scholarly journals Supraorbital and mini-pterional keyhole craniotomies for brain tumors: a clinical and anatomical comparison of indications and outcomes in 204 cases

2021 ◽  
pp. 1-11
Author(s):  
Michael B. Avery ◽  
Regin Jay Mallari ◽  
Garni Barkhoudarian ◽  
Daniel F. Kelly
Keyword(s):  
Brain Tumors ◽  
Tumor Resection ◽  
Middle Cranial Fossa ◽  
Extent Of Resection ◽  
Sylvian Fissure ◽  
Anterior Cranial Fossa ◽  
Posterior Aspect ◽  
Surgical Access ◽  
Parasellar Region ◽  
Cranial Fossa

OBJECTIVE The authors’ objective was to compare the indications, outcomes, and anatomical limits of supraorbital (SO) and mini-pterional (MP) craniotomies in patients with intra- and extraaxial brain tumors, and to assess approach selection, utility of endoscopy, and surgical field overlap. METHODS A retrospective analysis was conducted of all brain tumor patients who underwent an SO or MP approach. The analyzed characteristics included pathology, endoscopy use, extent of resection, length of stay (LOS), and complications. On the basis of preoperative MRI data, tumor heatmaps were constructed to compare surgical access provided by both routes, including coronal projection heatmaps for parasellar tumors. RESULTS From 2007 to 2020, 158 patients underwent 173 (84.8%) SO craniotomies and 30 patients underwent 31 (15.2%) MP craniotomies; 71 (34.8%) procedures were reoperations. Of these 204 operations, 110 (63.6%) SO and 21 (67.7%) MP approaches were for extraaxial tumors (meningiomas in 65% and 76.2%, respectively). Gliomas and metastases together represented 84.1% and 70% of intraaxial tumors accessed with SO and MP approaches, respectively. Overall, 56.1% of tumors accessed with the SO approach and 41.9% of those accessed with the MP approach were in the parasellar region. Axial projection heatmaps showed that SO access extended along the entire ipsilateral and medial contralateral anterior cranial fossa, parasellar region, ipsilateral sylvian fissure, medial middle cranial fossa, and anterior midbrain, whereas MP access was limited to the ipsilateral middle cranial fossa, sylvian fissure, lateral parasellar region, and posterior aspect of anterior cranial fossa. Coronal projection heatmaps showed that parasellar access extended further superiorly with the SO approach compared with that of the MP approach. Endoscopy was utilized in 98 (56.6%) SO craniotomies and 7 (22.6%) MP craniotomies, with further tumor resection in 48 (49%) and 5 (71.4%) cases, respectively. Endoscope-assisted tumor removal was clustered in areas that were generally at farther distances from the craniotomy or in angled locations such as the cribriform plate region where microscopic visualization is limited. Gross-total or near-total resection was achieved in 120/173 (69%) SO approaches and 21/31 (68%) MP approaches. Major complications occurred in 11 (6.4%) SO approaches and 1 (3.2%) MP approach (p = 0.49). The median LOS decreased to 2 days in the last 2 years of the study. CONCLUSIONS This clinical experience suggests the SO and MP craniotomies are versatile, safe, and complementary approaches for tumors located in the anterior and middle cranial fossae and perisylvian and parasellar regions. The SO route, used in 85% of cases, achieved greater overall reach than the MP route. Both approaches may benefit from expanded visualization with endoscopy.

Preservation of hearing in surgery for acoustic neuromas

1993 ◽  
Vol 78 (6) ◽  
pp. 864-870 ◽  
Author(s):  
Michael E. Glasscock ◽  
James W. Hays ◽  
Lloyd B. Minor ◽  
David S. Haynes ◽  
Vincent N. Carrasco
Keyword(s):  
Hearing Preservation ◽  
Middle Cranial Fossa ◽  
Senior Author ◽  
Speech Discrimination ◽  
Content Type ◽  
Auditory Evoked Response ◽  
Surgical Access ◽  
Acoustic Neuromas ◽  
Cranial Fossa ◽  
Fine Print

