An Update on the Surgical Treatment of Temporal Bone Paraganglioma

2000 ◽  
Vol 13 (1_suppl) ◽  
pp. 179-188
Author(s):  
Kris S. Moe ◽  
Daqing Li ◽  
Thomas E. Linder ◽  
Stephan Schmid ◽  
Ugo Fisch
Keyword(s):  
Surgical Treatment ◽  
Temporal Bone ◽  
Surgical Resection ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Disease Free Survival ◽  
Current Therapy ◽  
Intracranial Extension ◽  
Tumor Excision ◽  
Intradural Tumor

In 1982, Fisch described his results for the surgical treatment of 74 paragangliomas of the temporal bone, 5 years after his description of the infratemporal fossa approaches (types A and B). This study reviews the subsequent experience of the Department of Otolaryngology—Head and Neck Surgery of the University of Zürich with more than 136 surgically treated cases of paraganglioma of the temporal bone and discusses our current therapy 20 years after the initial description. One hundred nineteen (90%) of the patients had advanced tumors (Fisch class C or C+D), and 81 (68%) had intracranial extension. Total tumor excision was possible in 109 (82%) patients. Subtotal excision was performed in 22 (17%) patients, 21 of whom had intradural tumor invasion. In these cases, the resection was limited not by actual tumor size but by the degree of intracranial intradural tumor extension. Partial tumor excision was undertaken in only 1 patient with a C4De2Di2 tumor. The success rate in preservation of function of the lower cranial nerves was encouraging. Of the 69 patients whose facial nerve status was followed postoperatively, 81% maintained Fisch grade 76 to 100% (House-Brackman grades I and II). Analysis of follow-up data ranging from 2 to 11 years demonstrated 98% disease-free survival when total tumor extirpation was possible. In the patients who underwent subtotal or partial surgical resection there has been no subsequent tumor growth detected by either clinical or neuroradiological evaluation. We have confirmed after more than 20 years of experience that the infratemporal fossa approaches are a safe, highly effective means of surgical management of paragangliomas of the temporal bone, allowing eradication or arrest of disease with minimal morbidity. Limited intradural surgical resection in cases of very extensive tumors can greatly benefit patients for whom complete excision is not an option.

The clinicopathologic features and optimal surgical treatment of duodenal gastrointestinal tumor.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 519-519
Author(s):  
Seungjae Lee ◽  
Ki Byung Song
Keyword(s):  
Multivariate Analysis ◽  
Surgical Treatment ◽  
Surgical Resection ◽  
Tumor Size ◽  
Disease Free Survival ◽  
Mitotic Count ◽  
Perioperative Outcomes ◽  
Survival Outcomes ◽  
Clinicopathologic Features ◽  
Duodenal Gist

519 Background: Because of unclear clinicopathologic features, the optimal surgical procedure for duodenal gastrointestinal stromal tumor (GIST) remains poorly defined. We analyze clinicopathological features and recommend optimal surgical treatment of duodenal GIST. Methods: From July, 2000 to April 2017, 118 patients who had localized duodenal GIST were treated by curative surgical resection at a single institution. We retrospectively reviewed the clinicopathological characteristics and survival outcomes. Results: In survival analysis of all patients, 5-year overall survival (OS) and disease-free survival (DFS) rate were 94.9 and 79.2%, respectively. 19 patients developed recurrent disease at a median of 26.1 months from surgery and most common recurrence site was liver (63.2%). In multivariate analysis, mitotic count was the statistically significant prognostic factors of DFS. Our 20 cases of duodenal GIST in 1st or 4th portion were completely resected by limited resection(LR), regardless of tumor size. 98 patients with GISTs in 2nd or 3rd portion of duodenum underwent LR (n = 53) or pancreaticoduodenectomy (PD) (n = 45). Patients in the LR group had a smaller median tumor size (4.0 vs 5.3 cm, p = 0.026), more antimesenteric-sided location (41 vs 7cases, p < 0.001), less late complications (1 vs 7 cases, p = 0.014) and no postoperative newly developed diabetes mellitus (0 vs 4 cases, p = 0.027) than those in the PD group. When 53 patients in LR group further divided into minimal invasive LR (MILR) (n = 12) and open-LR (n = 41), MILR group had shorter operation time (155.0 vs 218.8 minutes, p = 0.013) and postoperative hospital stay (12.0 vs 19.4 days, p = 0.036). Conclusions: Patients with duodenal GIST who underwent complete surgical resection have favorable survival outcomes. Predictor of disease recurrence at multivariate analysis was mitotic count. LR is feasible and effective surgical treatment for the patients with small-sized, and anti-mesenteric sided duodenal GIST in terms of long-term oncologic outcomes and quality of life. MILR has better perioperative outcomes than open LR. Therefore, we should consider MILR as optimal surgical treatment for the selected patients with duodenal GIST.

