Combined Exoscopic and Endoscopic Technique for Craniofacial Resection

We determined the feasibility of the combined exoscopic-endoscopic technique (CEE) as an alternative to the microscope in craniofacial resection (CFR). This retrospective study was conducted at a single institution and included eight consecutive patients with head and neck tumors who underwent CFR between September 2019 and July 2021. During the transcranial approach, microsurgery was performed using an exoscope in the same manner as in traditional microscopic surgery, and an endoscope was used at the blind spot of the exoscope. The exoscope provided images of sufficient quality to perform microsurgery, while the sphenoid sinus lumen was the blind spot of the exoscope during anterior (n = 3) and anterolateral CFR (n = 2), and the medial aspect of the temporal bone was the blind spot of the exoscope during temporal bone resection (n = 2). These blind spots were visualized by the endoscope to facilitate accurate transection of the skull base. The advantages of the exoscope and endoscope include compact size, ergonomics, surgical field accessibility, and equal visual experience for neurosurgeons and head and neck surgeons, which enabled simultaneous transcranial and transfacial surgical procedures. All the surgeries were successful without any relevant complications. CEE is effective in transcranial skull base surgery, especially CFR involving simultaneous surgical procedures.

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Skull Base Invasion Patterns of Malignant Head and Neck Tumors: A Neurosurgical Perspective

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-3402034 ◽

2020 ◽

Author(s):

Kenichiro Iwami ◽

Masazumi Fujii ◽

Naoki Nishio ◽

Takashi Maruo ◽

Yasushi Fujimoto ◽

...

Keyword(s):

Nasal Cavity ◽

Head And Neck ◽

Skull Base ◽

Temporal Bone ◽

Tumor Invasion ◽

Ethmoid Sinus ◽

Head And Neck Tumors ◽

Neck Tumors ◽

Lateral Skull Base ◽

Invasion Patterns

Abstract Objective Craniofacial resection (CFR) and temporal bone resection (TBR) on malignant head and neck tumors (MHNTs) invading skull base require accurate and precise determination of the tumor invasion. We investigated tumor skull base invasion patterns and surgical results in CFR and TBR cases. Methods We performed either CFR or TBR for 75 selected patients with the possibility of en bloc resection over the period between 2011 and 2018. The medical charts of the selected patients were reviewed. Results Primary tumor onset site (TOS) groups were: (1) nasal cavity/ethmoid sinus, 20 cases; (2) orbit, 10 cases; (3) maxillary sinus, 28 cases; and (4) external ear/temporomandibular joint, 17 cases. Grades for tumor invasion depth (TID) included: (I) extracranial invasion and skull base bone invasion; (II) extradural invasion; or (III) intradural invasion. Patients in groups 1 and 2 had a significantly higher frequency of grade II and III invasions than patients in groups 3 and 4. The main invasion site was nasal cavity superior wall and ethmoid sinus superior wall for group 1 tumors, orbit superior wall, and lateral skull base sphenoid bone for group 2 and 3 tumors, and lateral skull base temporal bone for group 4 tumors. Positive resection margins represented a significant negative prognostic factor. TID and TOS did not affect skull base margin status. Conclusion Skull base invasion of MHNTs exhibits certain fixed patterns in sites susceptible to invasion based on the TOS. The frequencies of extradural and intradural invasions differed, indicating the importance for accurate preoperative tumor evaluation.

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Experiences with the sternocleidomastoid muscle and myocutaneous flaps

The Journal of Laryngology & Otology ◽

10.1017/s0022215100112587 ◽

1990 ◽

Vol 104 (4) ◽

pp. 315-321 ◽

Cited By ~ 27

Author(s):

Rammohan Tiwari

Keyword(s):

Head And Neck ◽

Skull Base ◽

Temporal Bone ◽

Sternocleidomastoid Muscle ◽

Musculocutaneous Flap ◽

Musculocutaneous Flaps ◽

Myocutaneous Flaps

AbstractThe use of the sternocleidomastoid muscle and musculocutaneous flaps in the reconstruction of defects arising after surgery for cancer of the head and neck has been a subject of some discussion.Experience with these flaps over a ten year period from 1980 until 1989 is presented. Attention is drawn to the various types of flaps in vogue, their indications to date, benefits and drawbacks. A new reliable compound musculocutaneous flap developed by the author for use in defects of the skull base after total temporal bone excision is presented.

