Usefulness of Nasal Morphology in Surgical Approaches for Skull Base Tumors

2007 ◽  
Vol 17 (4) ◽  
pp. 283-286
Author(s):  
Neslihan Boyan ◽  
Emine Kizilkanat ◽  
Ibrahim Tekdemir ◽  
Roger Soames ◽  
Ozkan Oguz
Keyword(s):  
Skull Base ◽  
Surgical Approaches ◽  
Skull Base Tumors

scholarly journals 3D Printing-Assisted Skull Base Tumor Surgeries: An Institutional Experience

2021 ◽  
Author(s):  
Sanjeev Chopra ◽  
Ashim Kumar Boro ◽  
Virendra Deo Sinha
Keyword(s):  
3D Printing ◽  
Skull Base ◽  
Surgical Approaches ◽  
Skull Base Tumor ◽  
Confined Space ◽  
Skull Base Tumors ◽  
Patient Counselling ◽  
Training Tool ◽  
3D Printed ◽  
Neurovascular Structures

AbstractThree-dimensional (3D) printing technology in neurosurgery has gained popularity nowadays. Skull base contains many major neurovascular structures in a confined space, along with anatomical variations making surgical approaches to this region challenging. 3D-printed model of skull base tumors consists of the patient's bony skull base, actual tumor dimensions, and surrounding major neurovascular structures. We included a total number of five patients with skull base tumors (one case of planum sphenoidale meningioma, two cases of sellar tumor with suprasellar extension, and two cases of cerebellopontine angle tumor) and 3D-printed tumor model of each of them. These models were used for preoperative simulation and served as very true to life training tool. These help in increasing the efficacy of the surgeon, improves surgical safety and ergonomics. They were also used for patient counselling, educating about the disease, the surgical procedure, and associated risks.

scholarly journals Pediatric Skull Base Tumors

2021 ◽  
Author(s):  
Usman A. Khan ◽  
Jillian H. Plonsker ◽  
Robert C. Rennert ◽  
Michael L. Levy
Keyword(s):  
Quality Of Life ◽  
Skull Base ◽  
Neurofibromatosis Type ◽  
Surgical Anatomy ◽  
Surgical Approaches ◽  
Skull Base Tumors ◽  
Tumor Pathology ◽  
Neuro Imaging ◽  
Individualized Management

Management of pediatric skull base tumors requires a multi-disciplinary team that integrates advances in neuro-imaging, radiation, medical and surgical treatments, and allied therapies. Tumors of the skull base harbor complex genetic and molecular signatures that have major implications on prognosis and quality of life. Individualized management requires a strong inter-disciplinary alliance amongst practitioners, as well as a strong therapeutic alliance with the patient and family to navigate the complex decision-making process of treatments. In this chapter, we present our experience managing surgical lesions of the pediatric skull base. General considerations to tumor pathology genetics and radiobiology, diagnostic imaging, rehabilitation of cranial neuropathies and cognitive function, surgical anatomy and reconstructive options, and quality of life should be applied to each case. We also present location- and tumor-specific considerations in the anterior, middle, and posterior fossa skull base with a focus on surgical approaches and complication avoidance. Special consideration is given to syndromic tumors, particularly those from neurofibromatosis type 2 (NF-2). Tumors can exist in multiple cranial compartments and as such some redundancy in concepts is unavoidable. Nevertheless, each patient presents with a unique clinical picture and tumor behavior. Knowledge and proficiency in skull base approaches is a necessary tool in every pediatric neurosurgeon’s armamentarium.

Analysis of Surgical Approaches to Skull Base Tumors Involving the Pterygopalatine and Infratemporal Fossa

2019 ◽  
Vol 30 (2) ◽  
pp. 589-595 ◽  
Author(s):  
Hyo Jin Chung ◽  
In Seok Moon ◽  
Hyung-Ju Cho ◽  
Chang-Hoon Kim ◽  
Salma Saud Al Sharhan ◽  
...  
Keyword(s):  
Skull Base ◽  
Infratemporal Fossa ◽  
Surgical Approaches ◽  
Skull Base Tumors