✓Preservation of hearing was attempted in 161 cases of histologically confirmed acoustic neuroma removed by the senior author between January 1, 1970, and September 30, 1991. There were 136 patients with unilateral tumors: 22 patients had bilateral tumors (neurofibromatosis 2) and underwent a total of 25 procedures. Hearing was initially preserved in 35% of patients with unilateral tumors and in 44% of those with bilateral tumors. Results are reported in terms of pre- and postoperative pure tone average and speech discrimination scores. Surgical access to the tumor was obtained via middle cranial fossa and suboccipital approaches. The latter has been used more often over the past 5 years because of a lower associated incidence of transient facial paresis. Persistent postoperative headaches have been the most common complication following the suboccipital approach. The results of preoperative brain-stem auditory evoked response (BAER) studies were useful in predicting the outcome of hearing preservation attempts. Patients with intact BAER waveform morphology and normal or delayed latencies had a higher probability of hearing preservation in comparison to those with abnormal preoperative BAER morphology.

scholarly journals Picture Quiz: An unusual cause of headache – Answers

2005 ◽  
Vol 4 (1) ◽  
pp. 36-36
Author(s):  
Satyen Shukla ◽  
◽  
V Anand ◽  
Keyword(s):  
Middle Cranial Fossa ◽  
Leptomeningeal Carcinomatosis ◽  
Sylvian Fissure ◽  
Medial Aspect ◽  
Cranial Fossa ◽  
Suprasellar Cistern ◽  
The Right ◽  
4Th Ventricle

The MRI images (see page 27) show lobulated meningeal thickening along the medial aspect of the right middle cranial fossa extending into sylvian fissure, suprasellar cistern, interpenduncular cistern and roof of 4th ventricle which enhanced on postcontrast images. These appearances are diagnostic of metastatic leptomeningeal carcinomatosis.

scholarly journals Three-dimensional assessment of the middle cranial fossa and central skull base following Herbst appliance treatment

2018 ◽  
Vol 88 (6) ◽  
pp. 757-764
Author(s):  
Karine Sayure Okano ◽  
Lucia Helena Soares Cevidanes ◽  
Paula Loureiro Cheib ◽  
Antonio Carlos de Oliveira Ruellas ◽  
Marília Yatabe ◽  
...  
Keyword(s):  
Skull Base ◽  
Visual Analysis ◽  
Three Dimensional ◽  
Middle Cranial Fossa ◽  
Spatial Behavior ◽  
Anterior Cranial Fossa ◽  
Control Group ◽  
Anatomical Landmarks ◽  
Herbst Appliance ◽  
Cranial Fossa

ABSTRACT Objectives: The purpose of this three-dimensional (3D) study was to assess retrospectively the middle cranial fossa and central skull base of patients treated with the Herbst appliance (HA). Materials and Methods: 3D surface virtual models of 40 Class II, division 1 malocclusion patients were generated from cone-beam computed tomography (CBCT) acquired before treatment (T0) and after 8 months of HA treatment (T1). T0 and T1 3D models were superimposed volumetrically at the anterior cranial fossa. Twenty subjects who had been treated with the Herbst appliance (HAG) were compared to 20 subjects who were not treated orthopedically. The latter group served as a comparison control group (CG). Quantitative assessments of the location and directional changes were made with linear and angular measurements between anatomical landmarks. Qualitative assessments of the spatial behavior of the middle cranial fossa and central skull base relative to the anterior cranial fossa were displayed graphically for visualization with color maps and semitransparent overlays. Non-parametric tests were performed to compare the between the HAG and CG. Results: Point-to-point linear measurements and skeletal rotation (pitch, roll, and yaw) changes were very small along the observational period and were not significantly different between HAG and CG. Visual analysis of color maps and overlays confirmed that no changes in the cranial base were associated with HA. Conclusions: HA therapy did not produce clinically significant changes in the middle cranial fossa and central skull base.

scholarly journals Improving maximal safe brain tumor resection with photoacoustic remote sensing microscopy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Benjamin R. Ecclestone ◽  
Kevan Bell ◽  
Saad Abbasi ◽  
Deepak Dinakaran ◽  
Frank K. H. van Landeghem ◽  
...  
Keyword(s):  
Remote Sensing ◽  
Brain Tumors ◽  
Survival Rates ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Cancer Type ◽  
Label Free ◽  
Current Standard ◽  
Diagnostic Quality ◽  
Brain Tissues

