scholarly journals Giant Ossified Clival Chondrosarcoma Resection: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Walid Ibn Essayed ◽  
Ossama Al-Mefty
Keyword(s):  
Skull Base ◽  
Malignant Tumors ◽  
Young Patients ◽  
Radical Resection ◽  
Neurological Deficits ◽  
Adjuvant Radiation ◽  
Lower Grade ◽  
Grade Ii ◽  
Giant Size

Abstract Chondrosarcomas are a spectrum of tumors with variable clinical behavior, histologically classified as grades I, II, and III.1 Maximal surgical resection with adjuvant radiation is the gold standard for grade III malignant tumors.2,3 Lower-grade skull base chondrosarcomas have a slow progressive local growth pattern with an overall benign profile.1,4 In these grade I and II tumors, radical resection can be sufficient in achieving long-term control of the disease without the need for adjuvant therapy, thus avoiding the long-term side effects of irradiation in relatively young patients.4,5 As a slow-growing tumor, skull base chondrosarcoma might reach a giant size with progressive neurological deficits prior to diagnosis. In these cases, to achieve maximal resection, skull base approaches tailored to the patient's anatomy are essential.4,6 Cranial approach is frequently needed due to the calcified nature of part of the tumor that is not amenable to resection through the endonasal approach. The endoscope is extremely helpful combined with the microscopic resection. We demonstrate these techniques through in the surgery of a 39-yr-old female who presented with progressive neurological deficits from a giant ossified chondrosarcoma and underwent a combined petrosal approach for the resection of her tumor. A postoperative small enhancement remained stable on the 4-yr follow-up exam. The pathology confirmed grade II chondrosarcoma, with the patient recovering from her neurological deficit except the third nerve. The patient consented to the surgery and publication of images.  Image at 1:36 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, ©LWW, 1998.

P14.36 Characterising Meningiomas in young patients under 40

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii45-ii46
Author(s):  
M Attia ◽  
Y Mirkin ◽  
R Hershkovitch ◽  
Z R Cohen ◽  
Z Zibly ◽  
...  
Keyword(s):  
Skull Base ◽  
Medical Center ◽  
Young Patients ◽  
Case Series ◽  
Population Level ◽  
Who Grade ◽  
Younger Patients ◽  
Grade Ii ◽  
Grade Iii

Abstract BACKGROUND Meningiomas are the most common primary CNS tumor in adults, with a median age at diagnosis of 65 years and a female to male ratio of 2–3:1 (except in grade II, III meningiomas). Younger patients usually have a genetic background or history of prior radiation exposure. Based on population-level studies, approximately 80–85% of meningiomas are WHO grade I (benign), 15–18% grade II (atypical), and 1–3% grade III (anaplastic). This case series describes a single center experience of the presentation and pathology of meningiomas in patients under the age of 40. MATERIALS AND METHODS We reviewed the Sheba Medical Center Neurosurgery and radiotherapy databases containing patients who were operated on for meningioma between the years 2011–2020. Patients under 40 were selected and information from digital medical records was gathered on these patients, including pathology reports, surgical reports, clinical and radiological data, and the use of radiotherapy or medical treatments. RESULTS Of 600 patients in the database, 49 patients under 40 (8.3%) were identified and 54 tumors were reviewed (five patients were operated on for multiple meningiomas). 31 patients were female (63%); 2 were under 20 years old, 15 were age 20–29 and 32 were age 30–39 at first presentation. Seven patients had received prior radiation therapy for a childhood malignancy. 28 meningiomas were histology confirmed grade I (52%), 22 were grade II (41%), 2 were grade III (4%), and 2 (4%) were grade undetermined. 22 tumors were located in the skull base (41%) and 32 (59%) in the brain convexity. Of the skull base tumors, 16 were grade I, 5 were grade II, and one was grade III. Of the convexity tumors, 12 were grade I, 16 were grade II, and 2 were grade III. Median follow-up was 35 months, and longest follow-up time was 98 months. Six patients were treated with additional radiotherapy after surgery. CONCLUSION Our experience with meningioma patients under 40 revealed a different grade segregation than the older population, with younger patients showing a higher incidence of grade II tumors. These tumors are generally more aggressive, and require careful resection and consideration for post-surgical radiotherapy. Further validation with population based databases is required.

