scholarly journals Resection of Clival Chordoma Through the Anterior Clivectomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Paulo A S Kadri ◽  
Kenan I Arnautović ◽  
Walid Ibn Essayed ◽  
Ossama Al-Mefty
Keyword(s):  
Radical Resection ◽  
High Recurrence Rate ◽  
Simple Extension ◽  
Open Door ◽  
Tumor Removal ◽  
Direct Exposure ◽  
Clivus Chordoma ◽  
Extradural Approach ◽  
High Doses ◽  
Microscopic Techniques

Abstract Clival chordomas are rare malignant behaving tumors that grow, locally invade, metastasize, and seed, and they have a high recurrence rate.1,2 The longest disease control is achieved by radical resection followed by high doses of radiation therapy, commonly proton beam.3  To achieve radical tumor removal, multiple surgical procedures through different approaches might be required.4 Since the chordoma's origin is, and remains, extradural, an extradural approach is preferred, and can lead to intradural extension. Anterior approach is frequently utilized to remove the midline-located tumor and the eroded clivus.5  Several midline approaches were utilized, including the transbasal, transfacial, transcervical, open door, and Lefort's maxillotomies1; however, the same tumor removal can be achieved with a simple extension of the trans-sphenoidal approach, by resecting the anterior maxillary wall, of the contralateral to the lesion preponderant side.5 This approach coupled with the use of neuronavigation on mobile head and endoscopic-assisted technique allowed to achieve a wide and direct exposure, with the ability to resect extra- and intradural tumors.2,5 Lately, the endonasal endoscopic technique became popular as an alternative4; however, we found a great advantage in the ability to combine the stereoscopic microsurgical technique with the endoscopic dissection, in addition to avoiding the extensive nasal dissection and its complications.  We present a case of a 63-yr old woman with an upper clivus chordoma compressing the brainstem who underwent a gross total resection by endoscopic-assisted microscopic techniques through an anterior clivectomy approach. Patient consented to the procedure and publication of her images.

scholarly journals Anesthetic Considerations in a Case With Massive Recurrent Clivus Chordoma

2019 ◽  
Vol 6 (2) ◽  
pp. 76-78
Author(s):  
Pardis Soltanpoor ◽  
Faranak Behnaz ◽  
Hamidreza Azizi Faresani ◽  
Afsoun Seddighi ◽  
Maede Karimian
Keyword(s):  
Incidence Rate ◽  
Recurrence Rate ◽  
Malignant Tumors ◽  
High Recurrence Rate ◽  
Low Grade ◽  
Clival Chordoma ◽  
Insidious Onset ◽  
Clivus Chordoma ◽  
Anesthetic Considerations ◽  
Slow Growing

Chordomas rare low grade slow-growing malignant tumors with an incidence rate of 1 in 100000 individuals.32% of chordomas occur in the clivus. Diagnosing Clival chordomas could be challenging due to their rare prevalence, insidious onset, and tendency to involve anywhere throughout the craniospinal column. Treating these tumors can also present as a challenge due to their proximity to vital structures and high recurrence rate. We present a case of massive recurrent Clival chordoma in a 27-year-old patient and discuss the anesthetic considerations in such cases.

scholarly journals ENDOTHELIAL DYSFUNCTION UNDER INFLUENCE OF IONIZING RADIATION: PATHOGENETIC BASIS AND OPPORTUNITIES OF PHARMACOLOGICAL CORRECTION

2018 ◽  
Vol 25 (4) ◽  
pp. 124-131 ◽  
Author(s):  
K. V. SAROYAN ◽  
I. N. SYTNIK ◽  
V. O. SOLDATOV ◽  
M. A. PERSHINA ◽  
N. I. ZHERNAKOVA ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Ionizing Radiation ◽  
Regulatory Systems ◽  
Direct Exposure ◽  
Radiation Induced ◽  
Radioactive Radiation ◽  
Pharmacological Correction ◽  
High Doses

The problem of radiation-induced lesions is becoming increasingly urgent. Studies in recent years show that one of the most vulnerable  tissues is the endothelium when exposed to high doses of ionizing  radiation. The study of the pathogenetic bases of this phenomenon has  shown that damage to endotheliocytes occurs both at the expense of  the direct exposure to radiation and due to the systemic disturbance of  homeostasis which leads to the disadaptation of the executive and  regulatory systems of the organism. In this review we considered the  mechanisms of the development of endothelial dysfunction under the influence of radioactive radiation and possible methods of pharmacological correction of this condition.