Abstract Malignant brain tumors are among the deadliest neoplasms with the lowest survival rates of any cancer type. In considering surgical tumor resection, suboptimal extent of resection is linked to poor clinical outcomes and lower overall survival rates. Currently available tools for intraoperative histopathological assessment require an average of 20 min processing and are of limited diagnostic quality for guiding surgeries. Consequently, there is an unaddressed need for a rapid imaging technique to guide maximal resection of brain tumors. Working towards this goal, presented here is an all optical non-contact label-free reflection mode photoacoustic remote sensing (PARS) microscope. By using a tunable excitation laser, PARS takes advantage of the endogenous optical absorption peaks of DNA and cytoplasm to achieve virtual contrast analogous to standard hematoxylin and eosin (H&E) staining. In conjunction, a fast 266 nm excitation is used to generate large grossing scans and rapidly assess small fields in real-time with hematoxylin-like contrast. Images obtained using this technique show comparable quality and contrast to the current standard for histopathological assessment of brain tissues. Using the proposed method, rapid, high-throughput, histological-like imaging was achieved in unstained brain tissues, indicating PARS’ utility for intraoperative guidance to improve extent of surgical resection.

Comparison of Motor Outcome in Patients Undergoing Awake vs General Anesthesia Surgery for Brain Tumors Located Within or Adjacent to the Motor Pathways

Neurosurgery ◽  
2019 ◽  
Vol 85 (3) ◽  
pp. E470-E476 ◽  
Author(s):  
Roni Zelitzki ◽  
Akiva Korn ◽  
Eti Arial ◽  
Carmit Ben-Harosh ◽  
Zvi Ram ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Brain Tumors ◽  
General Anesthesia ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Awake Craniotomy ◽  
Motor Deficits ◽  
Surgical Removal ◽  
Motor Outcome

Abstract BACKGROUND Surgical removal of intra-axial brain tumors aims at maximal tumor resection while preserving function. The potential benefit of awake craniotomy over craniotomy under general anesthesia (GA) for motor preservation is yet unknown. OBJECTIVE To compare the clinical outcomes of patients who underwent surgery for perirolandic tumors while either awake or under GA. METHODS Between 2004 and 2015, 1126 patients underwent surgical resection of newly diagnosed intra-axial tumors in a single institution. Data from 85 patients (44 awake, 41 GA) with full dataset who underwent resections for perirolandic tumors were retrospectively analyzed. RESULTS Identification of the motor cortex required significantly higher stimulation thresholds in anesthetized patients (9.1 ± 4 vs 6.2 ± 2.7 mA for awake patients, P = .0008). There was no group difference in the subcortical threshold for motor response used to assess the proximity of the lesion to the corticospinal (pyramidal) tract. High-grade gliomas were the most commonly treated pathology. The extent of resection and residual tumor volume were not different between groups. Postoperative motor deficits were more common in the anesthetized patients at 1 wk (P = .046), but no difference between the groups was detected at 3 mo. Patients in the GA group had a longer mean length of hospitalization (10.3 vs 6.7 d for the awake group, P = .003). CONCLUSION Awake craniotomy results in a better early postoperative motor outcome and shorter hospitalization compared with patients who underwent the same surgery under GA. The finding of higher cortical thresholds for the identification of the motor cortex in anesthetized patients may suggest an inhibitory effect of anesthetic agents on motor function.

scholarly journals Clinical Application of Shear Wave Elastography for Assisting Brain Tumor Resection

2021 ◽  
Vol 11 ◽  
Author(s):  
Huan Wee Chan ◽  
Christopher Uff ◽  
Aabir Chakraborty ◽  
Neil Dorward ◽  
Jeffrey Colin Bamber
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Tumor Resection ◽  
Shear Wave Elastography ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Normal Brain ◽  
Mri Scan ◽  
Significant Difference ◽  
Brain Tumor Resection

