The median radiotherapy dose was 73.8 Gy radiobiologic equivalent (GyRBE; range, 69.6-74.4). Ninety patients (80%) had gross disease at radiotherapy and 7 (6%) were treated for locally recurrent disease following surgery. Median follow-up was 4.4 years (range, 0.4-12.6); for living patients, it was 4.6 years (range, 0.4-12.6), and for deceased patients, 4.1 years (range, 1.2-11.2). At 5 years after radiotherapy, the actuarial overall survival, disease-specific survival, local control, and freedom from distant metastasis rates were 78% (n = 87), 83% (n = 93), 74% (n = 83), and 99% (n = 111), respectively. The median time to local progression was 2.4 years (range, 0.8-7). Local control and disease-specific survival by resection status was 95% versus 70% (P = 0.28) and 100% versus 80% (P = 0.06) for gross total, versus subtotal, resection or biopsy alone, respectively. There were no serious acute toxicities (grade ≥ 3) related to radiotherapy. Conclusion High-dose PT alone or after surgical resection for skull-base chordoma reaffirms the favorable 5-year actuarial local control rate compared with conventional techniques with acceptable late-complication–free survival. Outcomes following gross total resection and adjuvant PT were excellent. Further follow-up of this cohort is necessary to better characterize long-term disease control and late toxicities.

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Cavernous Malformations in and Around the Third Ventricle: Indications, Approaches, and Outcomes

Operative Neurosurgery ◽

10.1093/ons/opz294 ◽

2019 ◽

Vol 18 (6) ◽

pp. 736-746

Author(s):

M Neil Woodall ◽

Joshua S Catapano ◽

Michael T Lawton ◽

Robert F Spetzler

Keyword(s):

Third Ventricle ◽

Lateral Wall ◽

Clinical Results ◽

Extent Of Resection ◽

Subtotal Resection ◽

Total Resection ◽

Cavernous Malformations ◽

Presenting Symptoms ◽

The Third

Abstract BACKGROUND Cavernous malformations in structures in and around the third ventricle are a challenging conceptual and surgical problem. No consensus exists on the ideal approach to such lesions. OBJECTIVE To perform a retrospective review of our institutional database to identify and evaluate approaches used to treat cavernous malformations located in and around the third ventricle. METHODS Information was extracted regarding lesion size and location, extent of resection, time to last follow-up, surgical approach, presenting symptoms, preoperative and postoperative neurological status, and specific approach-related morbidity. RESULTS All 39 neurosurgical operations (in 36 patients) were either an anterior interhemispheric (AIH) (44%, 17/39) or a supracerebellar infratentorial (SCIT) (56%, 22/39) approach. Gross-total resection was achieved in 23 of 39 procedures (59%), a near-total resection in 1 (3%), and subtotal resection in 15 (38%). For the 31 patients with at least 3 mo of follow-up, the mean modified Rankin Scale (mRS) score was 1.5. Of the 31 patients, 25 (81%) had an mRS score of 0 to 2, 4 had a mRS score of 3 (13%), and 1 each had a mRS score of 4 (3%) or 5 (3%). CONCLUSION Most approaches to cavernous malformations in and around the third ventricle treated at our institution have been either an AIH or a SCIT approach. The AIH approach was used for lesions involving the lateral wall of the third ventricle or the midline third ventricular floor, whereas the SCIT approach was used for lesions extending from the third ventricle into the dorsolateral midbrain, with acceptable clinical results.

