Oscillopsia following orbitotomy for intracranial tumor resection

Background: Oscillopsia is a visual phenomenon in which an individual perceives that their environment is moving when it is in fact stationary. In this report, we describe two patients with pulsatile oscillopsia following orbitocranial approaches for skull base meningioma resection. Case Description: Two patients, both 42-year-old women, underwent orbitocranial approaches for resection of a right sphenoid wing (Patient 1) and left cavernous sinus (Patient 2) meningioma. Patient 1 underwent uncomplicated resection and was discharged home without neurologic or visual complaints; she presented 8 days later with pulsatile oscillopsia. This was managed expectantly, and MRA revealed no evidence of vascular pathology. She has not required intervention as of most recent follow-up. Patient 2 developed trochlear and trigeminal nerve palsies following resection and developed pulsatile oscillopsia 4 months postoperatively. After patching and corrective lens application, the patient’s symptoms had improved by 26 months postoperatively. Conclusion: Oscillopsia is a potential complication following skull base tumor resection about which patients should be aware. Patients may improve with conservative management alone, although the literature describes repair of orbital defects for ocular pulsations in traumatic and with some developmental conditions.

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The Use of Polydioxanone Plates for Endoscopic Skull Base Repair

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2017.31.4411 ◽

2017 ◽

Vol 31 (2) ◽

pp. 122-126 ◽

Cited By ~ 9

Author(s):

Fahad Al-Asousi ◽

Christopher Okpaleke ◽

Anali Dadgostar ◽

Amin Javer

Keyword(s):

Skull Base ◽

Tumor Resection ◽

Case Series ◽

Sinus Surgery ◽

Csf Leak ◽

Skull Base Tumor ◽

Patient Reported ◽

Sinonasal Tumor ◽

Skull Base Defects

Background Many reconstructive techniques and materials have been reported for repair of skull base defects after sinonasal tumor excision, cerebrospinal fluid (CSF) leaks, and coverage of denuded bone. Synthetic materials have been developed for endoscopic skull base repair to avoid donor-site morbidity. Polydioxanone plate is a bioabsorbable implant designed for nasal septal reconstruction and has the ability to retain strength for at least 10 weeks and absorbs in 6 months. Objectives This study aimed to describe the use of polydioxanone plates in endoscopic skull base defect and CSF leak repair, and to describe our experience with the surgical technique and postoperative management. Methods This was a retrospective case series of patients who, between May 2013 and December 2015, underwent endoscopic sinus surgery and skull base repair for CSF leak or after excision of a skull base tumor by using polydioxanone plates. Patients who presented with sinonasal inflammatory disease or skull base tumors underwent endoscopic skull base repair by using polydioxanone plates in an underlay fashion and mucosal membrane grafts with or without adjuvant materials in an overlay fashion. The patients were reviewed at 6 days, 6 weeks, and 3 months after surgery. Postoperative adverse events, including CSF leak, infection, bleeding, headache, and graft failure, were recorded. Results The cases of seven patients (five women, two men; mean age, 53.9 years) were reviewed. Five patients underwent sinonasal tumor resection and two underwent repair for CSF leak. The mean (standard deviation) defect size was 16.4 ± 11.4 mm. There was no evidence of postoperative CSF leak, and lumbar drains were not used. One patient reported transient headache and facial pressure at the 6-week follow-up visit. The surgeons’ experience with polydioxanone plate placement, postoperative healing, and follow-up was satisfactory. Conclusion Polydioxanone could be used to achieve rigid repair of endoscopic skull base defects. These early results, although promising, require validation in clinical trials.

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Use of a Novel Side-Cutting Aspiration Device for Microscopic and Endoscopic Skull Base Tumor Resection

Skull Base ◽

10.1055/s-2011-1274232 ◽

2011 ◽

Vol 21 (S 01) ◽

Author(s):

Nancy McLaughlin ◽

Daniel Kelly ◽

Kiarash Shahlaie ◽

Leo F. Ditzel Filho ◽

Daniel Prevedello ◽

...

Keyword(s):

Skull Base ◽

Tumor Resection ◽

Skull Base Tumor

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Short diameter may be a useful simple indicator of the tumor response in skull base meningiomas after conventionally fractionated stereotactic radiotherapy

European Radiology ◽

10.1007/s00330-021-07707-1 ◽

2021 ◽

Author(s):

Keiichi Takehana ◽

Daisuke Nakamura ◽

Alshaymaa Abdelghaffar ◽

Megumi Uto ◽

Tomohiro Katagiri ◽

...

