PubMed Central (PMC3 - NLM DTD)
(2,081,148 recursos)
Archive of life sciences journal literature at the U.S. National Institutes of Health (NIH), developed and managed by NIH's National Center for Biotechnology Information (NCBI) in the National Library of Medicine (NLM).
362.
Skull Base Reconstruction in the Pediatric Patient - DeMonte, Franco; Moore, Brian A.; Chang, David W.
Tumors of the skull base are rare in children and adolescents and present a complicated management problem for oncologists and surgeons alike. Surgical resection is an integral component of the management of many pediatric neoplasms, especially those that are benign or, though not frankly malignant, are locally invasive. The general principles of skull base reconstruction following tumor ablation are applicable to nearly all patients; the reconstructive algorithm, however, is particularly complex in the pediatric population and the potential benefits of therapy must be balanced against the cumulative impact on craniofacial growth and maturity and the donor site morbidity. A retrospective...
363.
A Comprehensive Algorithm for Anterior Skull Base Reconstruction after Oncological Resections - Gil, Ziv; Abergel, Avraham; Leider-Trejo, Leonor; Khafif, Avi; Margalit, Nevo; Amir, Aharon; Gur, Eyal; Fliss, Dan M.
Objective: To present our method for anterior skull base reconstruction after oncological resections. Methods: One hundred nine patients who had undergone 120 anterior skull base resections of tumors (52 malignant [43%], 68 benign [57%]) via the subcranial approach were studied. Limited dural defects were closed primarily or reconstructed using a temporalis fascia. Large anterior skull base defects were reconstructed by a double-layer fascia lata graft. A split calvarial bone graft, posterior frontal sinus wall, or three-dimensional titanium mesh were used when the tumor involved the frontal, nasal, or orbital bones. A temporalis muscle flap was used to cover the orbital...
365.
Reconstruction of Lateral Skull Base Defects after Tumor Ablation - Thurnher, Dietmar; Novak, Christine B.; Neligan, Peter C.; Gullane, Patrick J.
Neoplasms located in the lateral skull base region present a challenge for evaluation and management due to their difficult anatomic location and the complex reconstruction that is required following extensive tumor resection. Repair following tumor ablation requires a watertight dural seal, obliteration of the dead space, and coverage with vascularized soft tissue. Advances in radiologic imaging, diagnostic pathology, and surgical techniques and a multidisciplinary team for tumor ablation and reconstruction have significantly improved the treatment of these patients, minimized the occurrence of postoperative complications, and maximized patient outcome and quality of life. In this article, we present our experience in...
366.
Endoscopic Reconstruction of Cranial Base Defects following Endonasal Skull Base Surgery - Snyderman, Carl H.; Kassam, Amin B.; Carrau, Ricardo; Mintz, Arlan
The expanded endonasal approach provides access to the entire ventral skull base for resection of neoplasms involving the skull base and brain. The creation of large defects of the bone and dura endoscopically presents unique reconstructive challenges. A layered reconstruction of the dura with inlay and onlay fascial grafts covered with fat grafts is an effective technique for repair. An intranasal balloon catheter is used to provide counterpressure in the early phase of healing and a lumbar spinal drain is a useful adjunct in patients at increased risk of a cerebrospinal fluid leak. Vascularized flaps may be necessary in some...
367.
Microvascular Reconstruction of the Skull Base: A Clinical Approach to Surgical Defect Classification and Flap Selection - Pusic, Andrea L.; Chen, Constance M.; Patel, Snehal; Cordeiro, Peter G.; Shah, Jatin P.
Skull-base tumor resection and reconstruction produce a major physiologic and anatomic impact on the patient. At our institution, the use of vascularized, free-tissue transfer has replaced pedicled flaps as the preferred modality for reconstructing complex cranial base defects involving resection of dura, brain, or multiple major structures adjacent to skull base, including the orbit, palate, mandible, skin, and other structures. The goals of reconstruction are to: (1) support the brain and orbit; (2) separate the CNS from the aerodigestive tract; (3) provide lining for the nasal cavity; (4) re-establish the nasal and oropharyngeal cavities; (5) provide volume to decrease dead...
368.
CO2 Laser Fascia to Dura Soldering for Pig Dural Defect Reconstruction - Forer, Boaz; Vasileyev, Tamar; Gil, Ziv; Brosh, Tamar; Kariv, Naam; Katzir, Abraham; Fliss, Dan M.