Radical Resection of a Giant Epidermoid Tumor Associated With Miniature Chordoma Utilizing a Combined Endoscopic-Microscopic Technique: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Daryoush Tavanaiepour ◽  
Mohammad Abolfotoh ◽  
Walid Ibn Essayed ◽  
Ossama Al-Mefty
Keyword(s):  
Cerebellopontine Angle ◽  
Squamous Epithelium ◽  
Radical Resection ◽  
Cell Debris ◽  
Total Removal ◽  
Epidermoid Tumor ◽  
Cerebellar Retraction ◽  
Radical Removal ◽  
Microscopic Techniques ◽  
Transmastoid Approach

Abstract Epidermoid tumors arise from misplaced squamous epithelium and enlarge through the accumulation of desquamated cell debris.1 Notwithstanding the prevailing conservative attitudes to minimize morbidity, optimal treatment consists of total removal of the capsule2,3; therefore, giant and multicompartmental tumors are particularly challenging. The utilization of simultaneous endoscopic microscopic techniques by tandem endoscopic and microscopic dissection to overcome the shortcomings of both modalities, markedly enhances the ability of radical removal,4 thus eliminating or at least long-delaying inevitable recurrences with subsequent accumulated morbidity. The transmastoid approach by skeletonizing and reflexing the transverse-sigmoid sinus offers wide exposure of the cerebellopontine angle avoiding cerebellar retraction and allowing 4-hands dissection.5 The patient is a 17-yr-old male with a giant epidermoid tumor in the cerebellopontine angle, extending through the incisura. The patient underwent surgical resection with maximum pursuit of the epithelial capsule. After removing the epidermoid tumor, a miniature intra and extradural midclival tumor was encountered and removed with a proven pathology of chordoma. Patient did well postoperatively with relief of his hemifacial spasms. Patient consented for surgery and photograph publication. Image at 1:23, ©1997, O. Al-Mefty, used with permission. All rights reserved.

scholarly journals Development and clinical validation of a novel six-gene signature for accurately predicting the recurrence risk of patients with stage II/III colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zaoqu Liu ◽  
Taoyuan Lu ◽  
Jing Li ◽  
Libo Wang ◽  
Kaihao Xu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Experimental Validation ◽  
Radical Resection ◽  
Recurrence Risk ◽  
Gene Signature ◽  
Gene Expression Omnibus ◽  
Stage Ii ◽  
High Recurrence Rate ◽  
Free Survival ◽  
Number Of Patients

Abstract Background A large number of patients with stage II/III colorectal cancer (CRC) have a high recurrence rate after radical resection. We aimed to develop a novel tool to stratify patients with different recurrence-risk for optimizing decision-making in post-operative surveillance and therapeutic regimens. Methods We retrospectively enrolled four independent cohorts from the Gene Expression Omnibus and 66 CRC tissues from our hospital. The initial signature discovery was conducted in GSE143985 (n = 91). This was followed by independent validation of this signature in GSE17536 (n = 111), GSE29621 (n = 40), and GSE92921 (n = 59). Further experimental validation using qRT-PCR assays (n = 66) was performed to ensure the robustness and clinical feasible of this signature. Results We developed a novel recurrence-related signature consisting of six genes. This signature was validated to be significantly associated with dismal recurrence-free survival in five cohorts GSE143985 (HR: 4.296 [2.612–7.065], P < 0.0001), GSE17536 (HR: 2.354 [1.662–3.334], P < 0.0001), GSE29621 (HR: 3.934 [1.622–9.539], P = 0.0024), GSE92921 (HR: 7.080 [2.011–24.924], P = 0.0023), and qPCR assays (HR: 3.654 [2.217–6.020], P < 0.0001). This signature was also proven to be an independent recurrent factor. More importantly, this signature displayed excellent discrimination and calibration in predicting the recurrence-risk at 1–5 years, with most AUCs were above 0.9, average C-index for the five cohorts was 0.8795, and near-perfect calibration. Conclusions We discovered and experimental validated a novel gene signature with stable and powerful performance for identifying patients at high recurrence-risk in stage II/III CRC.

