Surgical management of midline skull-base tumors: a new approach

1989 ◽  
Vol 71 (5) ◽  
pp. 705-710 ◽  
Author(s):  
David Uttley ◽  
Anne Moore ◽  
Daniel J. Archer
Keyword(s):  
Skull Base ◽  
Tumor Resection ◽  
Subsequent Development ◽  
Neurological Status ◽  
Surgical Approaches ◽  
Upper Cervical Spine ◽  
Skull Base Tumors ◽  
Content Type ◽  
Csf Fistula ◽  
Wound Breakdown

✓ Many surgical approaches to the clivus and upper cervical spine have been used in the treatment of skull-base tumors over the past 50 years. However, the outcome of surgery has been complicated by difficulties of access to the whole clivus, together with pharyngeal wound breakdown with subsequent development of cerebrospinal fluid (CSF) fistula and meningitis. A technique described recently utilized Le Fort I osteotomy to improve exposure of the clivus in the approach to vertebrobasilar aneurysms, facilitating control of the aneurysm and reducing the risk of posttraumatic CSF fistula. The same approach, via maxillotomy, has permitted partial or total tumor resection in 13 consecutive procedures carried out at Atkinson Morley's Hospital on 10 patients presenting with tumors of the skull base. Neurological status was either improved or unchanged in all patients postoperatively, and pain relief was obtained in five of eight cases in which this was a presenting symptom. No patient developed a CSF fistula following surgery. Cosmetic results were good, and no problems related to malocclusion were reported. This approach may be used to advantage in the surgical treatment of skull-base tumors, at initial presentation, and can be repeated without undue difficulty should there be tumor recurrence.

Extended anterior subcranial approach for skull base tumors: long-term results

1995 ◽  
Vol 82 (6) ◽  
pp. 1002-1010 ◽  
Author(s):  
Joram Raveh ◽  
Jon B. Turk ◽  
Kurt Lädrach ◽  
Rolf Seiler ◽  
Nelson Godoy ◽  
...  
Keyword(s):  
Skull Base ◽  
Frontal Lobe ◽  
Anterior Skull Base ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Skull Base Tumors ◽  
En Bloc ◽  
Content Type ◽  
Anterior Cranial Base ◽  
Anterior Access

✓ The extended anterior subcranial approach differs significantly from more traditional surgical approaches to the skull base in that it allows a broad inferior access to the anterior skull base planes with tumor exposure from below rather than via the transfrontal route. The authors initially used the subcranial approach in 1978 for the treatment of high-velocity skull base trauma and certain craniofacial anomalies. In 1980 they expanded the indications to include the combined neurosurgical—otolaryngological resection of various skull base tumors. Osteotomy of the frontonasoorbital external skeletal frame provides optimum anterior access to the orbital and sphenoethmoidal planes as well as to the nasal and paranasal cavities while avoiding frontal lobe retraction and the external facial incisions characteristic of transcranial and transfacial approaches. The improved visualization of the anterior skull base and clival—sphenoidal region facilitates en bloc tumor removal, optic nerve decompression, exposure of the medial aspect of the cavernous sinus, and watertight realignment of the anterior cranial base dura. In this report the authors present their experience over the past 13 years with 104 patients who underwent operation via the extended subcranial approach. Because extensive frontal lobe manipulation and external facial incisions are avoided with this approach, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced. The extended anterior subcranial method is therefore an excellent alternative to traditional transfacial-transcranial skull base approaches for the removal of selected skull base tumors.

Reconstruction of the skull base after tumor resection: an overview of methods

2002 ◽  
Vol 12 (5) ◽  
pp. 1-5 ◽  
Author(s):  
James K. Liu ◽  
Zahid Niazi ◽  
William T. Couldwell
Keyword(s):  
Skull Base ◽  
Malignant Tumors ◽  
Tumor Resection ◽  
Infectious Complications ◽  
Skull Base Tumors ◽  
Skull Base Reconstruction ◽  
Life Threatening ◽  
Dural Defects ◽  
Reconstructive Techniques ◽  
Do So