Background and objectives: The purposes of this study were to demonstrate that laser soldering is safe and effective for tissue bonding in dural reconstruction and to compare this new reconstruction technique to an established one. Study design: A temperature-controlled fiberoptic CO2 laser system or fibrin glue were used for in vitro dural defect reconstruction in two groups of pigs. The CO2 laser technique was also used for dural reconstruction in live pigs. Results: The burst pressure of the reconstructed dura by the laser system was significantly higher than that of fibrin glue (mean pressure 258.5?±?117.3 cm H2O and 76.8?±?47.2 cm...
369.
Reconstruction of Skull Base and Fronto-orbital Defects following Tumor Resection - Laedrach, Kurt; Lukes, Anton; Raveh, Joram
Reconstruction of the anterior skull base and fronto-orbital framework following extensive tumor resection is both challenging and controversial. Dural defects are covered with multiple sheets of fascia lata that provide sufficient support and avoid herniation. Plating along the skull base is contraindicated. After resection of orbital walls, grafting is necessary if the periosteum or parts of the periorbital tissue had to be removed, to avoid enophthalmus or strabism. Free bone grafts exposed to the sinonasal or pharyngeal cavity are vulnerable to infection or necrosis: therefore, covering the grafts with vascularized tissue, such as the Bichat fat-pad or pedicled temporalis flaps,...
370.
How I Do It: Endoscopic-Microscopic Anterior Skull Base Reconstruction - Draf, W.; Schick, B.
Reconstruction of the anterior skull base must be secure and watertight. Failure to achieve this places the patient at risk of the development of cerebral sepsis. We have developed the technique of endonasal duraplasty and have achieved a 90% long-term success rate. In this article we described the key elements of our technique starting with radiographic and fluorescein localization of a skull base defect. The main steps in reconstruction and materials used are detailed, together with modifications of our technique for certain difficult situations and tips for success. Attention is drawn to potential pitfalls that have been identified over 25...
371.
Surgical Management of PICA Aneurysm and Incidental Facial Nerve Schwannoma: Case Report - Bian, Liu-Guan; Sun, Qing-Fang; Tirakotai, Wuttipong; Zhao, Wei-Guo; Bertalanffy, Helmut; Shen, Jian-Kang
We report a patient with a posterior inferior cerebellar artery (PICA) aneurysm and an incidental facial nerve schwannoma at the cerebellopontine angle (CPA). A 46-year-old woman presented with the sudden onset of a severe headache, nausea, and vomiting. She had no other abnormal neurological symptoms and signs. Computed tomography (CT) showed hemorrhage in the fourth ventricle. Cerebral angiography demonstrated an aneurysm arising from the tonsillomedullary segment of the left PICA. A facial nerve schwannoma was incidentally found as the aneurysm was being clipped. The aneurysm was clipped via a left transcondylar approach. Subsequently, the schwannoma (2?×?3?×?2 mm) was resected from...
372.
Quality of Life following Surgery for Malignancies of the Anterior Skull Base - Woertgen, Chris; Rothoerl, Ralf Dirk; Hosemann, Werner; Strutz, Jürgen
Radical surgery combined with postoperative radiation is recommended to achieve the best outcomes in patients suffering from malignant anterior skull base tumors. However, information on the impact of such treatment on the quality of life of these patients is sparse. This retrospective study evaluated quality of life in patients with anterior skull base malignancies after transdural resection and radiotherapy. At follow-up, 36% of the patients were alive (mean survival time, 39 months). Only 45% of the patients were able to work in their previous occupation a mean of 15 months after surgery. At follow-up, 58% of the patients had a...
373.
The High Rate CIS Auditory Brainstem Implant for Restoration of Hearing in NF-2 Patients - Behr, Robert; Müller, Joachim; Shehata-Dieler, Wafaa; Schlake, Hans-Peter; Helms, Jan; Roosen, Klaus; Klug, Norfrid; Hölper, Bernd; Lorens, Artur
Aim: Hearing preservation is one of the major goals of acoustic neuroma surgery. In NF-2 patients, bilateral hearing loss is frequently caused by the disease or results from its treatment. Several implant devices for electrical stimulation of the cochlear nucleus have been developed to restore serviceable hearing in these patients. We report our experience and results using a high rate continuous interleaved sampling (CIS) auditory brainstem implant (ABI). Methods: Between June 1997 and May 2004, 24 NF-2 patients were managed by our group. In 20 patients an ABI was implanted successfully. The cochlear nucleus was located using anatomical landmarks and...