Extended anterior subcranial approach for skull base tumors: long-term results

1995 ◽  
Vol 82 (6) ◽  
pp. 1002-1010 ◽  
Author(s):  
Joram Raveh ◽  
Jon B. Turk ◽  
Kurt Lädrach ◽  
Rolf Seiler ◽  
Nelson Godoy ◽  
...  
Keyword(s):  
Skull Base ◽  
Frontal Lobe ◽  
Anterior Skull Base ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Skull Base Tumors ◽  
En Bloc ◽  
Content Type ◽  
Anterior Cranial Base ◽  
Anterior Access

✓ The extended anterior subcranial approach differs significantly from more traditional surgical approaches to the skull base in that it allows a broad inferior access to the anterior skull base planes with tumor exposure from below rather than via the transfrontal route. The authors initially used the subcranial approach in 1978 for the treatment of high-velocity skull base trauma and certain craniofacial anomalies. In 1980 they expanded the indications to include the combined neurosurgical—otolaryngological resection of various skull base tumors. Osteotomy of the frontonasoorbital external skeletal frame provides optimum anterior access to the orbital and sphenoethmoidal planes as well as to the nasal and paranasal cavities while avoiding frontal lobe retraction and the external facial incisions characteristic of transcranial and transfacial approaches. The improved visualization of the anterior skull base and clival—sphenoidal region facilitates en bloc tumor removal, optic nerve decompression, exposure of the medial aspect of the cavernous sinus, and watertight realignment of the anterior cranial base dura. In this report the authors present their experience over the past 13 years with 104 patients who underwent operation via the extended subcranial approach. Because extensive frontal lobe manipulation and external facial incisions are avoided with this approach, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced. The extended anterior subcranial method is therefore an excellent alternative to traditional transfacial-transcranial skull base approaches for the removal of selected skull base tumors.

scholarly journals Tumors of the skull base in children: review of tumor types and management strategies

2002 ◽  
Vol 12 (5) ◽  
pp. 1-13 ◽  
Author(s):  
Eve C. Tsai ◽  
Stephen Santoreneos ◽  
James T. Rutka
Keyword(s):  
Skull Base ◽  
Pediatric Population ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Surgical Approaches ◽  
Skull Base Tumors ◽  
Nasopharyngeal Angiofibroma ◽  
Review Management ◽  
Skull Base Lesions ◽  
Skull Base Anatomy

Although many treatment strategies for skull base tumors in adults have been reported, relatively little has been reported regarding such therapies in the pediatric population. Skull base tumors in children present a therapeutic challenge because of their unique pathological composition, the constraints of the maturing skull and brain, and the small size of the patients. In this review, the authors examine the pediatric skull base lesions that occur in the anterior, middle, and posterior cranial base, focusing on unique pediatric tumors such as encepahalocele, fibrous dysplasia, esthesioneuroblastoma, craniopharyngioma, juvenile nasopharyngeal angiofibroma, cholesteatoma, chordoma, chondrosarcoma, and Ewing sarcoma. They review management strategies that include radio- and chemotherapy, as well as surgical approaches with emphasis on the modifications and complications associated with the procedures as they apply in children. Evidence for the advantages and limitations of radiotherapy, chemotherapy, and surgery as it pertains to the pediatric population will be examined. With a working knowledge of skull base anatomy and special considerations of the developing craniofacial skeleton, neurosurgeons can treat skull base lesions in children with acceptable morbidity and mortality rates. Outcomes in this population may be better than those in adults, in part because of the benign histopathology that frequently affects the pediatric skull base, as well as the plasticity of the maturing nervous system.

scholarly journals Endoscopic Resection of Pediatric Skull Base Tumors: An Evidence-Based Review

2018 ◽  
Vol 80 (05) ◽  
pp. 527-539 ◽  
Author(s):  
Kerolos Shenouda ◽  
Brian T. Yuhan ◽  
Ahsan Mir ◽  
Nathan Gonik ◽  
Jean Anderson Eloy ◽  
...  
Keyword(s):  
Skull Base ◽  
Endoscopic Resection ◽  
Pediatric Population ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Skull Base Tumors ◽  
Nasopharyngeal Angiofibroma ◽  
Invasive Approach ◽  
Presenting Symptoms

