Cranial chordomas: results of radical excision

2001 ◽  
Vol 10 (3) ◽  
pp. 1-7 ◽  
Author(s):  
Chandranath Sen ◽  
Aymara Triana
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Recurrent Disease ◽  
Postoperative Radiotherapy ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Residual Tumor ◽  
Radical Excision ◽  
Proton Beam Irradiation ◽  
Csf Leakage

Object The authors analyze their experience with the treatment of 29 patients who underwent radical excision of skull base chordomas. Methods Modern skull base surgical techniques were used in all patients who were treated between August 1991 and July 2000. The degree of tumor resection was gauged according to intraoperative inspection and postoperative high-resolution imaging findings. There were 21 patients with primary disease and eight with recurrent disease. Total resection was accomplished in 18 patients. Five patients had undergone radiotherapy prior to the present surgery, and an additional eight patients underwent postoperative radiotherapy. There were no surgery-related deaths. In five patients who died of the disease, surgery and radiotherapy had failed to effect a cure. Two of the remaining patients are alive with recurrent disease, and there is questionable evidence of recurrence in another patient. All 24 patients are functioning independently. Cranial nerve impairment was the most common postoperative deficit, followed by cerebrospinal fluid (CSF) leakage and infection. Conclusions The use of skull base techiniques in radical surgery provides an opportunity to excise the tumor and the involved bone. In most cases the procedure-related cranial nerve deficits improve over time. The complications of CSF leakage and infection can be minimized and are preventable. Proton beam irradiation is an excellent adjuvant treatment but is reserved for patients with definite tumor recurrence or residual tumor that can be identified on the imaging studies.

scholarly journals Lateral skull base malignancies

2002 ◽  
Vol 12 (5) ◽  
pp. 1-4 ◽  
Author(s):  
Benjamin M. McGrew ◽  
C. Gary Jackson ◽  
Raquel A. Redtfeldt
Keyword(s):  
Skull Base ◽  
Postoperative Radiotherapy ◽  
Survival Rates ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Lateral Skull Base ◽  
The Mean ◽  
Poor Outcomes

Object Historically poor outcomes have been characteristic in patients with lateral skull base malignancies. As advances in skull base surgical techniques have been made, complete resection has increasingly been achieved. This has resulted in improved survival rates and local tumor control. Methods The authors performed a retrospective review of 95 patients treated for lateral skull base malignancies. The mean age of the patients was 49.4 years. There were 44 females and 51 males. The mean follow-up period was 50 months. Resection was performed in all patients, and postoperative radiotherapy was undertaken in 54% of the cases. Local disease control was maintained in 73% of the patients. Tumor involvement of the facial nerve and intracranial tumor extension did not jeopardize the rate of local control. Conclusions Despite the fact that technical advances in skull base surgery have resulted in a higher incidence of complete tumor resection and improved survival rates, a respect for the poor prognosis historically associated with lateral skull base malignancies should be maintained and treatment should be appropriately aggressive.

Clival chordomas: clinical management, results, and complications in 71 patients

2010 ◽  
Vol 113 (5) ◽  
pp. 1059-1071 ◽  
Author(s):  
Chandranath Sen ◽  
Aymara I. Triana ◽  
Niklas Berglind ◽  
James Godbold ◽  
Raj K. Shrivastava
Keyword(s):  
Skull Base ◽  
Proton Beam ◽  
Positive Impact ◽  
Tumor Resection ◽  
Radical Resection ◽  
Surgical Approaches ◽  
Malignant Neoplasms ◽  
Radical Excision ◽  
Number Of Patients ◽  
Csf Leakage

Object Chordomas are rare malignant neoplasms arising predominantly at the sacrum and skull base. They are uniformly lethal unless treated with aggressive resection and proton beam irradiation. The authors present results of the surgical management of a large number of patients with clivus chordomas. Factors that influence the surgeon's ability to achieve radical tumor resection are also evaluated. Methods Between 1991 and 2005, 71 patients with clivus chordomas underwent surgery. The average follow-up was 66 months (median 60 months, range 3–189 months). Sixty-five patients had complete records that were analyzed in the present report. Thirty-five percent of them had undergone surgery before being treated by the authors. They were evaluated with MR imaging and CT scanning and underwent surgery utilizing a variety of skull base techniques aimed at achieving radical excision. Many also underwent postoperative radiation, usually in the form of proton beam therapy. The patients were followed up with serial imaging at regular intervals as well as with neurological evaluation. Results Radical tumor resection was achieved in 58% of the group. The overall 5-year survival rate was 75%. Radical resection had a positive impact on survival. The ability to achieve radical resection was dependent on the preoperative tumor volume and the number of anatomical areas involved by the tumor. Cranial nerve impairment and CSF leakage were the most frequent postoperative complications. Conclusions Radical excision is the ideal surgical goal in the treatment of clival chordomas and can be achieved with reasonable risks. Several different surgical approaches may be necessary to accomplish this.