374.
A Case of Multiple Primary Tumors of the Anterior Skull Base - Lenarz, Minoo; Durisin, Martin; Becker, Hartmut; Brandis, Almuth; Lenarz, Thomas
We report a case of synchronous olfactory bulb meningioma and undifferentiated carcinoma of the nose and paranasal sinuses that involved and destroyed the anterior skull base and mimicked intracranial invasion by a carcinoma. The heterogeneity of tissue types in the skull base gives rise to a diverse variety of benign and malignant neoplasms which have totally different prognoses. Synchronous development of benign and malignant primary tumors both originating from and involving the skull base at the same location is very rare and may cause confusion for both the skull base surgeon and neuroradiologist.
375.
External Auditory Canal Hemangioma: Case Report - Verret, D.J.; Spencer Cochran, C.; DeFatta, Robert J.; Samy, Ravi N.
A patient with a hemangioma completely within the external auditory canal is reported.
376.
Transnasal Transsphenoidal Endoscopic Repair of CSF Leakage Using Multilayer Acellular Dermis - Ismail, Ahmed Soliman; Costantino, Peter D.; Sen, Chandranath
Cerebrospinal fluid (CSF) leaks result from a communication between the subarachnoid space and the upper aerodigestive tract. Because of the risk of complications such as meningitis, brain abscess, and pneumocephalus, all persistent CSF leaks should be repaired. Surgical repair may be achieved transcranially or extracranially using a wide variety of autogenous, allogenic, and synthetic patching materials. We report our results with a transnasal transsphenoidal endoscopic approach for the repair of CSF leaks coupled with a multilayer closure using acellular dermis (Alloderm). We conducted a retrospective review of all patients presenting to our institution over the past 5 years with isolated...
377.
Treatment of Large and Giant Residual and Recurrent Vestibular Schwannomas - Ramina, Ricardo; Coelho Neto, Maurício; Bordignon, Kelly Cristina; Mattei, Tobias; Clemente, Rogério; Pires Aguiar, Paulo Henrique
This report is a retrospective analysis of the surgical outcome of 15 patients (8 females, 7 males; mean age, 37.8 years) with residual or recurrent vestibular schwannomas operated on between 1987 and 2005. These 15 patients were part of a larger series of 252 consecutive vestibular schwannoma excisions. Tumors were classified as large (10) when their diameter exceeded 3.5 cm and giant (5) when their diameter exceeded 4.5 cm. All patients had previously undergone surgery. Hearing was lost in all cases, 8 had complete facial nerve palsy, 6 had trigeminal nerve deficits, 5 had cranial nerve IX and X palsy,...
378.
Utilization of Preoperative Cerebrospinal Fluid Drain in Skull Base Surgery - Bien, Alexander G.; Bowdino, Bradley; Moore, Gary; Leibrock, Lyal
Objective: Retrospectively assess the efficacy of lumbar cerebrospinal fluid (CSF) drainage placed preoperatively in skull base operations in decreasing the incidence of postoperative CSF fistula. Methods: A retrospective review of 150 patients undergoing a posterior fossa craniotomy from 1989 to 2000 was conducted. Patients were divided into those receiving preoperative lumbar drains and those that did not. The rates of postoperative CSF leakage were compared between the two groups. Patient data were analyzed to determine if there were other comorbidities affecting the postoperative incidence of CSF leakage such as smoking, diabetes, or hypertension. Results: Between 1989 and 1994, 25/72 (35%)...
380.
Prevention of Postexenteration Complications by Obliteration of the Orbital Cavity - Spiegel, Jeffrey H.; Varvares, Mark A.
Objective: In patients for whom aggressive disease processes have necessitated the surgical removal of the orbital contents, many reconstructive options are available to address the exenteration cavity. While cavity lining, such as with a skin graft, has been commonly employed, areas of bone injury or loss may still provide a pathway for bacteria to access the cranial vault. We suggest that complete obliteration of the cavity provides a protective barrier, which minimizes this risk. Design: A retrospective review of four patients with significant intracranial infectious complications following orbital exenteration. All patients were managed at a tertiary care academic medical center....
361.