Successful surgical management of malignant skull base tumors depends on both tumor resection and reconstruction of the cranial base defect. The primary goals of skull base reconstruction are to repair dural defects, to prevent the development of cerebrospinal fluid fistulas, and to provide a protective barrier that isolates the intracranial contents from the nasopharynx and paranasal sinuses. Failure to do so can result in potentially life-threatening infectious complications. With modern skull base and reconstructive techniques, malignant tumors in this region, which were once deemed inoperable, can now be safely removed. The authors review the different modalities available for skull base reconstruction following tumor resection.

scholarly journals 3D Printing-Assisted Skull Base Tumor Surgeries: An Institutional Experience

2021 ◽  
Author(s):  
Sanjeev Chopra ◽  
Ashim Kumar Boro ◽  
Virendra Deo Sinha
Keyword(s):  
3D Printing ◽  
Skull Base ◽  
Surgical Approaches ◽  
Skull Base Tumor ◽  
Confined Space ◽  
Skull Base Tumors ◽  
Patient Counselling ◽  
Training Tool ◽  
3D Printed ◽  
Neurovascular Structures

AbstractThree-dimensional (3D) printing technology in neurosurgery has gained popularity nowadays. Skull base contains many major neurovascular structures in a confined space, along with anatomical variations making surgical approaches to this region challenging. 3D-printed model of skull base tumors consists of the patient's bony skull base, actual tumor dimensions, and surrounding major neurovascular structures. We included a total number of five patients with skull base tumors (one case of planum sphenoidale meningioma, two cases of sellar tumor with suprasellar extension, and two cases of cerebellopontine angle tumor) and 3D-printed tumor model of each of them. These models were used for preoperative simulation and served as very true to life training tool. These help in increasing the efficacy of the surgeon, improves surgical safety and ergonomics. They were also used for patient counselling, educating about the disease, the surgical procedure, and associated risks.

scholarly journals Pediatric Skull Base Tumors

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.

Evaluation of a new concept for the management of skull base chordomas and chondrosarcomas

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 165-170 ◽  
Author(s):  
Guenther Christian Feigl ◽  
Otto Bundschuh ◽  
Alireza Gharabaghi ◽  
Sam Safavi-Abassi ◽  
Amr El Shawarby ◽  
...  
Keyword(s):  
Skull Base ◽  
Tumor Volume ◽  
Tumor Resection ◽  
Volume Reduction ◽  
Recurrence Rates ◽  
Content Type ◽  
The Mean ◽  
Tumor Volume Reduction ◽  
Fine Print

Object. Chordomas and chondrosarcomas of the skull base are rare locally invasive tumors associated with high recurrence rates. The aim of this study was to evaluate the concept of microsurgical tumor volume reduction followed by early gamma knife surgery (GKS). Methods. Thirteen patients with 15 tumors were treated between October 2000 and June 2003. There were three patients (23.1%) with chordomas and 10 (76.9%) with chondrosarcomas. There were nine men and four women who ranged in age between 19 and 69 years. All patients first underwent maximal tumor resection. Within 2 to 10 months after surgery they were treated with GKS. The mean postoperative tumor volume treated with GKS was 9.7 cm3 (range 1.4–20.3 cm3). Follow-up computerized tomography and magnetic resonance imaging examinations with volumetric tumor analysis were performed every 6 months after GKS. The mean treatment dose was 17 Gy and the mean isodose was 52%. The mean follow-up duration was 17 months during which there was only one tumor recurrence at the margin of the radiation field. The mean volume reduction was 35.4%. Conclusions. Results of this treatment strategy are encouraging but the efficacy of this multimodal treatment combining surgery and early GKS requires a longer follow up.

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.

scholarly journals Endoscopic-assisted Craniofacial Resection

2011 ◽  
Vol 3 (3) ◽  
pp. 156-160
Author(s):  
Aliasgar Moiyadi ◽  
Deepa Nair ◽  
Prathamesh S Pai
Keyword(s):  
Skull Base ◽  
Tumor Resection ◽  
Additional Treatment ◽  
Anterior Skull Base ◽  
Skull Base Tumors ◽  
Craniofacial Resection ◽  
Endoscopic Endonasal ◽  
The Past ◽  
Select Group ◽  
Sinonasal Tumor

ABSTRACT Management of anterior skull base tumors has progressed steadily since AS Ketcham popularized the craniofacial surgical technique in the seventies with good results. In the past two decades, endoscopic sinonasal tumor resection has been established as an additional treatment option. For tumors that cross the anterior skull base, a cranial access is vital to encompass the tumor all around. For a select group of these transcranial lesions, the sinonasal component is suitable for an endoscopic endonasal oncologically safe resection along with a traditional transcranial access to complete the resection. This article endeavors to describe the endoscopicassisted craniofacial combining the advantages of a transnasal minimal access to reduce facial morbidity and the transcranial access for superior control of tumors with adequate margins.

