scholarly journals Skull base surgery for tumors in children: long-term clinical and functional outcome

2013 ◽  
Vol 11 (5) ◽  
pp. 496-503 ◽  
Author(s):  
Caroline Hayhurst ◽  
Dawn Williams ◽  
Jawad Yousaf ◽  
David Richardson ◽  
Barry Pizer ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Hospital Stay ◽  
Functional Outcome ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Surgical Morbidity ◽  
Long Term Outcome ◽  
Csf Leakage

Object Skull base tumors in children are rare but require complex approaches with potential morbidity to the developing craniofacial skeleton, in addition to tumor-related morbidity. Reports of long-term clinical and functional outcome following skull base approaches in children are scarce. The authors report long-term outcome in children with tumors undergoing multidisciplinary skull base surgery. Methods A retrospective analysis was undertaken of children undergoing surgery at a single institution between 1998 and 2008 for benign and malignant lesions of the anterior, middle, or posterior cranial base. Patients with craniopharyngioma, pituitary tumors, and optic glioma were excluded. Histology, surgical morbidity, length of hospital stay, progression-free survival, and adjuvant therapy were recorded. Functional and cognitive outcome was assessed prospectively using the Late Effects Severity Score (LESS). Results Twenty-three children ranging in age from 13 months to 15 years underwent skull base approaches for resection of tumors during the study period. The median follow-up duration was 60 months. Tumor types included meningioma, schwannoma, rhabdomyosarcoma, neuroblastoma, angiofibroma, and chordoma. Complete resection was achieved in 12 patients (52%). Thirteen patients (57%) had benign histology. The median hospital stay was 7 days. There were 3 deaths, 1 perioperative and 2 from tumor progression. Two patients had CSF leakage (9%) and 2 developed meningitis. Two children (9%) had residual neurological deficit at last follow-up evaluation. Thirteen (59%) of 22 surviving patients received adjuvant therapy. The majority of the patients remain in mainstream education and 19 of the 20 surviving children have an LESS of 3 or lower. Conclusions Children tolerate complex skull base procedures well, with minimal surgical-related morbidity as well as good long-term tumor control rates and functional outcomes from maximal safe resection combined with adjuvant treatment when required.

Long-Term Olfactory Outcome after Nasoseptal Flap Reconstructions in Midline Skull Base Surgery

2017 ◽  
Vol 31 (5) ◽  
pp. 334-337 ◽  
Author(s):  
Michael B. Soyka ◽  
Carlo Serra ◽  
Luca Regli ◽  
Eva Meier ◽  
David Holzmann
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Nasoseptal Flap ◽  
Nasal Breathing ◽  
Donor Side ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up

Background The nasoseptal flap (NSF) is a universally used surgical technique to cover defects of the skull base after extended sinonasal surgery. Long-term follow-up of complications, sequelae, and smell function is largely unknown. Objective The main objective of this study was to investigate monorhinal olfaction after transsphenoidal skull base surgery. Methods Patients who underwent skull base surgery for midline lesions (craniopharyngioma and pituitary tumors) by using a NSF, also referred to as the Haddad flap, were assessed for their long-term outcome. Endoscopic examination was conducted and the bilateral “Sniffin’ Sticks” test was performed before surgery. Each side was tested separately in the postoperative follow-up consultation. Results Twenty patients were included in the study. No flap failures were observed. One anterior perforation and one small posterior septal perforation were found during long-term follow-up. None of the patients had nasal breathing impairment, whereas two patients had nose bleeds. A significant decrease in olfactory function was observed on the flap donor side in four patients (20%) compared with that observed in one patient (5%) on the opposite side. Conclusion NSF reconstructions for midline lesions were efficient and safe in the long term. Olfactory impairment on the donor side was frequently encountered. Although subclinical, these findings justified a monorhinal smell testing before surgery, which possibly prevented bilateral smell impairment in patient with preexisting single-sided olfactory loss.

scholarly journals Long-term outcome and quality of life after CNS cavernoma resection: eloquent vs. non-eloquent areas

2021 ◽  
Author(s):  
Loay Shoubash ◽  
Jörg Baldauf ◽  
Marc Matthes ◽  
Michael Kirsch ◽  
Matthias Rath ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
Preoperative Evaluation ◽  
Patient Counseling ◽  
Surgical Morbidity ◽  
Term Outcome ◽  
Long Term Outcome