scholarly journals Recent advances in understanding and managing chordomas

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2902 ◽  
Author(s):  
Carl Youssef ◽  
Salah G. Aoun ◽  
Jessica R. Moreno ◽  
Carlos A. Bagley
Keyword(s):  
Radical Resection ◽  
Particle Beam ◽  
Axial Skeleton ◽  
High Recurrence Rate ◽  
Beam Radiation ◽  
Genetic Studies ◽  
Primary Bone Tumors ◽  
Recent Advances ◽  
Primary Bone ◽  
Slow Growing

Chordomas are rare primary bone tumors arising from embryonic remnants of the notochord. They are slow-growing, locally aggressive, and destructive and typically involve the axial skeleton. Genetic studies have identified several mutations implicated in the pathogenesis of these tumors. Treatment poses a challenge given their insidious progression, degree of local invasion at presentation, and high recurrence rate. They tend to respond poorly to conventional chemotherapy and radiation. This makes radical resection the mainstay of their treatment. Recent advances in targeted chemotherapy and focused particle beam radiation, however, have improved the management and prognosis of these tumors.

scholarly journals The Correction of The Auricle in Neurofibroma with Aggressive Tumor Removal Principle and Two Stages Total Ear Reconstruction

1970 ◽  
Vol 1 (3) ◽  
Author(s):  
Kristaninta Bangun ◽  
Zung Chung Chen
Keyword(s):  
Satisfactory Result ◽  
Costal Cartilage ◽  
Radical Resection ◽  
Benign Tumors ◽  
Anatomical Site ◽  
Ear Reconstruction ◽  
Tumor Removal ◽  
Two Stage ◽  
Large Tumor ◽  
Aggressive Tumor

Background: Neurofibroma is a major facial hamartoma and is one of the most destructive and debilitating disease affecting the skin, muscle, mucosa, and the skeletal systems. Involvement of the ear usually increases the dimensions of the auricular skin and underlying tissues, distorts normal architecture along with auricular malpositioning, producing an ear that is abnormal in size, shape and position. The correction of the auricle in neurofibroma and benign tumors of the head and neck has been reported, but overall favorable results appear difficult to attain. We present a case of neurofibroma of the auricle in which radical resection was performed, and reconstruction was done in a two-stage surgery with satisfactory result. Patient and Methods: A 30 years-old female presented with type-1 neurofibroma to our office, especially concerned of a large tumor growth on the right auricle. With prior experience in treating microtia cases by Nagata’s method, we performed a two-stage operation on the patient. The first operation involved excising the whole auricular mass, and fabricating as well as grafting of a three-dimensional costal cartilage framework. In the second stage, the ear was elevated.Result: Nine months after the second surgery, the result was satisfactory with good auricular definition attained, and proper elevation of the ear at the correct anatomical site. No sign of neurofibroma recurrence was found on the surrounding reconstructed auricle.Summary: In our experience, the correction Neurofibroma of the ear by using the aggressive tumor removal principle combined with Nagata’s two-stage total ear reconstruction delivered a satisfactory result.

