scholarly journals Chondrosarcoma in petroclival synchondrosis without visual change

2020 ◽  
pp. 400-404
Author(s):  
Messias Villa Mendonça ◽  
Raphael Oliveira Ramos Franco Netto ◽  
João Italo Fortaleza De Melo ◽  
Victor Augusto Ramos Fernandes ◽  
Luiz Dias Dutra ◽  
...  
Keyword(s):  
Cranial Nerves ◽  
Petrous Apex ◽  
Age Group ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Visual Change ◽  
Malignant Bone Tumours ◽  
Base Of The Skull ◽  
Middle Aged Adults ◽  
Chondroid Matrix

Chondrosarcomas are a heterogeneous group of malignant bone tumours that share the production of the chondroid matrix in common. At the base of the skull, they are most commonly found in the region of the various synchondroses with an affinity for the petroclival fissure, they are locally invasive tumours, with little capacity to perform metastasis. The age group affected is variable, however, they frequently occur in middle-aged adults. Its clinical manifestation depends on the location and local extent; headache or paralysis of cranial nerves, particularly of the VI nerve is a frequent sign. As the petrous apex cannot be viewed directly, imaging studies such as computed tomography and magnetic resonance imaging play an important role in the evaluation of injuries. We present a case of a 36-year-old patient with chondrosarcoma of petroclival syndromes without visual changes. For the identification of this pathology, a battery of imaging tests was used and the diagnosis was made assertively, preserving the best choices for the treatment of the patient.

Hamartomas of the Internal Auditory Canal: Report of Two Cases

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 944-949 ◽  
Author(s):  
Gustavo A. Carvalho ◽  
Cordula Matthies ◽  
Enrique Osorio ◽  
Madjid Samii
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Facial Nerve ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Auditory Brainstem ◽  
Tumor Infiltration ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Tumor Removal

Abstract OBJECTIVE AND IMPORTANCE To highlight the clinical, radiological, and surgical findings and therapeutic options for this rare entity, which may mimic a purely intrameatal vestibular schwannoma, and to define the particular aspects of preoperative differential diagnosis and surgical management. CLINICAL PRESENTATION Two patients presented with clinical findings typical of vestibular schwannomas, i.e., tinnitus, hearing loss of 30 dB, and an intrameatal contrast-enhancing lesion on magnetic resonance imaging studies. TECHNIQUE The lesions were exposed via a suboccipital transmeatal approach, and tumor infiltration of the cochlear and/or facial cranial nerves was identified. In view of the unclear intraoperative histology, surgical management was based on criteria of cranial nerve function. In Patient 1, after nerve decompression by subtotal tumor removal, preserved auditory brainstem responses and facial nerve electromyography indicated functional nerve preservation and facilitated the decision for partial resection. In Patient 2, minimal tumor dissection resulted in complete loss of auditory brainstem response without reversibility. Therefore, a radical tumor removal was performed that sacrificed the cochlear but preserved the facial nerve. CONCLUSION Symptoms and signs of internal auditory canal hamartomas are congruent with other typical pathological lesions of the internal auditory canal and cerebellopontine angle. Accurate preoperative diagnosis by radiological means is not possible, but careful evaluation of the different signal intensities on magnetic resonance imaging studies may indicate this rare pathological condition. Intraoperative surgical findings of tumor infiltration of the faciocochlear cranial nerve complex may support simple observation. In view of the nonneoplastic characteristic of these lesions, a more conservative approach is justified. The decision should be based on the functional status of the cranial nerves, for which reliable electrophysiological monitoring is indispensable.

Zygomatic Approach to Cavernous Sinus Chordoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Antonio Aversa ◽  
Ossama Al-Mefty
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Radical Resection ◽  
High Rate ◽  
Petrous Apex ◽  
High Dose ◽  
Middle Fossa ◽  
Cavernous Carotid Artery

Abstract Chordoma is not a benign disease. It grows invasively, has a high rate of local recurrence, metastasizes, and seeds in the surgical field.1 Thus, chordoma should be treated aggressively with radical resection that includes the soft tissue mass and the involved surrounding bone that contains islands of chordoma.2–5 High-dose radiation, commonly by proton beam therapy, is administered after gross total resection for long-term control. About half of chordoma cases occupy the cavernous sinus space and resecting this extension is crucial to obtain radical resection. Fortunately, the cavernous sinus proper extension is the easier part to remove and pre-existing cranial nerves deficit has good chance of recovery. As chordomas originate and are always present extradurally (prior to invading the dura), an extradural access to chordomas is the natural way for radical resection without brain manipulation. The zygomatic approach is key to the middle fossa, cavernous sinus, petrous apex, and infratemporal fossa; it minimizes the depth of field and is highly advantageous in chordoma located mainly lateral to the cavernous carotid artery.6–12 This article demonstrates the advantages of this approach, including the mobilization of the zygomatic arch alleviating temporal lobe retraction, the peeling of the middle fossa dura for exposure of the cavernous sinus, the safe dissection of the trigeminal and oculomotor nerves, and total control of the petrous and cavernous carotid artery. Tumor extensions to the sphenoid sinus, sella, petrous apex, and clivus can be removed. The patient is a 30-yr-old who consented for surgery.