Keyword(s):

Skull Base ◽

Stereotactic Radiotherapy ◽

Tumor Volume ◽

Tumor Response ◽

Fractionated Stereotactic Radiotherapy ◽

Skull Base Meningioma ◽

Skull Base Meningiomas ◽

Simple Indicator ◽

Conventionally Fractionated

Abstract Objectives The purpose of this study was to assess the radiological change patterns in skull base meningiomas after conventionally fractionated stereotactic radiotherapy (CFSRT) to determine a simple and valid method to assess the tumor response. Materials and methods Forty-one patients with a benign skull base meningioma treated by CFSRT from March 2007 to August 2015 were retrospectively evaluated. We measured tumor volume (TV), long-axis diameter (LD), and short-axis diameter (SD) on both pre-treatment images and follow-up images of 1, 3, and 5 years after CFSRT, respectively. The paired t test was used to detect differences in the LD and SD change rates. Spearman’s correlation coefficients were calculated to evaluate relationships between the TV and the diameters changes. Results The number of available follow-up MRIs that was performed at 1, 3, and 5 years after the CFSRT was 41 (100%), 34 (83%), and 23 (56%), respectively. The change rates of SD were significantly higher than those of LD at every time point and more strongly correlated with the change rates of tumor volume at 3 and 5 years after CFSRT. Conclusions SD may be useful as a simple indicator of the tumor response for skull base meningioma after CFSRT. Key Points • The change rate in short-axis diameter is a useful and simple indicator of the response of skull base meningioma to conventionally fractionated stereotactic radiotherapy. • Conventionally fractionated stereotactic radiotherapy for skull base meningioma achieved excellent 5-year local control.

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Efficacy and Safety of Intraoperative Lumbar Drain in Endoscopic Skull Base Tumor Resection: A Meta-Analysis

Frontiers in Oncology ◽

10.3389/fonc.2020.00606 ◽

2020 ◽

Vol 10 ◽

Author(s):

Xiaoming Guo ◽

Yueli Zhu ◽

Yuan Hong

Keyword(s):

Skull Base ◽

Meta Analysis ◽

Tumor Resection ◽

Skull Base Tumor ◽

Efficacy And Safety ◽

Lumbar Drain

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Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases

Journal of Neurosurgery ◽

10.3171/2016.9.jns16997 ◽

2018 ◽

Vol 128 (2) ◽

pp. 631-638 ◽

Cited By ~ 6

Author(s):

Sampath Chandra Prasad ◽

Karthikeyan Balasubramanian ◽

Enrico Piccirillo ◽

Abdelkader Taibah ◽

Alessandra Russo ◽

...

Keyword(s):

Facial Nerve ◽

Skull Base ◽

Skull Base Tumor ◽

Nerve Function ◽

Postoperative Result ◽

Lateral Skull Base ◽

Number Of Patients ◽

Study Results ◽

Grade Iii

OBJECTIVEThe aim in this study was to review the technique and outcomes of cable graft interpositioning of the facial nerve (FN) in lateral skull base surgeries.METHODSThe authors retrospectively evaluated data from patients who had undergone cable graft interpositioning after nerve sacrifice during skull base tumor removal between June 1987 and May 2015. All patients had undergone lateral skull base approaches to remove tumors at a quaternary referral center in Italy. Facial nerve function was evaluated before and after surgery using the House-Brackmann (HB) grading system.RESULTSTwo hundred thirteen patients were eligible for study. The mean follow-up was 44.3 months. The most common pathology was vestibular schwannoma (83 cases [39%]), followed by FN tumor (67 cases [31%]). Facial nerve tumors had the highest incidence of nerve interruption (67 [66%] of 102 cases). Preoperative FN function was normal (HB Grade I) in 105 patients (49.3%) and mild (HB Grade II) in 19 (8.9%). At the last postoperative follow-up, 108 (50.7%) of the 213 patients had recovered to Grade III nerve function. Preoperative HB grading of the FN was found to have a significant effect on outcome (p = 0.002).CONCLUSIONSCable graft interpositioning is a convenient and well-accepted procedure for immediate restoration of the FN. The study results, over a large number of patients, showed that the stitch-less fibrin glue–aided coaptation technique yields good results. The best possible postoperative result achieved was an HB Grade III. The chances of a good postoperative result increase when FN function is normal preoperatively. Slow-growing tumors of the cerebellopontine angle had a favorable outcome after grafting.

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Quantitative and qualitative 5-aminolevulinic acid–induced protoporphyrin IX fluorescence in skull base meningiomas

Neurosurgical FOCUS ◽

10.3171/2011.2.focus1112 ◽

2011 ◽

Vol 30 (5) ◽

pp. E8 ◽

Cited By ~ 49

Author(s):

Kimon Bekelis ◽

Pablo A. Valdés ◽

Kadir Erkmen ◽

Frederic Leblond ◽

Anthony Kim ◽

...