Surgical Treatment of Skull-Base Malignancy

1984 ◽  
Vol 92 (1) ◽  
pp. 94-99 ◽  
Author(s):  
Sam E. Kinney ◽  
Benjamin G. Wood
Keyword(s):  
Surgical Treatment ◽  
Skull Base ◽  
Temporal Bone ◽  
Surgical Resection ◽  
Survival Rates ◽  
Surgical Approaches ◽  
Bone Resection ◽  
En Bloc ◽  
Temporal Bone Surgery ◽  
Temporal Bone Resection

Improved radiographic diagnosis and new surgical approaches make it possible to consider surgical treatment of skull-base malignancies. For many years treatment of external auditory canal and middle ear malignancies has involved subtotal or radical temporal bone surgery; these approaches and techniques will be discussed in detail, in our experience the need for radical temporal bone resection has changed considerably. Total tumor removal followed by radiation therapy seems to yield survival rates and relief of pain equal to formal temporal bone resection with the attendant complications. The new radio-diagnostic techniques, including high-resolution computerized tomographic scans and digital subtraction angiography, allow better assessment of skull-base lesions. If we can determine by computerized tomography that a skull-base malignancy is well defined and not extending into different areas, en bloc surgical resection might be indicated. Details of this radiologic evaluation will be presented along with some surgical approaches to lesions possibly amenable to surgical resection.

Surgical removal of giant acoustic neurinomas involving the skull base

1989 ◽  
Vol 71 (4) ◽  
pp. 611-615 ◽  
Author(s):  
Yutaka Sawamura ◽  
Yoku Nakagawa ◽  
Toshio Ikota ◽  
Hiroshi Abe
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Petrous Bone ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Sphenoidal Sinus ◽  
Content Type

✓ Neurinomas arising from the peripheral branch of the acoustic nerve distal to the internal auditory canal in the temporal bone are rare. Two advanced skull-base neurinomas are described which were situated mainly in the temporal petrous bone, and extended to the parapharyngeal space anteriorly, to the lateral cervical portion inferiorly, into the sphenoidal sinus medially, and into the middle and posterior cranial fossae compressing the brain stem. Both patients had been deaf for several years without other neurological deficits. The operative findings revealed that the fifth, seventh, and caudal cranial nerves were intact; therefore, it was suspected that these neurinomas originated primarily within the cochlea or the vestibule in the temporal bone. The tumors were completely removed via an extradural approach, with good results. Since the surgical treatment of such advanced skull-base neurinomas is difficult, the operative infratemporal fossa approach is described in detail.

scholarly journals Primary giant myxoma of the temporal bone with major intracranial extension: presenting with hearing impairment and ear polyp

2016 ◽  
Vol 30 (4) ◽  
pp. 540-546
Author(s):  
Guru Dutta Satyarthee ◽  
Luis Rafael Moscote-Salazar
Keyword(s):  
Temporal Bone ◽  
World Literature ◽  
Infratemporal Fossa ◽  
Interesting Case ◽  
Intracranial Extension ◽  
Cardiac Tumors ◽  
External Ear ◽  
Medline Search ◽  
Polypoidal Mass ◽  
First Case

Abstract Myxomas are mesenchymal origin, benign tumor, constituting approximately half of the benign cardiac tumors. Occasionally, it may also occurs at other locations, though the intracranial location of a myxoma is considered exceptionally rare. Only isolated few cases of intracranial myxoma are reported in the literature, almost all were locally confined within the originating bone. The extensive Pubmed and Medline search yielded only eight cases of primary myxoma arising in the temporal bone with extension into intracranial compartment. However intracranial extension is limited as early detection, however, Osterdock et al reported a case also arising from temporal bone with extensive intracranial extension. Author report an interesting case of intracranial myxoma in 27- year- old- male, involving the temporal bone associated with extensive bony erosion and also extending into infratemporal fossa, mastoid, and frontoparietal region and a polypoidal mass protruding into external ear. To the best of knowledge of authors, temporal myxoma presenting with external ear polypoidal mass, which underwent successful surgical excision is not reported and represent first case in the world literature.