Current Concepts in the Management of Tumors of the Skull Base

1998 ◽  
Vol 5 (2) ◽  
pp. 138-149 ◽  
Author(s):  
Akio Morita ◽  
Laligam N. Sekhar ◽  
Donald C. Wright
Keyword(s):  
Skull Base ◽  
Malignant Tumors ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Cranial Base ◽  
Benign Tumors ◽  
Tumor Control ◽  
High Morbidity ◽  
Fractionated Radiotherapy

Background: Due to their involvement with critical neurovascular structures, tumors located in the cranial base present challenges to neurosurgeons and are associated with high morbidity and mortality. Methods: Rates of tumor control, complications, patient outcomes, and recurrences were extracted and summarized from two decades of our surgical and radiological treatment follow-up and review of the medical literature. Results: Recent advances in surgical techniques involving cranial base approaches have made surgical intervention safer and curative resection more likely. In managing benign tumors, surgical resection is the gold standard for treatment. While immediate complications are still significant, long-term outcomes in most cases are excellent. Focused radiosurgery using a gamma knife or linear accelerator has produced favorable outcomes, and it improves the management of small or minimally symptomatic cranial base tumors. For slow-growing malignant tumors, extensive surgery followed by radiotherapy achieves the best outcome. In managing highly malignant tumors, outcome is determined by the effects of chemotherapy and radiotherapy. On some occasions, surgery is needed to obtain greater control of highly malignant tumors. Conclusions: Skull base tumors are relatively common, and management of these tumors is rapidly evolving. The combination of surgical excision using cranial base techniques, radiosurgery, fractionated radiotherapy, and chemotherapy should be individually tailored based on the location and pathological aggressiveness of the tumor and the symptomatology of the patient. Appreciation is expressed to Jennifer Pryll for her illustrative and photographic assistance and to Joseph Reister for editing and preparing the manuscript.

Microvascular Decompression for Glossopharyngeal Neuralgia: Long-term Effectiveness and Complication Avoidance

Neurosurgery ◽  
2004 ◽  
Vol 54 (4) ◽  
pp. 884-890 ◽  
Author(s):  
John H. Sampson ◽  
Peter M. Grossi ◽  
Katsuyuki Asaoka ◽  
Takanori Fukushima
Keyword(s):  
Microvascular Decompression ◽  
Neurological Deficits ◽  
Long Term Results ◽  
Glossopharyngeal Neuralgia ◽  
Complete Relief ◽  
Long Term Follow Up ◽  
Nerve Paresis ◽  
Grade Ii

Abstract OBJECTIVE To establish the long-term safety, efficacy, and durability of microvascular decompression (MVD) for the treatment of glossopharyngeal neuralgia, this study presents the immediate (<6 mo) postoperative and long-term results of a large series of 47 patients with treated with MVD. METHODS Operative reports and hospital charts were analyzed to collect demographic information, clinical presentation, and surgical findings. Surgical results and complications were ascertained by direct patient contact or by contact with the patient's family or physician if the patient was dead. Long-term (>10 yr) personal follow-up was available for 29 of 47 patients. RESULTS Forty-six (98%) of 47 patients experienced complete relief of pain immediately after MVD. Long-term follow-up was available for 29 of these 47 patients (range, 125–211 mo; median, 152 mo, or 12.7 yr), and 28 of these 29 patients continued to be pain-free. Permanent neurological deficits (>6 mo) attributed to the surgery were observed in 5 (11%) of 47 patients. Of these patients, 4 of 5 had mild hoarseness or dysphagia or both, and one had a Grade II/VI facial nerve paresis. CONCLUSION This study demonstrates that MVD is a safe, effective, and durable surgical procedure for producing prolonged pain relief in patients with medically intractable glossopharyngeal neuralgia.