Abstract Objectives To perform a systematic review examining experiences with endoscopic resection of skull base lesions in the pediatric population, with a focus on outcomes, recurrence, and surgical morbidities. Methods PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science databases were evaluated. Studies were assessed for level of evidence. Bias risk was evaluated using the Cochrane Bias tool, Grades of Recommendation, Assessment, Development and Evaluation (GRADE), and Methodological Index for Non-Randomized Studies (MINORS) criteria. Patient characteristics, pathology, site of primary disease, presenting symptoms, stage, procedure specific details, and complications were evaluated. Results were reported using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis guidelines. Results Ninety-three studies met criteria for inclusion, encompassing 574 patients with skull base tumors. The GRADE and MINORS criteria determined the overall evidence to be moderate quality. The most common benign and malignant pathologies included juvenile nasopharyngeal angiofibromas (n = 239) and chondrosarcomas (n = 11) at 41.6 and 1.9%, respectively. Of all juvenile nasopharyngeal angiofibroma tumors, most presented at stage IIIa and IIIb (25.8 and 27.3%, respectively). Nasal obstruction (16.5%) and headache (16.0%) were common symptoms at initial presentation. Surgical approaches included endoscopic endonasal (n = 193, 41.2%) and endoscopic extended transsphenoidal (n = 155, 33.1%). Early (< 6 weeks) and late (>6 weeks) complications included cerebrospinal fluid leak (n = 36, 17.3%) and endocrinopathy (n = 43, 20.7%). Mean follow-up time was 37 months (0.5–180 months), with 86.5% showing no evidence of disease and 2.1% having died from disease at last follow-up. Conclusion Endoscopic skull base surgery has been shown to be a safe and effective method of treating a variety of pediatric skull base tumors. If appropriately employed, the minimally invasive approach can provide optimal results in the pediatric population.

Surgical management of midline skull-base tumors: a new approach

1989 ◽  
Vol 71 (5) ◽  
pp. 705-710 ◽  
Author(s):  
David Uttley ◽  
Anne Moore ◽  
Daniel J. Archer
Keyword(s):  
Skull Base ◽  
Tumor Resection ◽  
Subsequent Development ◽  
Neurological Status ◽  
Surgical Approaches ◽  
Upper Cervical Spine ◽  
Skull Base Tumors ◽  
Content Type ◽  
Csf Fistula ◽  
Wound Breakdown

✓ Many surgical approaches to the clivus and upper cervical spine have been used in the treatment of skull-base tumors over the past 50 years. However, the outcome of surgery has been complicated by difficulties of access to the whole clivus, together with pharyngeal wound breakdown with subsequent development of cerebrospinal fluid (CSF) fistula and meningitis. A technique described recently utilized Le Fort I osteotomy to improve exposure of the clivus in the approach to vertebrobasilar aneurysms, facilitating control of the aneurysm and reducing the risk of posttraumatic CSF fistula. The same approach, via maxillotomy, has permitted partial or total tumor resection in 13 consecutive procedures carried out at Atkinson Morley's Hospital on 10 patients presenting with tumors of the skull base. Neurological status was either improved or unchanged in all patients postoperatively, and pain relief was obtained in five of eight cases in which this was a presenting symptom. No patient developed a CSF fistula following surgery. Cosmetic results were good, and no problems related to malocclusion were reported. This approach may be used to advantage in the surgical treatment of skull-base tumors, at initial presentation, and can be repeated without undue difficulty should there be tumor recurrence.

The Pediatric Anterior Skull Base: An Otolaryngologist's Perspective

2016 ◽  
Vol 7 (2) ◽  
pp. 143-148
Author(s):  
Ron B Mitchell ◽  
Andrew J Chang ◽  
Gopi B Shah
Keyword(s):  
Skull Base ◽  
Endoscopic Surgery ◽  
Pediatric Population ◽  
Adult Population ◽  
Anterior Skull Base ◽  
Surgical Approaches ◽  
Skull Base Tumors ◽  
Skull Base Lesions ◽  
Head Neck

ABSTRACT Anterior skull base tumors have traditionally posed a therapeutic challenge. However, the advancement of skull base and endoscopic surgery has allowed for more of these lesions to be amenable to surgical resection. Though common in the adult population, surgical approaches in the pediatric population is not widely described. This chapter discusses the presentation and treatment for various pediatric anterior skull base lesions. Surgical approaches, complications, and the role of the otolaryngologist is also discussed. How to cite this article Chang AJ, Mitchell RB, Shah GB. The Pediatric Anterior Skull Base: An Otolaryngologist's Perspective. Int J Head Neck Surg 2016;7(2):143-148.

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