Introduction: Surgical Approaches to the Cerebellopontine Angle video supplement

It is with great pleasure and pride we submit this Neurosurgical Focus video supplement on surgical approaches to the CPA angle. We had the privilege of viewing a multitude of videos describing surgical pathology and technique for lesions within the cerebellar pontine angle. The quality of work was outstanding! Hours of review were required to narrow down the videos for this supplement. This issue consists of 23 videos that we feel offer unique surgical pearls to the viewer in clinical evaluation, surgical planning and surgery, and outcomes. The videos are of different clinical problems and offer education for both the novice and expert skull base surgeon. We enjoyed being a part of this project, and feel very proud of its content and authors. We are confident that you will enjoy this supplement.

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Surgical Approaches to Cerebellopontine Angle: A 17-Year Experience of Our Skull Base Team

Otolaryngology ◽

10.1177/0194599814541629a287 ◽

2014 ◽

Vol 151 (1_suppl) ◽

pp. P228-P228

Author(s):

Isabel A. Correia ◽

Vítor Sousa ◽

Luis Marques-Pinto ◽

Victor Gonçalves ◽

Ezequiel Barros

Keyword(s):

Skull Base ◽

Cerebellopontine Angle ◽

Surgical Approaches

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Pediatric Skull Base Tumors

10.5772/intechopen.95605 ◽

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.

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Quality of life following endoscopic endonasal resection of anterior skull base cancers

Journal of Neurosurgery ◽

10.3171/2013.8.jns13296 ◽

2013 ◽

Vol 119 (6) ◽

pp. 1401-1409 ◽

Cited By ~ 48

Author(s):

Paolo Castelnuovo ◽

Davide Lepera ◽

Mario Turri-Zanoni ◽

Paolo Battaglia ◽

Andrea Bolzoni Villaret ◽

...

Keyword(s):

Quality Of Life ◽

Skull Base ◽

Tertiary Care ◽

Anterior Skull Base ◽

Surgical Approaches ◽

Partial Recovery ◽

Endoscopic Endonasal ◽

Significant Difference ◽

Study Population

Object For several decades, the exclusive purpose in the management of anterior skull base malignancies has been to increase survival rates. Recently, given the improved prognosis achieved, more attention has been focused on quality of life (QOL) as well. Producing data on QOL in anterior skull base cancers is hampered by the rarity of the neoplasm and the lack of specific questionnaires. The purpose of this study was to assess health-related QOL in a large and homogeneous cohort of patients affected by anterior skull base cancers who had undergone endoscopic endonasal resection. Methods The authors conducted a retrospective review of patients treated for sinonasal and skull base cancers via an endoscopic endonasal approach at two Italian tertiary care referral centers. All patients were asked to complete the Anterior Skull Base Surgery Questionnaire to evaluate their QOL before and 1 month and 1 year after surgical treatment. To assess which parameters affect QOL, the study population was divided into subgroups according to age, sex, stage of disease, surgical approach, and adjuvant therapy. Results One hundred fifty-three patients were enrolled in this study according to the adopted inclusion criteria. Overall QOL started at a score of 4.68 for the preoperative period, sharply decreased as far as a score of 4.03 during the 1st postoperative month, and rose again to a score of 4.59 over the course of 1 year after treatment, with a significant difference among the 3 values (p < 0.05). The specific symptoms and physical status domains registered poorer results at the 1-year assessment (4.00 and 4.71, respectively) than at the preoperative assessment (both domains 4.86), with a statistically significant reduction in scores (p < 0.05). Worse outcomes were associated with several variables: age > 60 years (difference of 0.21 points between the preoperative and 1-year period, p < 0.05), expanded surgical approaches with transnasal craniectomy (decrease of 0.20 points between the preoperative and 1-year period, p < 0.05), and postoperative radiotherapy (score of 4.53 at the 1-year period vs 4.70 in patients without any adjuvant treatment, p < 0.05). No statistically significant differences were found when analyzing the study population according to sex (p > 0.1) and T classification of disease at presentation (p > 0.05). Conclusions Radical endoscopic endonasal resection led to either complete or at least partial recovery of patient QOL within the 1st postoperative year.