Long-Term Outcome of Surgically Treated Malignant Tumors of the Nasal Cavity and Paranasal Sinuses Involving Anterior Skull Base

Skull Base ◽  
2007 ◽  
Vol 17 (S 1) ◽  
Author(s):  
Takashi Tokutomi ◽  
Yueching Wong ◽  
Kikuo Sakamoto ◽  
Kiyokawa Kensuke ◽  
Tadashi Nakashima ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Skull Base ◽  
Paranasal Sinuses ◽  
Malignant Tumors ◽  
Anterior Skull Base ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 481 ◽  
Author(s):  
Oscar J. Manrique ◽  
Ali Charafeddine ◽  
Amjed Abu-Ghname ◽  
Joseph Banuelos ◽  
Steven R. Jacobson ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Young Patients ◽  
Retrospective Chart Review ◽  
Roc Curves ◽  
Adjuvant Radiation ◽  
Obese Women ◽  
Term Outcome ◽  
Long Term Outcome

Background and objectives: Differences in patient anatomy and physiology exist between young and older patients undergoing breast reconstruction after mastectomy. Breast cancer has been described as being more aggressive, more likely to receive radiation, contralateral mastectomy, as well as bilateral reconstruction in young patients. Our purpose is to report long-term experience on two-staged implant-based breast reconstruction (IBR) in young females, with complication sub-analysis based on obesity and adjuvant radiation. Materials and Methods: Retrospective chart review of all consecutive young patients who underwent two-staged IBR at our institution, between 2000 and 2016, was performed. Patients between 15 and 40 years old with least 1-year follow-up were included. Univariate logistic regression models and receiver operating characteristic (ROC) curves were created. Results: Overall 594 breasts met our inclusion criteria. The mean age was 34 years, and the median follow-up was 29.6 months. Final IBR was achieved in 98% of breasts. Overall, 12% of breasts had complications, leading to explantations of 5% of the devices. Adjuvant radiation was followed by higher rates of total device explantations (p = 0.003), while obese patients had higher rates of total complications (p < 0.001). For each point increase in BMI, the odds of developing complications increased 8.1% (p < 0.001); the cutoff BMI to predict higher complications was 24.81 kg/m2. Conclusions: This population demonstrates high successful IBR completion and low explantation rates. These data suggest that obese women and those with planned adjuvant radiation deserve special counseling about their higher risk of complications.

scholarly journals Long-Term Clinical Outcome of First Recurrence Skull Base Meningiomas

2019 ◽  
Vol 9 (1) ◽  
pp. 106
Author(s):  
Yuki Kuranari ◽  
Ryota Tamura ◽  
Noboru Tsuda ◽  
Kenzo Kosugi ◽  
Yukina Morimoto ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Skull Base ◽  
Tumor Size ◽  
Removal Rate ◽  
World Health ◽  
Who Grade ◽  
Multiple Lesions ◽  
Grade Ii ◽  
Skull Base Meningiomas

Skull base meningiomas (SBMs) are considered to be less aggressive and have a slower growth rate than non-SBMs. However, SBMs often develop local recurrences after surgical resection. Gross total removal is difficult because SBMs are deep-seated tumors and involve critical neurovascular structures. The treatment strategy for recurrent SBMs remains controversial. The present study aimed to evaluate the long-term clinical course and prognostic factors associated with shorter progression-free survival (PFS) of recurrent SBMs. This retrospective study included 85 recurrent SBMs from 65 patients who underwent surgery from January 2005 to September 2018. Overall survival (OS) and PFS were evaluated, and the associations among shorter PFS and age, sex, tumor size, lesions, World Health Organization (WHO) grading, removal rate, and time since prior surgery were analyzed. The median follow-up period for PFS was 68 months. The 2-, 5-, and 10-year PFS rates were 68.0%, 52.8%, and 22.7%, respectively. WHO grade II or III, multiple lesions, and tumor size were significantly associated with shorter PFS (p < 0.0001, p = 0.030, and p = 0.173, respectively). Although, radiotherapy did not improve PFS and OS for overall patients, PFS of the patients with subtotal and partial removal for WHO grade II SBMs was significantly improved by the radiotherapy. Multivariate analysis identified WHO grade II or III and multiple lesions as independent prognostic factors for shorter PFS (p < 0.0001 and p = 0.040, respectively). It is essential to estimate the risks associated with shorter PFS for patients with recurrent SBMs to aid in the development of appropriate postoperative strategies.