AbstractThe aim of this study is to analyze the long-term quality of life after surgery of cavernoma. A monocentric retrospective study was conducted on 69 patients with cavernoma treated microsurgically between 2000 and 2016. The eloquence was adopted from Spetzler-Martin definition. A most recent follow-up was elicited between 2017 and 2019, in which the quality of life (QoL) was evaluated with the Short Form-12 questionnaire (SF12). Forty-one lesions were in eloquent group (EG), 22 in non-eloquent group (NEG), 3 in orbit, and 3 in the spinal cord. Postoperative worsening of the modified Rankin scale (mRS) occurred in 19.5% of cases in EG versus 4.5% in NEG. After a mean follow-up of 6.5 years (SD 4.6), the neurological status was better or unchanged compared to baseline in 85.4% of EG and 100% of NEG. Regarding QoL assessment of 44 patients (EG n = 27, NEG n = 14) attended the last follow-up. Patients after eloquent cavernoma resection reported a non-inferior QoL in most SF12 domains (except for physical role) compared to NEG. However, they reported general health perception inferior to norms, which was affected by the limited physical and emotional roles. At a late follow-up, the surgical morbidity was transient in the NEG and mostly recovered in the EG. The QoL comparison between eloquent and non-eloquent cavernomas created interesting and new data after prolonged follow-up. These results add value for decision-making as well as patient counseling for future encountered cases. Preoperative evaluation of QoL is recommended for future studies to assess QoL dynamics.

Abstract TP127: Mortality and Recurrence in Atherosclerotic Ischemic Stroke: Long-term Follow-up

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Miguel A Barboza ◽  
Rodrigo Uribe ◽  
Fabiola Serrano ◽  
Luis C Becerra-Pedraza ◽  
D. K Mantilla-Barbosa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Median Time ◽  
Smoking History ◽  
Stroke Recurrence ◽  
Active Smoking ◽  
Long Term Outcome ◽  
Long Term Follow Up

Background and purpose: Atherosclerotic ischemic stroke is the second most frequent etiology of stroke in the adult population. Functional outcome, mortality and recurrence of stroke rates on the long-term follow-up are poorly studied. This study investigates long-term outcome among patients with ischemic stroke secondary to atherosclerotic causality, and identifies the main factors associated with poor outcome, recurrence, and death. Methods: We analyzed data from our consecutive acute ischemic stroke database, over a period of 25 years (1990-2015). The endpoints were: bad outcome (Modified Rankin Score ≥3), recurrence and mortality at discharge, and final follow-up. Multivariate Cox and Kaplan-Meier analysis were used to estimate the probability of death and recurrence. Results: A total of 946 consecutive atherosclerotic stroke patients were included (571 [60.4%] males, median age 65 years [interquartile range 57-73 years] for the entire population); dyslipidemia (64.2%), hypertension (63.3%), diabetes (35.0%), and active smoking history (31.8%) were the most prevalent risk factors.After a median follow-up of 38 months (IQR 12-75 months), 59.3% patients had a bad outcome at discharge. A result of 26.1% had stroke recurrence (median time until recurrence: 9 months [IQR 12-84 months], with 12.9% cases presenting ≥2 recurrences), and 24.1% were dead (median time to death: 18.5 months [IQR 11-74 months]) at the final follow-up period. After multivariate adjustment, hypertension (HR 4.2, CI 95% 2.8-6.1; p<0.001) was the strongest predictor of recurrence. Additionally, diabetes (HR 2.6, CI 95% 2.0-3.5; p<0.001), bad functional outcome after recurrence (HR 2.3, CI 95% 1.9-2.9; p<0.001), age ≥65 years (HR 2.2, CI 95% 1.7-2.9; p<0.001), and active smoking (HR 1.8, CI 95% 1.3-2.3; p<0.001) were the strongest predictors of mortality. Conclusions: Atherosclerotic ischemic stroke has a high rate of recurrence, associated mainly with hypertension. Mortality is predicted by diabetes, bad functional outcome at recurrence, and older age.

Long-Term Outcome of Skull Base Surgery with Microvascular Reconstruction for Malignant Disease

2006 ◽  
Vol 118 (5) ◽  
pp. 1151-1158 ◽  
Author(s):  
S A. Reza Nouraei ◽  
Yasmin Ismail ◽  
Christopher J. Gerber ◽  
Peter J. Crawford ◽  
Neil R. McLean ◽  
...  
Keyword(s):  
Skull Base ◽  
Malignant Disease ◽  
Skull Base Surgery ◽  
Microvascular Reconstruction ◽  
Term Outcome ◽  
Long Term Outcome

Anterior Skull Base Surgery in Pediatrics—Neurologic Long-Term Outcome

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
O. Bozinov ◽  
C. Unsinn ◽  
M. Neidert ◽  
J.-K. Burkhardt ◽  
M. Grotzer
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Anterior Skull Base ◽  
Term Outcome ◽  
Long Term Outcome