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Surgical Technique and Outcomes in the Treatment of Spinal Cord Ependymomas: Part II: Myxopapillary Ependymoma

Operative Neurosurgery ◽

10.1227/neu.0b013e3181fdf912 ◽

2011 ◽

Vol 68 (suppl_1) ◽

pp. ons90-ons94 ◽

Cited By ~ 4

Author(s):

Elisa J Kucia ◽

Peter H Maughan ◽

Udaya K Kakarla ◽

Nicholas C Bambakidis ◽

Robert F Spetzler

Keyword(s):

Spinal Cord ◽

Radiation Therapy ◽

Gross Total Resection ◽

Subtotal Resection ◽

Myxopapillary Ependymoma ◽

Postoperative Radiation ◽

Total Resection ◽

Postoperative Radiation Therapy ◽

Duration Of Symptoms

Abstract BACKGROUND: Myxopapillary ependymomas usually occur in the filum terminale of the spinal cord. OBJECTIVE: This report summarizes our experience treating myxopapillary ependymomas. METHODS: The records of 34 patients (14 men, 20 women; mean age 45.5 years; age range, 14-88 years) who underwent resection of a myxopapillary ependymoma between 1983 and 2006 were reviewed for age, sex, tumor location, symptoms at diagnosis, duration of symptoms, treatment before presentation, extent of surgical resection, adjuvant therapy, length of follow-up, evidence of recurrence, and complications. Neurological examinations performed at presentation, immediately after surgery, and last follow-up were graded according to the McCormick grading scale. RESULTS: The average duration of symptoms before diagnosis was 22.2 months. The most common symptom was pain followed by weakness, bowel/bladder symptoms, and numbness. The rate of gross total resection was 80%. All patients with a subtotal resection (20%) underwent postoperative radiation therapy. Presentation and outcomes of patients who underwent subtotal resection followed by radiation therapy were compared with those who underwent gross total resection. There was no significant difference in neurological grade between the groups at presentation or final follow-up. The overall recurrence rate was 10% (3/34 patients). CONCLUSION: The goal of surgical treatment of myxopapillary ependymomas is resection to the greatest extent possible with preservation of function. In cases of subtotal resection, postoperative radiation therapy may improve outcome. If neurological function is maintained at treatment, these indolent lesions allow years of good function.

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Long-term Follow-up of Pediatric Benign Cerebellar Astrocytomas

Neurosurgery ◽

10.1227/neu.0b013e31822ff0ed ◽

2011 ◽

Vol 70 (1) ◽

pp. 40-48 ◽

Cited By ~ 41

Author(s):

Hideki Ogiwara ◽

Robin M. Bowman ◽

Tadanori Tomita

Keyword(s):

Tumor Recurrence ◽

Spontaneous Regression ◽

Residual Tumor ◽

Subtotal Resection ◽

Total Resection ◽

Postoperative Imaging ◽

Group A ◽

Group B

Abstract BACKGROUND The long-term prognosis of cerebellar astrocytomas needs to be reviewed. OBJECTIVE To elucidate the factors influencing tumor recurrence or progression and to determine how long these patient with cerebellar astrocytomas require surveillance with neuroimaging. METHODS A retrospective review of 101 children surgically treated for a cerebellar astrocytoma and followed up for < 10 years was performed. RESULTS Mean follow-up was 18.4 years. Total resection confirmed by postoperative imaging was performed in 51 patients (50.5%; group A). Twenty-three patients (22.8%) had surgical total resection; however, equivocal residual tumor was found on postoperative imaging (group B). Subtotal resection leaving a portion of brainstem or cerebellar peduncle was performed in 27 patients (26.7; group C). Of these 50 residual tumors, 16 (32%) showed spontaneous regression and 8 (16%) showed arrested growth. Radiographic recurrence or progression was noted in 29 patients (28.7%). Only 3 of 51 patients (5.9%) of group A with total resection had recurrence, whereas 26 of 50 residual tumors (52%; groups B and C) progressed. The only factor affecting recurrence or progression by multivariate analysis was the extent of surgical resection. All tumor recurrence or progression except for 1 (96.6%) occurred within 8 years from the original surgery (range, 2–132 months). CONCLUSIONS Overall prognosis of cerebellar astrocytomas is good; the 10-year survival rate was 100% and recurrence- or progression-free rate was 71.3% in our cohort. Almost half of residual tumors showed spontaneous regression or arrested growth in the long term. Eight to 10 years is considered to be a reasonable follow-up period by neuroimaging.

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