Impact of Treatment Modalities Upon Survival Outcomes in Skull Base and Clival Chordoma: An NCDB Analysis

2022 ◽  
Author(s):  
Ethan Gregory Muhonen ◽  
Tyler M. Yasaka ◽  
Brandon Lehrich ◽  
Khodayar Goshtasbi ◽  
Peter Papagiannopoulos ◽  
...  
Keyword(s):  
Overall Survival ◽  
Skull Base ◽  
Tumor Size ◽  
Large Scale ◽  
Malignant Tumors ◽  
Margin Status ◽  
Treatment Modalities ◽  
Survival Outcomes ◽  
Adjuvant Radiation ◽  
Positive Margins

Objectives: Skull base chordomas are locally aggressive malignant tumors derived from the notochord remnant. There are limited large-scale studies examining the role and extent of surgery and radiation therapy. Design: Analysis of the National Cancer Database (NCDB) was performed to evaluate the survival outcomes of various treatments, and to assess for predictors of overall survival (OS). Participants: Retrospective, population-based cohort study of patients diagnosed with a clival/skull base chordoma between 2004-2015 in the NCDB. Main Outcome Measures: The primary outcome was overall survival (OS). Results: 468 cases were identified. 49% of patients received surgery and 20.7% had positive margins. Mean age at diagnosis was 48.4 years in the surgical cohort, and 55% were male. Of the surgical cohort, 33.8% had negative margins, 20.7% had positive margins, and 45.5% had unknown margin status. Age ≥ 65 (HR 3.07, 95% CI 1.63-5.76, p<0.001), diagnosis between 2010-2015 (HR 0.49, 95% CI 0.26-0.90, p=0.022), tumor size >5 cm (HR 2.29, 95% CI 1.26-4.15, p=0.007) and government insurance (HR 2.28, 95% CI 1.24-4.2, p=0.008) were independent predictors of OS. When comparing surgery with or without adjuvant radiation, no survival differences were found, regardless of margin status (P=0.66). Conclusions: Surgery remains the mainstay of therapy. Advanced age over 65, large tumor size, and government insurance were predictors of worse OS. While negative margins and the use of adjuvant radiation did not appear to impact OS, these may very well reduce local recurrences. A multidisciplinary approach is critical in achieving optimal outcomes in this challenging disease.

NCOG-50. CHARACTERIZING MENINGIOMA IN YOUNG PATIENTS UNDER 40

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi163-vi163
Author(s):  
Moshe Attia ◽  
Yehoshua Mirkin ◽  
Rotem Hershcovitch ◽  
Zvi Cohen ◽  
Zion Zibly ◽  
...  
Keyword(s):  
Skull Base ◽  
Medical Center ◽  
Young Patients ◽  
Case Series ◽  
Population Level ◽  
Population Based ◽  
Who Grade ◽  
Younger Patients ◽  
Grade Ii ◽  
Grade Iii

Abstract BACKGROUND Meningiomas are the most common primary CNS tumor in adults, with a median age at diagnosis of 65 years. Younger patients usually have a genetic background or history of prior radiation exposure. Population-level studies suggest 80-85% of meningiomas are WHO grade I (benign), 15-18% grade II (atypical), and 1-3% grade III (anaplastic). This case series describes a single center experience of meningiomas in patients under 40. METHODS We reviewed the Sheba Medical Center Neurosurgery and radiotherapy databases containing patients operated on for meningioma between 2011-2020. Digital medical records were retrieved, including pathology reports, surgical reports, clinical and radiological data, and use of radiotherapy or medical treatments. RESULTS Of 600 patients in the database, 47 patients under 40 (7.8%) were identified and 54 tumors were reviewed (five patients had multiple operation). 32 patients were female (68%) ; 2 were under 20 years old, 17 were age 20-30 and 28 were age 31-39 at first presentation. Seven patients had received prior radiation therapy for a childhood malignancy. 28 meningiomas were histology confirmed grade I (52%), 22 were grade II (41%), 2 were grade III (4%), and 2 (4%) were grade undetermined. 22 tumors were located in the skull base (41%) and 32 (59%) in the brain convexity. 16 skull base tumors were grade I, five were grade II, and one was grade III. 12 convexity tumors were grade I, 16 were grade II, and two were grade III. Median follow-up was 35 months (range 1 - 98 months). CONCLUSION Our experience with meningioma patients under 40 revealed a different grade segregation than the older population, with younger patients showing a higher incidence of grade II tumors. These tumors are generally more aggressive, and require careful resection and consideration for post-surgical radiotherapy. Further validation with population based databases is required.

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