Keyword(s):

Skull Base ◽

Aminolevulinic Acid ◽

Tumor Resection ◽

Protoporphyrin Ix ◽

Complete Resection ◽

Qualitative Assessment ◽

Neoplastic Tissue ◽

Surgical Microscope ◽

Skull Base Meningioma ◽

Skull Base Meningiomas

Object Complete resection of skull base meningiomas provides patients with the best chance for a cure; however, surgery is frequently difficult given the proximity of lesions to vital structures, such as cranial nerves, major vessels, and venous sinuses. Accurate discrimination between tumor and normal tissue is crucial for optimal tumor resection. Qualitative assessment of protoporphyrin IX (PpIX) fluorescence following the exogenous administration of 5-aminolevulinic acid (ALA) has demonstrated utility in malignant glioma resection but limited use in meningiomas. Here the authors demonstrate the use of ALA-induced PpIX fluorescence guidance in resecting a skull base meningioma and elaborate on the advantages and disadvantages provided by both quantitative and qualitative fluorescence methodologies in skull base meningioma resection. Methods A 52-year-old patient with a sphenoid wing WHO Grade I meningioma underwent tumor resection as part of an institutional review board–approved prospective study of fluorescence-guided resection. A surgical microscope modified for fluorescence imaging was used for the qualitative assessment of visible fluorescence, and an intraoperative probe for in situ fluorescence detection was utilized for quantitative measurements of PpIX. The authors assessed the detection capabilities of both the qualitative and quantitative fluorescence approaches. Results The patient harboring a sphenoid wing meningioma with intraorbital extension underwent radical resection of the tumor with both visibly and nonvisibly fluorescent regions. The patient underwent a complete resection without any complications. Some areas of the tumor demonstrated visible fluorescence. The quantitative probe detected neoplastic tissue better than the qualitative modified surgical microscope. The intraoperative probe was particularly useful in areas that did not reveal visible fluorescence, and tissue from these areas was confirmed as tumor following histopathological analysis. Conclusions Fluorescence-guided resection may be a useful adjunct in the resection of skull base meningiomas. The use of a quantitative intraoperative probe to detect PpIX concentration allows more accurate determination of neoplastic tissue in meningiomas than visible fluorescence and is readily applicable in areas, such as the skull base, where complete resection is critical but difficult because of the vital structures surrounding the pathology.

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The applicability of established clinical and histopathological risk factors for tumor recurrence during long-term postoperative care in meningioma patients

Neurosurgical Review ◽

10.1007/s10143-021-01697-w ◽

2021 ◽

Author(s):

Swenja Lüthge ◽

Dorothee Cäcilia Spille ◽

Andrea Ulrike Steinbicker ◽

Stephanie Schipmann ◽

Eileen Maria Susanne Streckert ◽

...

Keyword(s):

Risk Factors ◽

Skull Base ◽

Tumor Recurrence ◽

Skull Base Tumor ◽

High Grade ◽

Entire Cohort ◽

Long Term Follow Up ◽

Base Location

Abstract Risk factors to predict late-onset tumor recurrence in meningioma patients are urgently needed to schedule control intervals during long-term follow-up. We therefore analyzed the value of established risk factors for postoperative meningioma recurrence for the prediction of long-term prognosis. Correlations of clinical and histopathological variables with tumor relapse after 3, 5, and 10 years following microsurgery were analyzed in uni- and multivariate analyses, and compared to findings in the entire cohort. In the entire cohort (N = 1218), skull base location (HR: 1.51, 95%CI 1.05–2.16; p = .026), Simpson ≥ IV resections (HR: 2.41, 95%CI 1.52–3.84; p < .001), high-grade histology (HR: 3.70, 95%CI 2.50–5.47; p < .001), and male gender (HR: 1.46, 95%CI 1.01–2.11; p = .042) were independent risk factors for recurrence. Skull base location (HR: 1.92, 95%CI 1.17–3.17; p = .010 and HR: 2.02, 95%CI 1.04–3.95; p = .038) and high-grade histology (HR: 1.87, 95%CI 1.04–3.38; p = .038 and HR: 2.29, 95%CI 1.07–4.01; p = .034) but not subtotal resection (HR: 1.53, 95%CI .68–3.45; p = .303 and HR: 1.75, 95%CI .52–5.96; p = .369) remained correlated with recurrence after a recurrence-free follow-up of ≥ 3 and ≥ 5 years, respectively. Postoperative tumor volume was related with recurrence in general (p < .001) but not beyond a follow-up of ≥ 3 years (p > .05). In 147 patients with a follow-up of ≥ 10 years, ten recurrences occurred and were not correlated with any of the analyzed variables. Skull base tumor location and high-grade histology but not the extent of resection should be considered when scheduling the long-term follow-up after meningioma surgery. Recurrences ≥ 10 years after surgery are rare, and predictors are lacking.

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