Midface Resection And Reconstruction In Head And Neck Oncology: A 20 Years Single Institution Experience

Background: Midface tumors are relatively uncommon as midface comprises less than 1% of all malignant tumors and incorporate a distinct group of lesions, with a high variety of histological types and biological behavior. The purpose of the study is to present our experience in managing patients with advanced midface tumors for a 20-year period.Materials & Methods: From January 2000 to May 2020, we performed 72 excisions and reconstructions in 36 patients where their medical records were reviewed by the head and neck oncology clinic. The commonest anatomical site of the primary was the maxilla in 19 patients and bilaterally in 5 patients. In 15 patients there was an orbital and anterior fossa extension. In 6 patients there was a parotid and middle ear extension and in 1 patient there was a lip involvement.Results: Surgical resection included maxillectomy in the majority of the cases in combination with orbital exenteration or orbitectomy and anterior fossa resection. In 8 cases parotidectomy and mastoidectomy/ core petrosectomy was performed. One patient was subjected to total petrosectomy. Reconstruction was performed with radial forearm osteocutaneous free flap in 4 cases, latissimus with scapular bone flap in one case, lengthening temporalis myoplasty in 19 cases, rectus femoris in one case and anterolateral thigh flap in 5 cases in combination with temporalis and vastus lateralis in one case respectively and bilateral karapandzic flap in 1 case. The patients were followed-up from 2005 to 2020. To date, 23 patients (63.8%) are disease free with no recurrences of the disease and 4.4% of all patients presented disease recurrence during the follow-up period.Conclusions: In conclusion midface resections are safely performed with a combination of microvascular and dynamic reconstruction of the face offering our patients quality of life improvement.Level of Evidence: Level V, therapeutic study

Transcranial approaches for pituitary adenomas: current indications and clinical and radiological outcomes

Background The indications of transcranial approaches for pituitary adenomas have declined in the last decades with the widespread performance of endoscopic transsphenoidal approaches. The aim of the study was to review the current indications of transcranial approaches for pituitary adenomas and to evaluate the clinical and radiological outcome following these approaches. Patients and methods This study included 16 patients with fresh, residual, or recurrent pituitary adenomas operated upon by transcranial approaches alone or in combination with transsphenoidal approaches. The indication to perform a transcranial approach was reviewed for each patient. Postoperative clinical outcome and the extent of tumor resection were assessed. Results The indications of transcranial approaches were significant parasellar and/or anterior fossa extensions in 6 patients, failed previous transsphenoidal surgery in 3 patients, giant adenoma extending into the third ventricle in 3 patients, dumbbell-shaped adenoma in 2 patients, and doubtful diagnosis in 2 patients. Two patients with invasive giant adenomas were operated upon by a combined approach. There was a single mortality. Permanent complications included visual loss in one patient, third nerve palsy in one patient, hypopituitarism in two patients, and permanent diabetes insipidus in two patients. Gross total resection was achieved in one patient, subtotal resection in seven patients, and partial resection in eight patients. Conclusion Transcranial approaches are still needed for some complex pituitary adenomas particularly giant tumors with significant lateral, anterior, or superior extensions, tumors with fibrous consistency particularly after failure of transsphenoidal approach, and dumbbell-shaped tumors with severe constriction at the diaphragm.

“Slipped capital femoral epiphysis in a 25-year-old hypogonadic man with a large cranial chondroma: causality or coincidence? “

Background Slipped capital femoral epiphysis (SCFE) is a hip disorder frequently occurring in adolescence. In adults it is rare and so far very few cases have been documented. Case presentation This report presents a 25-year-old patient diagnosed with an anterior fossa giant chondroma, hypogonadotropic hypogonadism, and SCFE. The patient underwent surgical and hormonal therapy. His symptoms revealed, and he became a father. Conclusions Every patient diagnosed with SCFE in adulthood should undergo endocrinological assessment based on physical examination and laboratory tests.