Transtemporal Skull Base Surgery

1995 ◽  
Vol 112 (5) ◽  
pp. P119-P119
Author(s):  
C. Gary Jackson ◽  
James L. Netterville
Keyword(s):  
Functional Outcome ◽  
Skull Base ◽  
Cranial Nerve ◽  
Skull Base Surgery ◽  
Tumor Resection ◽  
Operative Management ◽  
Educational Objectives ◽  
Defect Reconstruction ◽  
Lateral Skull Base

Educational objectives: To become familiar with diagnostic and operative management principles for lateral skull-base disease and its ICE, emphasizing not only multi-disciplinary tumor resection but functional outcome and to be familiar with concepts of defect reconstruction and cranial nerve rehabilitation that maximize postresection functional outcome.

scholarly journals Intraoperative magnetic resonance imaging–assisted transsphenoidal pituitary surgery in patients with acromegaly

2010 ◽  
Vol 29 (4) ◽  
pp. E9 ◽  
Author(s):  
David Bellut ◽  
Martin Hlavica ◽  
Christoph Schmid ◽  
René L. Bernays
Keyword(s):  
Pituitary Adenomas ◽  
High Field ◽  
Remission Rate ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Residual Tumor ◽  
Imaging Results ◽  
Duration Of Surgery

Object Acromegaly is a rare disease, usually caused by a growth hormone (GH)–producing pituitary adenoma. If untreated, severe cardiovascular, metabolic, cosmetic, and orthopedic disturbances will result. Surgery is generally recommended as the first-line treatment. Transsphenoidal surgical techniques were recently extended by the introduction of intraoperative MR (iMR) imaging. In the present study, the contribution of ultra-low-field (0.15-T) iMR imaging to tumor resection, complication avoidance, and endocrinological and neurological outcome was analyzed. Methods A series of 39 consecutive transsphenoidal iMR imaging–guided (using the PoleStar N20 device) surgical procedures performed between September 2005 and August 2009 for GH-producing pituitary adenomas was retrospectively analyzed. In addition to the patients' clinical data, the following criteria were evaluated independently: duration of surgery; length of hospital stay; endocrinological parameters; results of neurological examinations; and pre-, post-, and intraoperative MR imaging results. Results Thirty-seven patients with acromegaly underwent 39 transsphenoidal surgeries for pituitary adenomas. During a median follow-up period of 30 months (range 9–56 months), the remission rate was 73.5% in 34 patients with primary surgery and 20% in 5 cases with previous surgery; overall the remission rate was 66.7%. There were no serious postoperative complications. Detection of tumor remnant on iMR imaging led to a 5.1% increase in remission rate. Conclusions In this largest study to date of GH-producing pituitary adenomas in which iMR imaging–guided transsphenoidal surgery was analyzed, the results suggest that this method is a highly effective and safe treatment modality, even compared with previously published surgical series in which high-field iMR imaging was used. Limitations of iMR imaging are the detection of small residual tumor in the cavernous sinus and persisting disease that could not be observed, even on diagnostic high-field follow-up MR images. This points to a general limitation regarding remission rates that can be achieved using iMR imaging. Nevertheless, iMR imaging led to an increase of the remission rate in this study.

scholarly journals Multimodal navigated skull base tumor resection using image-based vascular and cranial nerve segmentation: A prospective pilot study

2015 ◽  
Vol 6 (1) ◽  
pp. 172 ◽  
Author(s):  
Parviz Dolati ◽  
Abdulkerim Gokoglu ◽  
Daniel Eichberg ◽  
Amir Zamani ◽  
Alexandra Golby ◽  
...  
Keyword(s):  
Pilot Study ◽  
Skull Base ◽  
Cranial Nerve ◽  
Tumor Resection ◽  
Skull Base Tumor ◽  
Prospective Pilot Study

scholarly journals Jugular foramen tumors: diagnosis and treatment

2004 ◽  
Vol 17 (2) ◽  
pp. 31-40 ◽  
Author(s):  
Ricardo Ramina ◽  
Joao Jarney Maniglia ◽  
Yvens Barbosa Fernandes ◽  
Jorge Rizzato Paschoal ◽  
Leopoldo Nizan Pfeilsticker ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Skull Base ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Lower Cranial Nerve ◽  
Nerve Paralysis ◽  
Great Auricular Nerve ◽  
Csf Leakage ◽  
Nerve Anastomosis