Aneurysmal Bone Cyst: A Review of 150 Patients

2005 ◽  
Vol 23 (27) ◽  
pp. 6756-6762 ◽  
Author(s):  
Henry J. Mankin ◽  
Francis J. Hornicek ◽  
Eduardo Ortiz-Cruz ◽  
Jorge Villafuerte ◽  
Mark C. Gebhardt
Keyword(s):  
Aneurysmal Bone Cyst ◽  
Local Recurrence Rate ◽  
Bone Cyst ◽  
Secondary Development ◽  
Bone Cysts ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Treatment Protocols ◽  
Imaging Appearance ◽  
Aneurysmal Bone Cysts

PurposeWe have reviewed a series of 150 aneurysmal bone cysts treated over the last 20 years.Patients and MethodsThe lesions were principally located in the tibia, femur, pelvis, humerus, and spine and, in most cases, presented the imaging appearance originally described by Jaffe and Lichtenstein as a blowout with thin cortices.ResultsOnly one of the patients was believed to have an osteoblastoma of the spine with secondary development of an aneurysmal bone cyst, and none of the patients developed additional lesions. The patients were treated primarily with curettage and implantation of allograft chips or polymethylmethacrylate, but some patients were treated with insertion of autografts or allografts. The local recurrence rate was 20%, which is consistent with that reported by other centers.ConclusionAneurysmal bone cysts are enigmatic lesions of unknown cause and presentation and are difficult to distinguish from other lesions. Overall, the treatment is satisfactory, but it is possible that newer approaches, such as improved magnetic resonance imaging studies, may help diagnose the lesions and allow the physicians to plan for more effective treatment protocols.

scholarly journals Brief breath holding may confound functional magnetic resonance imaging studies

2005 ◽  
Vol 24 (4) ◽  
pp. 284-290 ◽  
Author(s):  
David F. Abbott ◽  
Helen I. Opdam ◽  
Regula S. Briellmann ◽  
Graeme D. Jackson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Functional Magnetic Resonance Imaging ◽  
Breath Holding ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Imaging Studies

Custom-tailored transdural anterior transpetrosal approach to ventral pons and retroclival regions

2006 ◽  
Vol 104 (1) ◽  
pp. 38-46 ◽  
Author(s):  
Hans-Jakob Steiger ◽  
Daniel Hänggi ◽  
Walter Stummer ◽  
Peter A. Winkler
Keyword(s):  
Carotid Artery ◽  
Cranial Nerves ◽  
Extent Of Resection ◽  
Venous Congestion ◽  
Petrous Apex ◽  
Anterior Transpetrosal Approach ◽  
Target Field ◽  
Custom Made ◽  
Anterior Petrosectomy ◽  
Spinal Catheter

Object The extradural anterior petrosectomy approach to the pons and midbasilar artery (mid-BA) has the main disadvantage that the extent of resection of the petrous apex cannot be as minimal as desired given that the surgical target field is not visible during bone removal. Unnecessary or excessive drilling poses the risk of injury to the internal carotid artery, vestibulocochlear organ, and seventh and eighth cranial nerves. The use of a custom-tailored transdural anterior transpetrosal approach can potentially avoid these pitfalls. Methods A technique for a transdural anterior petrosectomy was developed in the operating theater and anatomy laboratory. Following a subtemporal craniotomy and basal opening of the dura mater, the vein of Labbé is first identified and protected. Cerebrospinal fluid ([CSF] 50–100 ml) is drained via a spinal catheter. The tent is incised behind the entrance of the trochlear nerve toward the superior petrosal sinus (SPS), which is coagulated and divided. The dura is stripped from the petrous pyramid. Drilling starts at the petrous ridge and proceeds laterally and ventrally. The trigeminal nerve is unroofed. The internal acoustic meatus is identified and drilling is continued laterally as needed. The bone of the Kawase triangle toward the clivus can be removed down to the inferior petrosal sinus if necessary. Anterior exposure can be extended to the carotid artery if required. It is only exceptionally necessary to follow the greater superior petrosal nerve toward the geniculate ganglion and to expose the length of the internal acoustic canal. The modified transdural anterior petrosectomy exposure has been used in nine patients—two with a mid-BA aneurysm, two with a dural arteriovenous fistula, one with a pontine glioma, three with a pontine cavernoma, and one with a pontine abscess. In one patient with a mid-BA aneurysm, subcutaneous CSF collection occurred during the postoperative period. No CSF fistula or approach-related cranial nerve deficit developed in any of these patients. There was no retraction injury or venous congestion of the temporal lobe nor any venous congestion due to the obliteration of the SPS or the petrosal vein. Conclusions The custom-made transdural anterior petrosectomy appears to be a feasible alternative to the formal extradural approach.

The So-Called Cavernous Sinus: A Review of the Controversy and Its Implications for Neurosurgeons

Neurosurgery ◽  
1982 ◽  
Vol 11 (5) ◽  
pp. 712-717 ◽  
Author(s):  
John N. Taptas
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Sella Turcica ◽  
Middle Cranial Fossa ◽  
Cranial Fossa ◽  
Base Of The Skull ◽  
Extradural Space

Abstract The so-called cavernous sinus is a venous pathway, an irregular network of veins that is part of the extradural venous network of the base of the skull, not a trabeculated venous channel. This venous pathway, the internal carotid artery, and the oculomotor cranial nerves cross the medial portion of the middle cranial fossa in an extradural space formed on each side of the sella turcica by the diverging aspects of a dural fold. In this space the venous pathway has only neighborhood relations with the internal carotid artery and the cranial nerves. The space itself must be distinguished from the vascular and nervous elements that it contains. The revision of the anatomy of this region has not only theoretical interest but also important clinical implications.

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