BackgroundThe clinical outcomes for brain tumor resection have been shown to be significantly improved with increased extent of resection. To achieve this, neurosurgeons employ different intra-operative tools to improve the extent of resection of brain tumors, including ultrasound, CT, and MRI. Young’s modulus (YM) of brain tumors have been shown to be different from normal brain but the accuracy of SWE in assisting brain tumor resection has not been reported.AimsTo determine the accuracy of SWE in detecting brain tumor residual using post-operative MRI scan as “gold standard”.MethodsThirty-four patients (aged 1–62 years, M:F = 15:20) with brain tumors were recruited into the study. The intraoperative SWE scans were performed using Aixplorer® (SuperSonic Imagine, France) using a sector transducer (SE12-3) and a linear transducer (SL15-4) with a bandwidth of 3 to 12 MHz and 4 to 15 MHz, respectively, using the SWE mode. The scans were performed prior, during and after brain tumor resection. The presence of residual tumor was determined by the surgeon, ultrasound (US) B-mode and SWE. This was compared with the presence of residual tumor on post-operative MRI scan.ResultsThe YM of the brain tumors correlated significantly with surgeons’ findings (ρ = 0.845, p < 0.001). The sensitivities of residual tumor detection by the surgeon, US B-mode and SWE were 36%, 73%, and 94%, respectively, while their specificities were 100%, 63%, and 77%, respectively. There was no significant difference between detection of residual tumor by SWE, US B-mode, and MRI. SWE and MRI were significantly better than the surgeon’s detection of residual tumor (p = 0.001 and p < 0.001, respectively).ConclusionsSWE had a higher sensitivity in detecting residual tumor than the surgeons (94% vs. 36%). However, the surgeons had a higher specificity than SWE (100% vs. 77%). Therefore, using SWE in combination with surgeon’s opinion may optimize the detection of residual tumor, and hence improve the extent of brain tumor resection.

The impact of intra-operative high field magnetic resonance imaging on clinical decision making during oncologic neurosurgical procedures

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19599-19599
Author(s):  
J. S. Weinberg ◽  
K. Shah ◽  
G. Rao ◽  
E. F. Jackson ◽  
D. Suki ◽  
...  
Keyword(s):  
Decision Making ◽  
Brain Tumor ◽  
Brain Tumors ◽  
High Field ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Preoperative Imaging ◽  
Neurosurgical Procedures ◽  
The Impact

19599 Background: Existing image guided surgical (IGS) technology used during resection of brain tumors is based on preoperative imaging modalities and are limited by their inability to demonstrate extent of resection (EOR) and compensate for anatomical changes which occur as a result of surgical manipulation (e.g. brain shift, tumor resection, spinal fluid loss). Having the ability to perform MRI during brain tumor surgery obviates many of these limitations. The purpose of this study was to determine the impact of intra-operative imaging with a high field MRI on brain tumor resection. Methods: Since September 2006, a total of 23 patients with brain tumors underwent resection at The University of Texas M. D. Anderson Cancer Center with intra-operative MR guidance (BrainLAB IGS system integrated with a 1.5T Siemens Espree scanner). For each patient, appropriate imaging was performed prior to craniotomy. Resection was then performed using image guidance. Surgeons completed a questionnaire documenting the reason for the scan and provided an estimation of EOR prior to and after the intraoperative scan. Multiple intraoperative scans were performed at the discretion of the operating surgeon. Results: In 23 patients, 25 scans were performed. The patients had a diagnosis of glioma (21), lymphoma (1), and schwannoma (1). Reasons for performing a scan included: evaluate EOR in 23 (92%) or update the IGS system in 2 (8%). Surgeons indicated in 21/23 (91%) scans performed to evaluate the extent of resection that they would have terminated the surgery prior to the scan. In 9/21 cases (43%), further surgery was performed after the scan to maximize EOR. In 10/24 (42%) cases, the pre-scan estimate of residual tumor matched the post-scan amount. The amount of residual tumor was correctly assessed (within 10%) prior to review of the MRI in 19/24 cases. The correlation between the pre-scan estimation of residual tumor and actual post-scan tumor was high (correlation coefficient 0.81, p<0.05). Conclusions: High field intra- operative MRI with high spatial resolution is a useful adjunct to a neurosurgical oncology practice and alters surgical decision making in a significant number of cases. [Table: see text]

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