Object Jugular foramen tumors are rare skull base lesions that present diagnostic and complex management problems. The purpose of this study was to evaluate a series of patients with jugular foramen tumors who were surgically treated in the past 16 years, and to analyze the surgical technique, complications, and outcomes. Methods The authors retrospectively studied 102 patients with jugular foramen tumors treated between January 1987 and May 2004. All patients underwent surgery with a multidisciplinary method combining neurosurgical and ear, nose, and throat techniques. Preoperative embolization was performed for paragangliomas and other highly vascularized lesions. To avoid postoperative cerebrospinal fluid (CSF) leakage and to improve cosmetic results, the surgical defect was reconstructed with specially developed vascularized flaps (temporalis fascia, cervical fascia, sternocleidomastoid muscle, and temporalis muscle). A saphenous graft bypass was used in two patients with tumor infiltrating the internal carotid artery (ICA). Facial nerve reconstruction was performed with grafts of the great auricular nerve or with 12th/seventh cranial nerve anastomosis. Residual malignant and invasive tumors were irradiated after partial removal. The most common tumor was paraganglioma (58 cases), followed by schwannomas (17 cases) and meningiomas (10 cases). Complete excision was possible in 45 patients (77.5%) with paragangliomas and in all patients with schwannomas. The most frequent and also the most dangerous surgical complication was lower cranial nerve deficit. This deficit occurred in 10 patients (10%), but it was transient in four cases. Postoperative facial and cochlear nerve paralysis occurred in eight patients (8%); spontaneous recovery occurred in three of them. In the remaining five patients the facial nerve was reconstructed using great auricular nerve grafts (three cases), sural nerve graft (one case), and hypoglossal/facial nerve anastomosis (one case). Four patients (4%) experienced postoperative CSF leakage, and four (4.2%) died after surgery. Two of them died of aspiration pneumonia complicated with septicemia. Of the remaining two, one died of pulmonary embolism and the other of cerebral hypoxia caused by a large cervical hematoma that led to tracheal deviation. Conclusions Paragangliomas are the most common tumors of the jugular foramen region. Surgical management of jugular foramen tumors is complex and difficult. Radical removal of benign jugular foramen tumors is the treatment of choice, may be curative, and is achieved with low mortality and morbidity rates. Larger lesions can be radically excised in one surgical procedure by using a multidisciplinary approach. Reconstruction of the skull base with vascularized myofascial flaps reduces postoperative CSF leaks. Postoperative lower cranial nerves deficits are the most dangerous complication.

scholarly journals TRANSORAL REMOVAL OF SKULL BASE AND C1-C2 VERTEBRAL BODY TUMOURS AND NONTUMOROUS PATHOLOGY IN THE CRANIOCERVICAL JUNCTION ACCOMPANIED BY CRANIOVERTEBRAL INSTABILITY

2010 ◽  
Vol 16 (2) ◽  
pp. 149-152
Author(s):  
A. N. Shkarubo ◽  
A. O. Guscha
Keyword(s):  
Skull Base ◽  
Vertebral Body ◽  
New Technologies ◽  
Surgical Techniques ◽  
Craniocervical Junction ◽  
Early Rehabilitation ◽  
Hospitalization Period ◽  
Csf Leakage ◽  
Upper Cervical ◽  
Spinal Segments

27 patients aged 2,5-61 years with skull base and C1-C2 vertebral body tumours and nontumorous pathology in the craniocervical junction underwent surgery. All patients revealed craniovertebral instability. To perform OSD we used autobone and metallic wire in 1 case, "Ventrofix" - 2; "CCD" - 9, "Vertex" - 15. In 26 cases OSD was followed by transoral tumor removal; in 1 - removal of the skull base chordoma spreading into C1-C2 segments was followed by OSD. In our practice we used original patent instruments, devices and surgical techniques. After the tumor has been removed, the skull defect hermetic closure and plasty were performed using the original patent technique for preventing postoperative CSF leakage as well as different glue compositions. This technique proved to shorten hospitalization period and reduce treatment costs as well as launch an early rehabilitation programme - on the 3d-4th day after operation. Use of new technologies in surgical treatment of skull base tumors invading upper cervical spinal segments accompanied by craniovertebral instability allowed to improve surgical outcome and start up early rehabilitation.

scholarly journals The combined microscopic-endoscopic technique for radical resection of cerebellopontine angle tumors