Surgical treatment of juvenile nasopharyngeal angiofibroma with intracranial extension

2009 ◽  
Vol 4 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Nevo Margalit ◽  
Oshri Wasserzug ◽  
Ari De-Row ◽  
Avraham Abergel ◽  
Dan M. Fliss ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Adjuvant Therapy ◽  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
Nasopharyngeal Angiofibroma ◽  
Cranial Fossa ◽  
Midfacial Degloving

Object The purpose of this study was to describe the surgical treatment and outcomes of patients with intracranial extension of juvenile nasopharyngeal angiofibroma (JNA). Methods Twenty-one patients who underwent operations for JNAs between 1994 and 2008 were enrolled in the study. Seven patients (33%) had intracranial tumor extension. The middle cranial fossa and cavernous sinus were involved in 4 patients who underwent operations via the combined infratemporal fossa-midfacial degloving approach. The anterior skull base was involved in 3 patients who underwent the subcranialmidfacial degloving approach. Results Complete tumor removal was achieved in all patients. Postoperative complications included 1 case of soft-tissue infection. None of the patients had tumor recurrence after a mean follow-up of 42 months (range 29–85 months). No adjuvant therapy was required in any patient. Conclusions Combined approaches can be used effectively for treatment of JNAs with intracranial extension without the need for adjuvant therapy.

Infratemporal Fossa Approach for Glomus Tumors of the Temporal Bone

1982 ◽  
Vol 91 (5) ◽  
pp. 474-479 ◽  
Author(s):  
Ugo Fisch
Keyword(s):  
Temporal Bone ◽  
Internal Carotid ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Postoperative Treatment ◽  
Surgical Experience ◽  
Glomus Tumors ◽  
Intraoperative Management ◽  
New Type

The surgical experience with 74 glomus tumors of the temporal bone is presented. The article proposes new refinements in the classification of types C and D tumors and describes in detail the technique of blind sack closure of the external auditory canal, double ligation of the sigmoid sinus and the use of a special infratemporal fossa retractor. The postoperative treatment and intraoperative management of the internal carotid artery, facial nerve and cranial nerves IX, X, XI and XII including the technique and results of a new type of V-VII anastomosis are discussed.

The Medial wall of the Jugular Foramen

2009 ◽  
Vol 141 (3) ◽  
pp. 401-407 ◽  
Author(s):  
Bahar Keles ◽  
Maroun T. Semaan ◽  
Jose N. Fayad
Keyword(s):  
Temporal Bone ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Medial Wall ◽  
Surgical Morbidity ◽  
Hearing Research ◽  
Complex Anatomy ◽  
Temporal Bones ◽  
Neurovascular Structures

OBJECTIVE: To better understand the variable and complex anatomy of the jugular foramen (JF) and the relationship between the neurovascular structures in the medial wall of the jugular bulb (JB). STUDY DESIGN: A temporal bone anatomic study. SETTING: A temporal bone laboratory within a hearing research facility. SUBJECTS AND METHODS: Twenty-two temporal bones were dissected under the operating microscope. The JF anatomy was exposed by using the modified infratemporal fossa approach (no rerouting of the facial nerve). Pictures were taken at various intervals during the dissection. Distances between important structures were measured with two-point calipers and transferred to a millimetric scale. RESULTS: The right JF was found to be larger than the left side in 72.7 percent of the dissected temporal bones. A fibrous septum separated the glossopharyngeal (CN IX) from the vagus (CN X) and accessory (CN XI) nerves in 19 specimens (86.4%), and a complete bony septum was present in three specimens (13.6%). The CNs IX, X, and XI traveled anteromedially to the JB within the JF. The inferior petrosal sinus (IPS) drained into the medial wall of the JB at various locations by two or more channels. In most of the specimens (86.4%), the IPS separated CNs IX and X. CONCLUSION: The lower cranial nerves have an intimate relationship to the medial wall of the JB. Within the JF, the neurovascular structures vary in size, shape, and location. To minimize surgical morbidity, the surgeon should be familiar with the complex anatomy of the JB and its variations.