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Surgical approaches and strategies for skull base chordomas

Neurosurgical FOCUS ◽

10.3171/foc.2001.10.3.10 ◽

2001 ◽

Vol 10 (3) ◽

pp. 1-7 ◽

Cited By ~ 32

Author(s):

Norihiko Tamaki ◽

Tatsuya Nagashima ◽

Kazumasa Ehara ◽

Yasuhiko Motooka ◽

Kanak Kanti Barua

Keyword(s):

Quality Of Life ◽

Skull Base ◽

Radical Resection ◽

Surgical Approaches ◽

Recurrence Free Survival ◽

Total Removal ◽

Free Survival ◽

Skull Base Chordomas

Object The management of chordomas involving the skull base continues to present a number of treatment-related problems. Recently, both radical resection and charged-particle irradiation or stereotactic radiosurgery have reportedly been found effective for tumor control and for promoting a better quality of life in patients. In this article the authors analyzed the outcomes in 17 patients with skull base chordomas who were surgically treated at Kobe University Hospital between 1972 and 2000. Methods Preoperative radiological examinations included magnetic resonance imaging, computerized tomography, angiography, and balloon occlusion test of the internal carotid artery. Among the various surgical approaches used to remove the tumor were the frontoorbitozygomatic, transmaxillary, transcondylar, transsphenoidal, and the transbasal. Total removal was achieved in two (12%), near-total removal in three (18%), subtotal removal in nine (52%), and partial removal in three patients (18%). Since 1990, chordomas have been radically resected via various skull base approaches; the combined total or near-total removal rate has been 80% in this period. Radical removal of the tumors has not led to an increased risk. At the final follow-up review (mean 59.5 month), 75% of the patients were still alive, and 25% had died of chordoma recurrence. The overall recurrence-free survival rate was 82% at 3 years and 51% at 5 years. The 5-year recurrence-free survival rate in the five patients who underwent the operation during the past decade was 77% (mean follow up of 5.2 years). In two patients with recurrent tumors who underwent radiosurgery, no evidence of tumor regrowth was demonstrated at 3 years posttreatment. Conclusions The authors suggest that for the treatment of skull base chordomas radical resection is a key factor for longer survival and improved quality of life. Patients with sufficiently small tumors, which show a favorable configuration and location, can be suitable candidates for stereotactic radiosurgery.

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Postoperative headache after surgical treatment of cerebellopontine angle tumors: a systematic review

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06627-6 ◽

2021 ◽

Author(s):

Louis Pogoda ◽

Jelle S. Nijdam ◽

Diederik P. J. Smeeing ◽

Eduard H. J. Voormolen ◽

Fuat Ziylan ◽

...

Keyword(s):

Systematic Review ◽

Cerebellopontine Angle ◽

Tumor Resection ◽

Surgical Approaches ◽

Initial Screening ◽

Tumor Removal ◽

Screening Process ◽

Significant Difference ◽

Postoperative Headache

Abstract Purpose Postoperative headache (POH) is a complication that occurs after surgical resection of cerebellopontine angle (CPA) tumors. The two most common surgical approaches are the translabyrinthine (TL), and retrosigmoid (RS) approach. The objective of this systematic review was to investigate whether POH occurs more frequently after RS compared to TL approaches. Methods A systematic search was conducted in Cochrane, Pubmed and Embase. Studies were included if POH after CPA tumor removal was reported and both surgical approaches were compared. The methodological quality of the studies was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Results In total, 3,942 unique articles were screened by title and abstract. After the initial screening process 63 articles were screened for relevance to the inquiry, of which seven studies were included. Three studies found no significant difference between both surgical approaches (p = 0.871, p = 0.120, p = 0.592). Three other studies found a lower rate of POH in the TL group compared to the RS group (p = 0.019, p < 0.001, p < 0.001). Another study showed a significantly lower POH rate in the TL group after one and six months (p = 0.006), but not after 1 year (p = 0.6). Conclusion The results of this systematic review show some evidence of a lower rate of POH in favor of the TL approach versus the RS approach for CPA tumor resection. Prospective research studies are needed to further investigate this finding.

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