2015 ◽  
Vol 123 (5) ◽  
pp. 1301-1311 ◽  
Author(s):  
Mohammad Abolfotoh ◽  
Wenya Linda Bi ◽  
Chang-Ki Hong ◽  
Kaith K. Almefty ◽  
Abraham Boskovitz ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Residual Tumor ◽  
Senior Author ◽  
Endoscopic Technique ◽  
Total Resection ◽  
The Impact ◽  
Combined Technique

OBJECT The combined microscopic and endoscopic technique has shown significant advantages in the management of various lesions through different approaches. Endoscopic-assisted techniques have frequently been applied to cerebellopontine angle (CPA) surgery in the context of minimally invasive craniotomies. In this paper the authors report on the use of the endoscope in the CPA as a tool to increase the extent of resection, minimize complications, and preserve the function of the delicate CPA structures. They also describe a technique of the simultaneous use of the microscope and endoscope in the CPA and dissection of CPA tumors under tandem endoscopic and microscopic vision to overcome the shortcomings of introducing the endoscope alone in the CPA. The reliability of using the microscope alone in dissecting CPA tumors is evaluated, as is the effectiveness of the combined technique in increasing the resectability of various types of CPA tumors. METHODS The authors conducted a retrospective analysis of 50 patients who underwent combined microscopic-endoscopic resection of CPA tumors by the senior author over a period of 3 years (February 2011 to February 2014) at Brigham and Women's Hospital, Harvard Medical School. The reliability of the extent of microscopic removal was evaluated with endoscopic exploration. Additional resection was performed with both microscopic and the combined microscopic-endoscopic technique. Endoscopically verified total resection was validated by intraoperative or postoperative MRI. The function of the cranial nerves was evaluated to assess the impact of the combined technique on their function. RESULTS A tumor remnant was endoscopically identified in 69% of the 26 patients who were believed to have microscopic total resection. The utilization of the endoscopic visualization and dissection increased endoscopically verified total removal to 38 patients, and 82% of these patients had no sign of residual tumor on postoperative imaging. The technique was most effective with epidermoid tumors. There were a total of 17 new cranial nerve deficits in 10 patients. Preoperative fifth cranial nerve deficits improved in 52% and hearing improved in 29% of patients after surgery. CONCLUSIONS This method provides simultaneous microscopic and endoscopic visualization and dissection techniques through skull-base approaches to CPA tumors. It overcomes some of the shortcomings of endoscopic-assisted surgery, further extends the surgical field, and increases the radicality of tumor resection with good functional outcomes.

Does Intervention Improve the Natural Course of Glomus Tumors?

1992 ◽  
Vol 101 (8) ◽  
pp. 635-642 ◽  
Author(s):  
Johan H. M. Frijns ◽  
Hans van Dulken ◽  
Andel G. L. van der Mey ◽  
Cees J. Cornelisse ◽  
Hans L. Terpstra ◽  
...  
Keyword(s):  
Skull Base ◽  
Carotid Body ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Observation Time ◽  
Natural Course ◽  
Radical Excision ◽  
Glomus Tumors ◽  
Carotid Body Tumors

To acquire more insight into the results of treatment versus the “natural” course of glomus tumors, we studied the clinical data of 108 patients, in 58 of whom the disease was hereditary. During a period of 32 years (1956 to 1988), 175 tumors were diagnosed: 52 glomus jugulotympanic tumors, 32 vagal body tumors, and 91 carotid body tumors. The results of radical surgical treatment were disappointing for tumors located at the skull base, ie, nonradical in 59% (n = 23) of the cases, but very good for the carotid body tumors, for which 96% (n = 68) radical excision was achieved. Moreover, surgery at the level of the skull base dramatically increased morbidity, since it frequently induced cranial nerve palsy. During the follow-up period (maximal observation time 32 years, mean 13.5 years) none of the patients died of residual or recurrent tumor or developed distant metastases, irrespective of the mode and outcome of treatment. When these results are combined with the results of pedigree analysis, a realistic approximation of the “natural” course of the disease for both hereditary and nonfamilial tumors can be made. The results raise the question of whether this natural behavior is really improved by intervention. We conclude that removal of carotid body tumors and solitary vagal body tumors should be considered in order to prevent future morbidity. However, for skull base and bilateral glomus tumors a more conservative monitored “wait and see” policy can be sensible and should be considered in any proposal for treatment of head and neck paragangliomas. When there is serious progression of cranial nerve palsy or when intracranial growth becomes life-threatening, surgical intervention cannot be avoided. The main goal of glomus tumor treatment should be to reduce morbidity rather than trying to increase survival rates.

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