Abstract W MP105: Long Term Stroke Outcome and Caregiving Among Mexican Americans (MA) and Non-Hispanic Whites (NHW): The Population-Based Brain Attack Surveillance in Corpus Christi (BASIC) Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Brisa N Sanchez ◽  
Lynda Lisabeth ◽  
Darin Zahuranec ◽  
Melinda A Cox ◽  
Nelda Garcia ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Repeated Measures ◽  
Mexican Americans ◽  
Caregiver Strain ◽  
Stroke Survivors ◽  
Basic Study ◽  
Long Term Outcome ◽  
Post Stroke

Background: Long term stroke outcomes in MA are understudied, and the role of informal caregiving and caregiver strain in this population is unknown. We report a pilot study of long-term outcomes in BASIC. Methods: Patients previously interviewed at 90 days post-stroke were invited to participate in a telephone survey related to their 6 or 12 month post-stroke activities of daily living (ADLs) during March-May 2013. ADL score (average of 7 items, range 1-4) was analyzed by self-reported ethnicity using repeated measures models. In a separate sample interviewed at 90 days, patients were asked about willingness to participate in longer term follow-up and a subset of caregivers responded to the caregiver strain index (CSI, range 1-13, higher is worse). Results: Among patients alive at the time of interview, 87% of 39 MA and 74% of 19 NHW participated in the 6 month interview, and 84% of 32 MA and 88% of 8 NHW participated in the 12 month interview. No patients refused at either time point; the remainder could not be contacted. The figure shows trajectories of ADL score by ethnicity, and worsening scores among MA over time. Interest in longer-term follow-up was high (96% of 25 NHWs and 97% of 38 MAs). Caregivers of MA stroke survivors were most often children (41%) followed by spouses (36%), but were spouses (43%) followed by children (29%) for NHWs. Of 29 caregivers interviewed, 54% of MA and 57% of NHW reported being strained (CSI≥7). Caregiver strain was associated with 90-day ADL score: prevalence ratio = 1.34, 95%CI (1.01, 1.76) for 1 unit increase in ADL score. Conclusions: Our data demonstrate the feasibility of recruiting MA stroke survivors for long-term outcome assessments and suggests that MAs have worse functional outcome and greater functional declines than NHWs. The informal caregiver burden is related to functional outcome and is high in both ethnic groups.

Synthes Skull Base Surgery Award 113 Long-term Follow-up of Male Patients with Prolactinomas

Neurosurgery ◽  
2014 ◽  
Vol 61 ◽  
pp. 196
Author(s):  
Lukas Andereggen ◽  
Janine Frey ◽  
Robert H. Andres ◽  
Marwan El-Koussy ◽  
Emanuel Christ
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Long Term Follow Up ◽  
Male Patients

scholarly journals Management and Outcome of Hindfoot Trauma With Concomitant Talar Head Injury

2021 ◽  
pp. 107110072098002
Author(s):  
Esmee Wilhelmina Maria Engelmann ◽  
Olivier Wijers ◽  
Jelle Posthuma ◽  
Tim Schepers
Keyword(s):  
Functional Outcome ◽  
Case Series ◽  
Ankle Injuries ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Long Term Outcome ◽  
Talar Head ◽  
The Mean

Background: Talar head fractures account for 2.6% to 10% of all talar fractures and are often associated with concomitant musculoskeletal injuries. The current literature only describes a total of 14 patients with talar head fractures and, with that, guidelines for management are lacking. The aim of the current study was to evaluate the management and long-term outcome of patients who have hindfoot trauma with concomitant talar head fractures. Methods: This study includes a retrospective cohort of patients with talar head fractures. Patient characteristics, trauma mechanism, fracture characteristics, treatment, follow-up, and complications were reported. Functional outcome was assessed using the Foot Function Index (FFI) and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Quality of life was measured by the EuroQol-5D (EQ-5D). Twenty-one patients with acute fractures of the talar head were identified. The mean follow-up time was 4.9 years. Results: All patients sustained additional ipsilateral foot and/or ankle injuries. Fifteen patients had operative management of their talar head fracture. There were no postoperative wound infections and no cases of avascular necrosis. All fractures united, and 29% of patients developed posttraumatic osteoarthritis. The overall mean FFI score index was 34.2, and the mean AOFAS score was 70.7. The mean EQ-5D index score was 0.74. Conclusion: Talar head fractures always coincided with other (foot) fractures. Management and long-term functional outcome were affected by the extent of associated injuries. Due to the low incidence and high complexity of talar head fractures, early referral to dedicated foot surgeons and centralization of complex foot surgery is recommended. Level of Evidence: Level IV, retrospective case series.