Extramammary Paget Disease of the Vulva: A Case Series Examining Treatment, Recurrence, and Malignant Transformation

2018 ◽  
Vol 28 (3) ◽  
pp. 632-638 ◽  
Author(s):  
Roni Nitecki ◽  
Michelle Davis ◽  
Jaclyn C. Watkins ◽  
Yiru E. Wu ◽  
Allison F. Vitonis ◽  
...  
Keyword(s):  
Symptom Control ◽  
Tertiary Care ◽  
Case Series ◽  
Radical Resection ◽  
High Rate ◽  
Treatment Modalities ◽  
High Recurrence Rate ◽  
Paget Disease ◽  
Significant Difference ◽  
Disease Free

ObjectivesExtramammary Paget disease (EMPD) of the vulva is a rare lesion with a high recurrence rate ranging from 12% to 61%. The rate of underlying adenocarcinoma varies, but in the largest series was reported at 4%. Given the rarity of the disease there is a paucity of data to optimize treatment. This study aims to describe the management and recurrence patterns in a tertiary care setting and to offer suggestions for management in a modern-day setting.MethodsPatients with pathologically confirmed EMPD treated from 2000 to 2015 were retrospectively identified using an IRB approved database. Clinical data were abstracted from the electronic medical record. Pathology underwent central review.ResultsForty-four patients met criteria and underwent central pathology review. Forty-two patients were treated with surgical excision. Alternative treatment modalities included Mohs surgery in 3 patients and medical therapy in 20 patients. The median number of surgical procedures was 1 and the number of procedures ranged from 1 to 16. Twenty-five patients (56.8%) had recurrent disease with a median of 2 (1-6) recurrences per patient. The median disease-free interval was 28.7 months with a median follow up of 45.8 months (1.2-178.9 months). Three patients (7%) had invasive cancer and 7 patients (16%) were diagnosed with a separate malignancy at or following diagnosis of EMPD. Despite radical resection, the majority of patients had positive margins and there was no significant difference in disease recurrence between simple and radical resection (P = 0.69).ConclusionsPatients with EMPD in this series have a high rate of recurrence. Many undergo multi-modal therapy often with multiple providers. However, patients experience relatively long disease-free intervals with a low rate of associated malignancy. We propose an algorithm for management that focuses on symptom control and minimizing morbidity of treatment intervention once invasive disease has been excluded.

scholarly journals Non-Linear Relationship of Gamma-Glutamyl Transpeptidase To Lymphocyte Count Ratio With The Recurrence of Hepatocellular Carcinoma with Staging I-II: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Zeping Li ◽  
Lili Liang ◽  
Wen Duan ◽  
Chengmao Zhou ◽  
Jianjun Yang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Lymphocyte Count ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Radical Resection ◽  
High Recurrence Rate ◽  
Gamma Glutamyl Transpeptidase ◽  
Gamma Glutamyl ◽  
Count Ratio ◽  
Glutamyl Transpeptidase

Abstract Background high recurrence rate was a major factor for poor postoperative prognosis of hepatocellular carcinoma (HCC) patients. The present study was intended to evaluate the association of gamma-glutamyl transpeptidase to lymphocyte count ratio (GLR) and the recurrence of HCC with staging I-II in Chinese. Methods the retrospective cohort data was derived from the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2018 on 496 patients who underwent radical resection of HCC with staging I-II. Multivariable Cox regression models were used to determine hazard ratios (HR) and 95% confidence intervals (CIs) for the recurrence of HCC with staging I-II of each GLR tertile category. The restricted cubic spline model was used to find out the threshold effect. Results with the low tertile of GLR as the reference, multivariable-adjusted HRs and 95% CIs of the middle and high tertile categories were 1.748 (1.170, 2.612) and 2.078 (1.339, 3.227). In addition, there was a positive correlation (1.002 (1.001, 1.004)) and a non-liner relationship was found, whose point was 27.5. When the GLR was less than 27.5, the risk of recurrence increased, obviously with the increase in GLR levels (1.041 (1.014, 1.068)). Conclusions the GLR was independently associated with the recurrence of HCC patients with staging I-II. Furthermore, the relationship was positive and no-linear.

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