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Results of Surgery for Head and Neck Tumors that Involve the Carotid Artery at the Skull Base

Journal of Neuro-Ophthalmology ◽

10.1097/00041327-199712000-00045 ◽

1997 ◽

Vol 17 (4) ◽

pp. 287

Author(s):

M H Brisman ◽

C Sen ◽

P. Catalano

Keyword(s):

Carotid Artery ◽

Head And Neck ◽

Skull Base ◽

Head And Neck Tumors ◽

Neck Tumors ◽

Results Of Surgery

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Surgery of the anterior skull base for head and neck tumors.

Nippon Jibiinkoka Gakkai Kaiho ◽

10.3950/jibiinkoka.94.343 ◽

1991 ◽

Vol 94 (3) ◽

pp. 343-350 ◽

Cited By ~ 4

Author(s):

MINORU HIRANO ◽

KIMINORI SATO ◽

SHINZO TANAKA ◽

YOSHIAKI TAI ◽

YOJIRO INOUE ◽

...

Keyword(s):

Head And Neck ◽

Skull Base ◽

Anterior Skull Base ◽

Head And Neck Tumors ◽

Neck Tumors

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A Systematic Review on Re-irradiation with Charged Particle Beam Therapy in the Management of Locally Recurrent Skull Base and Head and Neck Tumors

International Journal of Particle Therapy ◽

10.14338/ijpt-20-00064.1 ◽

2021 ◽

Vol 8 (1) ◽

pp. 131-154

Author(s):

Mauricio E. Gamez ◽

Samir H. Patel ◽

Lisa A. McGee ◽

Terence T. Sio ◽

Mark McDonald ◽

...

Keyword(s):

Systematic Review ◽

Charged Particle ◽

Head And Neck ◽

Skull Base ◽

Head And Neck Tumors ◽

Second Primary ◽

Carbon Ions ◽

Curative Intent ◽

Carbon Ion ◽

Neck Tumors

Abstract Purpose To evaluate the clinical outcomes and treatment related toxicities of charged particle-based re-irradiation (reRT; protons and carbon ions) for the definitive management of recurrent or second primary skull base and head and neck tumors. Materials and Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied for the conduct of this systematic review. Published work in English language evaluating the role of definitive charged particle therapies in the clinical setting of reRT for recurrent or second primary skull base and head and neck tumors were eligible for this analysis. Results A total of 26 original studies (15 protons, 10 carbon ions, and 1 helium/neon studies) involving a total of 1,118 patients (437 with protons, 670 with carbon ions, and 11 with helium/neon) treated with curative-intent charged particle reRT were included in this systematic review. All studies were retrospective in nature, and the majority of them (n=23, 88 %) were reported as single institution experiences (87% for protons, and 90% for carbon ion-based studies). The median proton therapy reRT dose was 64.5 Gy (RBE 1.1) (range, 50.0 – 75.6 Gy ), while the median carbon ion reRT dose was 53.8 Gy (RBE 2.5 – 3.0) (range, 44.8 – 60 Gy ). Induction and/or concurrent chemotherapy was administered to 232 (53%) of the patients that received a course of proton reRT, and 122 (18%) for carbon ion reRT patients. ReRT with protons achieved 2-year local control rates ranging from 50% to 86%, and 41% to 92% for carbon ion reRT. The 2-year overall survival rates for proton and carbon ion reRT ranged from 33% to 80%, and 50% to 86% respectively. Late ≥ G3 toxicities ranged from 0% to 37%, with brain necrosis, ototoxicity, visual deficits, and bleeding as the most common complications. Grade 5 toxicities for all treated patients occurred in 1.4% (n= 16/1118) with fatal bleeding as the leading cause. Conclusions Based on current data, curative intent skull base and head and neck reRT with charged particle radiotherapy is feasible and safe in well-selected cases, associated with comparable or potentially improved local control and toxicity rates compared to historical reRT studies using photon radiotherapy. Prospective multi-institutional studies reporting oncologic outcomes, toxicity, and dosimetric treatment planning data are warranted to further validate these findings and to improve the understanding of the clinical benefits of charged particle radiotherapy in the reRT setting.