scholarly journals PC3 - 141 Long-Term Results of Stereotactic Radiosurgery for Skull Base Meningiomas

2016 ◽  
Vol 43 (S4) ◽  
pp. S21-S21
Author(s):  
O. Cohen-Inbar
Keyword(s):  
Tumor Progression ◽  
Skull Base ◽  
Clinical Improvement ◽  
Tumor Volume ◽  
Long Term Results ◽  
Tumor Control ◽  
Long Term Outcome ◽  
Skull Base Meningiomas

Gamma knife radiosurgery (GKRS) is well-established in the management of inaccessible, recurrent, or residual benign skull base meningiomas. Most series report clinical outcome parameters and complications in the short -intermediate period after radiosurgery. Reports of long-term tumor control and neurological status are still lacking. Objective: We report the presentation, treatment, and long-term outcome of skull base meningiomas after GKRS. Methods: From a prospectively collected IRB approved database, we selected patients with a WHO grade I skull base meningioma treated with a single-session GKRS and a minimum of 60 months follow up. 135 patients, 54.1% males (n=73) form the cohort. Median age was 54 years (19-80). Median tumor volume was 4.7 cm3 (0.5-23). Median margin dose was 15 Gy (7.5-36). Median follow up was 102.5 months (60.1-235.4). Patient and tumor characteristics were assessed to determine predictors of neurological function and tumor progression. Results: At last follow up, tumor volume control was achieved in 88.1% (n=119). Post-GKRS clinical improvement or stability was reported in 61.5%. The 5, 10, and 15 years actuarial progression free survival rates are 100%, 95.4%, and 68.8%, respectively. Favorable outcome (both tumor control and clinical preservation/improvement) was attained in 60.8% (n=79). Pre-GKRS performance status (KPS) was shown to influence tumor progression (p=0.0001) and post-GKRS clinical improvement / preservation (p=0.003). Conclusion: GKRS offers a highly durable rate of tumor control for WHO-I skull base meningiomas, with an acceptably low incidence of neurological deficits. KPS at the time of radiosurgery serves as a reliable long-term predictor of overall outcome.

Long-term impact of pediatric endoscopic endonasal skull base surgery on midface growth

2019 ◽  
Vol 23 (4) ◽  
pp. 523-530 ◽  
Author(s):  
Wendy Chen ◽  
Paul A. Gardner ◽  
Barton F. Branstetter ◽  
Shih-Dun Liu ◽  
Yue Fang Chang ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Cranial Base ◽  
Early Surgery ◽  
Endoscopic Endonasal ◽  
Anterior Maxilla ◽  
Surgery Group ◽  
Significant Difference

OBJECTIVECranial base development plays a large role in anterior and vertical maxillary growth through 7 years of age, and the effect of early endonasal cranial base surgery on midface growth is unknown. The authors present their experience with pediatric endoscopic endonasal surgery (EES) and long-term midface growth.METHODSThis is a retrospective review of cases where EES was performed from 2000 to 2016. Patients who underwent their first EES of the skull base before age 7 (prior to cranial suture fusion) and had a complete set of pre- and postoperative imaging studies (CT or MRI) with at least 1 year of follow-up were included. A radiologist performed measurements (sella-nasion [S-N] distance and angles between the sella, nasion, and the most concave points of the anterior maxilla [A point] or anterior mandibular synthesis [B point], the SNA, SNB, and ANB angles), which were compared to age- and sex-matched Bolton standards. A Z-score test was used; significance was set at p < 0.05.RESULTSThe early surgery group had 11 patients, with an average follow-up of 5 years; the late surgery group had 33 patients. Most tumors were benign; 1 patient with a panclival arteriovenous malformation was a significant outlier for all measurements. Comparing the measurements obtained in the early surgery group to Bolton standard norms, the authors found no significant difference in postoperative SNA (p = 0.10), SNB (p = 0.14), or ANB (0.67) angles. The S-N distance was reduced both pre- and postoperatively (SD 1.5, p = 0.01 and p = 0.009). Sex had no significant effect. Compared to patients who had surgery after the age of 7 years, the early surgery group demonstrated no significant difference in pre- to postoperative changes with regard to S-N distance (p = 0.87), SNA angle (p = 0.89), or ANB angle (p = 0.14). Lesion type (craniopharyngioma, angiofibroma, and other types) had no significant effect in either age group.CONCLUSIONSThough our cohort of patients with skull base lesions demonstrated some abnormal measurements in the maxillary-mandibular relationship before their operation, their postoperative cephalometrics fell within the normal range and showed no significant difference from those of patients who underwent operations at an older age. Therefore, there appears to be no evidence of impact of endoscopic endonasal skull base surgery on craniofacial development within the growth period studied.

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