Microsurgical resection of a glioblastoma multiforme of the medulla oblongata with intraoperative subcortical stimulation and mapping

2019 ◽  
Vol 1 (2) ◽  
pp. V1
Author(s):  
Sima Sayyahmelli ◽  
Jian Ruan ◽  
Bryan Wheeler ◽  
Mustafa K. Başkaya
Keyword(s):  
Glioblastoma Multiforme ◽  
Surgical Resection ◽  
Medulla Oblongata ◽  
Cranial Nerves ◽  
The Body ◽  
Fine Motor ◽  
Surgical Video ◽  
Inferior Aspect ◽  
Hyperintense Signal ◽  
Microsurgical Resection

Primary glioblastoma multiforme tumors of the medulla oblongata are rare, especially in the adult population. Perhaps due to this rarity, we are not aware of any previous reports addressing the resection of these tumors or their clinical outcomes.In this surgical video, we present a 43-year-old man with a 1-month history of left-sided paresthesia. The paresthesia initiated in the left hand, along with weakness and reduced fine motor control, and then spread to the entire left side of the body. He had recent weight loss, imbalance, difficulty in swallowing, and hoarseness in his voice. He also had a diminished gag reflex, and significant atrophy of the right side of the tongue with an accompanying deviation of the uvula and fasciculations of the tongue. MRI showed an infiltrative expansile mass within the medulla with peripheral enhancement and central necrosis. In T2/FLAIR sequences, a hyperintense signal extended superiorly into the left inferior aspect of the pons and left inferior cerebellar peduncle and inferiorly into the upper cervical cord.The decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy for surgical resection of this infiltrative expansile intrinsic mass in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials and monitoring of lower cranial nerves IX, X, XI, and XII. A gross-total resection of the enhancing portion of the tumor was performed, along with a subtotal resection of the nonenhancing portion. The surgery and postoperative course were uneventful. Histopathology revealed a grade IV astrocytoma. The patient received radiation therapy.In this surgical video, we demonstrate important steps for the microsurgical resection of this challenging glioblastoma multiforme of the medulla oblongata.The video can be found here: https://youtu.be/QHbOVxdxbeU.

scholarly journals Impact of Surgical Resection and Reasons for Poor Prognosis of Pelvic Osteosarcoma Based on the Bone Tumor Registry in Japan

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3320
Author(s):  
Satoshi Takenaka ◽  
Hironari Tamiya ◽  
Toru Wakamatsu ◽  
Sho Nakai ◽  
Yoshinori Imura ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Propensity Score ◽  
Surgical Resection ◽  
Bone Tumor ◽  
Poor Prognosis ◽  
Propensity Score Analysis ◽  
The Elderly ◽  
Tumor Stage ◽  
Tumor Registry ◽  
Score Analysis

Pelvic osteosarcoma has a poor prognosis compared to osteosarcomas in other locations, and the reasons for this remain unknown. Surgical resection of pelvic osteosarcoma is technically demanding and often results in dysfunction and complications. In this study, we investigated the reasons underlying the poor prognosis of pelvic osteosarcoma by comparing it to femoral osteosarcoma using data from the Bone Tumor Registry in Japan. We used propensity score analysis to determine whether surgical resection of pelvic osteosarcoma improved its prognosis. We demonstrated that pelvic osteosarcoma had a poor prognosis because it occurred more often in the elderly, often had larger tumor size, and had metastasis at presentation more often in comparison to femoral osteosarcoma. These three factors were also associated with the non-surgical treatment of pelvic osteosarcoma, which also led to a poor outcome. The overall survival rate was only comparable in pelvic osteosarcoma and femoral osteosarcoma in cases treated with surgical resection. Propensity score analysis revealed that surgical treatment improved the prognosis of pelvic osteosarcoma. As such, we propose that surgical resection should be considered based on tumor stage and patient age in order to improve the prognosis of pelvic osteosarcoma.

Sign in / Sign up

Export Citation Format

Share Document