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Embolization of Intracranial, Skull Base, Head and Neck Tumors

Principles of Neuro-Oncology ◽

10.1007/978-3-030-54879-7_15 ◽

2020 ◽

pp. 307-312

Author(s):

Gustavo Melo-Guzmán ◽

Jorge Luis Guevara-Moyano

Keyword(s):

Head And Neck ◽

Skull Base ◽

Head And Neck Tumors ◽

Neck Tumors

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PV-0203 Adaptive proton therapy for patients with Head and Neck tumors involving skull base

Radiotherapy and Oncology ◽

10.1016/s0167-8140(19)30623-1 ◽

2019 ◽

Vol 133 ◽

pp. S106-S107

Author(s):

S. Karaman ◽

R. Malyapa ◽

U. Langner ◽

T. Houser ◽

Z. Fellows ◽

...

Keyword(s):

Head And Neck ◽

Skull Base ◽

Proton Therapy ◽

Head And Neck Tumors ◽

Neck Tumors

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Initial experiences with the Amplatzer Vascular Plug 4 for permanent occlusion of the internal carotid artery in the skull base in patients with head and neck tumors

Neuroradiology ◽

10.1007/s00234-010-0823-1 ◽

2010 ◽

Vol 54 (1) ◽

pp. 61-64 ◽

Cited By ~ 3

Author(s):

Stephan Macht ◽

Christian Mathys ◽

Jörg Schipper ◽

Bernd Turowski

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Head And Neck ◽

Skull Base ◽

Internal Carotid ◽

Amplatzer Vascular Plug ◽

Vascular Plug ◽

Neck Tumors ◽

Permanent Occlusion ◽

Amplatzer Vascular Plug 4

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Intra-arterial Chemotherapy for Malignant Tumors of Head and Neck Region Using Three Types of Modified Injection Method

Interventional Neuroradiology ◽

10.1177/15910199030090s115 ◽

2003 ◽

Vol 9 (1_suppl) ◽

pp. 113-123 ◽

Cited By ~ 4

Author(s):

T. Kumagai ◽

N. Takeda ◽

S. Fukase ◽

H. Koshu ◽

A. Inoue ◽

...

Keyword(s):

Head And Neck ◽

Skull Base ◽

Infusion Rate ◽

Chemotherapeutic Agents ◽

Surgical Removal ◽

High Dose ◽

Skull Base Tumors ◽

Injection Method ◽

Neck Tumors

Relatively higher infusion rate in the intra-arterial chemotherapy (IA chemotherapy) could induce the higher concentration and the more sufficient distribution of chemotherapeutic agents on tumors. To get the relatively higher infusion rate in IA chemotherapy, we used three types of injection method: high-flow injection, high-dose injection with detoxification and flow-controlled injection method for the treatment of malignant brain tumors, skull base tumors and head and neck tumors. Between January 1997 and October 2001, twenty-seven patients (mean age 61 y.o.) with supratentorial glioblastoma (4 cases), supratentorial anaplastic astrocytoma (1), CNS lymphoma (2), matastatic skull base tumors (3), and neck tumors (15 squamous cell carcinoma, 1 malignant melanoma and 1 neuroblastoma) received our three types of IA chemotherapy. Sixty-five consecutive procedures were performed. Conventional radiation therapy and/or surgical removal were performed in some of these patients. The median follow-up period was 10 months ranging 2 to 56 months. Fifteen (55.6%) and 6 (22.2%) of 27 patients achieved complete response (CR) and partial response (PR) respectively after initial treatment [CR+PR: 21 (77.8%)]. All responded patients showed clinical improvement. The response rate declined to 55.6% at the end of follow-up period. Eighteen patients are still alive and 15 of them show no evidence of local recurrence. The median post treatment survival was 12 months. There was no serious complication except transient nausea in 4 of 27 (14%) patients, vertigo and granulocytopenia in 1 each (3%) of 27 patients. Our modified IA chemotherapy has provided favorable clinical and radiological results without technical difficulties and serious complications.

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