Reversal of cognitive, behavioral, and language impairments after the left frontal arachnoid cyst fenestration in a pediatric patient

Background: Arachnoid cysts (ACs) are cerebrospinal fluid-containing cysts located between the surface of the brain or spinal cord and arachnoid layer of the leptomeninges. ACs have been known to cause cognitive, language, and behavioral deficits and currently there is no standard treatment paradigm. Surgical indications include papilledema, increasing growth with mass effect causing neurological deficit, or rapid head growth, however, cognitive symptoms related to mass effect may not always be considered. Case Description: We present a 3-year-old male with an AC of the left anterior fossa causing frontal lobe compression with resultant behavioral, language, and cognitive deficits. Conclusion: Surgical intervention for AC decompression may be indicated when there are cognitive, behavioral, or language delays related to the mass effect and location of the AC. Neuropsychiatric testing or more advanced imaging studies may further support surgical treatment. After craniotomy for fenestration of the left frontal AC, there was drastic improvement in cognitive, language, and behavioral symptoms in our pediatric patient.

Fully endoscopic transcranial removal of anterior fossa meningioma through the minipterional keyhole approach in case with marked frontal sinuous pneumatization: clinical case

Transcranial surgery of skull base meningiomas currently remains the main method of treatment. Transnasal removal is possible in a number of cases, but it is associated with the risk of postoperative CSF-leak as a result of insolvency of the reconstruction of the skull base defect. Minimally invasive (keyhole) accesses provide a tumor overview comparable to standard accesses in most cases. The anterior-medial part of the anterior cranial fossa and the olfactory fossa is not accessible to the direct view from the minipterional craniotomy. The use of angular endoscopic optics in combination with additional resection or thinning of the bones in the orbital roof provides an overview sufficient to remove the tumor, but manipulations in this area require the use of specific tools. Aspirators, dissectors and coagulators should have bends of different expressions. The application of the described technique is advisable only in certain specially selected cases.

The Incidence Rate of Cranii Base Fracture in Dr. Kariadi Hospital Semarang Period 2019

Introduction: Head injury is a major cause of death, especially in young adults and a major cause of disability. The incidence of head injuries is increasing due to the increasing use of motorized vehicles. As many as 4% of cases of head fracture occur in the base of the cranii. Method: This research used a descriptive observational method. The data used is secondary data taken from medical records. In this study, we wanted to know the incidence of cranii base fracture cases due to head trauma in patients treated at Dr. Kariadi period 2019. Result: From 29 samples of medical records obtained, 48.3% had mild head trauma, 27.6% had moderate head trauma, and 24.1% had severe head trauma. Symptoms of patients with the most clinical symptoms of cranii base fracture were raccoon eyes 51.7%, with the most fracture locations in the anterior fossa as much as 51.7%. Conclusion: The incidence of cranii fracture due to head trauma at RSUP Dr. Kariadi in 2019 was found mostly over 40 years old and most of them were men. The type of injury is a minor head injury, with the largest location in the anterior fossa, and the most common clinical sign found in patients with cranii fracture is raccoon eyes.

The Incidence Rate of Cranii Base Fracture in Dr. Kariadi Hospital Semarang Period 2019

Introduction: Head injury is a major cause of death, especially in young adults and a major cause of disability. The incidence of head injuries is increasing due to the increasing use of motorized vehicles. As many as 4% of cases of head fracture occur in the base of the cranii. Method: This research used a descriptive observational method. The data used is secondary data taken from medical records. In this study, we wanted to know the incidence of cranii base fracture cases due to head trauma in patients treated at Dr. Kariadi period 2019. Result: From 29 samples of medical records obtained, 48.3% had mild head trauma, 27.6% had moderate head trauma, and 24.1% had severe head trauma. Symptoms of patients with the most clinical symptoms of cranii base fracture were raccoon eyes 51.7%, with the most fracture locations in the anterior fossa as much as 51.7%. Conclusion: The incidence of cranii fracture due to head trauma at RSUP Dr. Kariadi in 2019 was found mostly over 40 years old and most of them were men. The type of injury is a minor head injury, with the largest location in the anterior fossa, and the most common clinical sign found in patients with cranii fracture is raccoon eyes.