Analysis of Surgical Approaches to Skull Base Tumors Involving the Pterygopalatine and Infratemporal Fossa

2019 ◽  
Vol 30 (2) ◽  
pp. 589-595 ◽  
Author(s):  
Hyo Jin Chung ◽  
In Seok Moon ◽  
Hyung-Ju Cho ◽  
Chang-Hoon Kim ◽  
Salma Saud Al Sharhan ◽  
...  
Keyword(s):  
Skull Base ◽  
Infratemporal Fossa ◽  
Surgical Approaches ◽  
Skull Base Tumors

Usefulness of Nasal Morphology in Surgical Approaches for Skull Base Tumors

2007 ◽  
Vol 17 (4) ◽  
pp. 283-286
Author(s):  
Neslihan Boyan ◽  
Emine Kizilkanat ◽  
Ibrahim Tekdemir ◽  
Roger Soames ◽  
Ozkan Oguz
Keyword(s):  
Skull Base ◽  
Surgical Approaches ◽  
Skull Base Tumors

scholarly journals Introduction: surgical management of skull base meningiomas

2017 ◽  
Vol 43 (videosuppl2) ◽  
pp. Intro ◽  
Author(s):  
Gabriel Zada ◽  
Mustafa K Başkaya ◽  
Mitesh V. Shah
Keyword(s):  
Skull Base ◽  
Wide Spectrum ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Surgical Approaches ◽  
Cerebrospinal Fluid Leakage ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae ◽  
Skull Base Meningiomas

Meningiomas represent the most common primary intracranial neoplasm treated by neurosurgeons. Although multimodal treatment of meningiomas includes surgery, radiation-based treatments, and occasionally medical therapy, surgery remains the mainstay of treatment for most symptomatic meningiomas. Because of the intricate relationship of the dura mater and arachnoid mater with the central nervous system and cranial nerves, meningiomas can arise anywhere along the skull base or convexities, and occasionally even within the ventricular system, thereby mandating a catalog of surgical approaches that neurosurgeons may employ to individualize treatment for patients. Skull base meningiomas represent some of the most challenging pathology encountered by neurosurgeons, on account of their depth, invasion, vascularity, texture/consistency, and their relationship to bony anatomy, cranial nerves, and blood vessels. Resection of complex skull base meningiomas often mandates adequate bony removal to achieve sufficient exposure of the tumor and surrounding region, in order to minimize brain retraction and optimally identify, protect, control, and manipulate sensitive neurovascular structures. A variety of traditional skull base approaches has evolved to address complex skull base tumors, of which meningiomas are considered the paragon in terms of both complexity and frequency.In this supplemental video issue of Neurosurgical Focus, contributing authors from around the world provide instructional narratives demonstrating resection of a variety of skull base meningiomas arising from traditionally challenging origins, including the clinoid processes, tuberculum sellae, dorsum sellae, petroclival region, falco-tentorial region, cerebellopontine angle, and foramen magnum. In addition, two cases of extended endoscopic endonasal approaches for tuberculum sellae and dorsum sellae meningiomas are presented, representing the latest evolution in accessing the skull base for selected tumors. Along with key pearls for safe tumor resection, an equally important component of open and endoscopic skull base operations for meningiomas addressed by the contributing authors is the reconstruction aspect, which must be performed meticulously to prevent delayed cerebrospinal fluid leakage and/or infections. This curated assortment of instructional videos represents the authors’ optimal treatment paradigms pertaining to the selection of approach, setup, exposure, and principles to guide tumor resection for a wide spectrum of complex meningiomas.

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