PubMed Central (PMC3 - NLM DTD)
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).
Skull base surgery
Mostrando recursos 1 - 20 de 788
Predictive Value of Balloon Test Occlusion of the Internal Carotid Artery - Segal, David H.; Sen, Chandranath; Bederson, Joshua B.; Catalano, Peter; Sacher, Michael; Stollman, Aryeh L.; Lorberboym, Mordechai
Balloon test occlusion (BTO) of the internal carotid artery (ICA) is used in conjunction with single-photon emission computed tomography (SPECT) imaging to assess the cerebrovascular collateral reserve prior to surgical manipulation of the artery. The present report reviews 56 consecutive patients with tumors or vascular lesions at the base of the skull who underwent BTO and subsequent treatment on that basis within a 3-year period. Four patients underwent carotid sacrifice, since they tolerated the BTO and had normal SPECT imaging. Postoperatively, one patient had patchy infarcts in the frontal lobe, another a middle cerebral artery territory infarction, a third had...
Skull Base Tumor Volume and Surgical Margins: A Pilot Study - Schwimmer, Craig; Weissman, Jane; Simon, A. Michael; Janecka, Ivo P.
The relationship between preoperative assessment of tumor volume and oncologic adequacy of surgical margins was studied retrospectively. Our hypothesis was that the risk of inadequate, or positive, margins would rise with increasing tumor volume and that this would adversely affect survival. We anticipated that limitations of surgical approaches used until 1988 would be reflected in an increasing proportion of positive margins with increasing tumor volume. We conducted a pilot study of 25 patients with malignant tumors of the anterolateral cranial base operated on at the University of Pittsburgh Center for Cranial Base Surgery between 1987 and 1988. Preoperative computed tomography...
Radiotherapy in the Management of Temporal Bone Chemodectoma - Mendenhall, William M.; Parsons, James T.; Stringer, Scott P.; Cassisi, Nicholas J.; Singleton, George T.; Million, Rodney R.
Forty patients with 42 temporal bone chemodectomas were treated with radiotherapy alone (37 tumors) or subtotal resection and irradiation (5 tumors) at the University of Florida between 1968 and 1992. Thirty-three lesions were previously untreated, whereas 9 had undergone prior treatment (surgery, 6 lesions; radiotherapy, 1 lesion; or both, 2 lesions) and were treated for locally recurrent disease. All 3 patients who received prior radiotherapy had been treated at other institutions. Patients had minimum follow-up times as follows: 2 years, 40 patients (100%); 5 years, 31 patients (78%); 10 years, 21 patients (53%); 15 years, 16 patients (40%); 20 years,...
Reconstructing Complex Cranial Defects with a Preformed Cranial Prosthesis - Origitano, T.C.; Izquierdo, Ricardo; Scannicchio, Louis B.
Large cranial defects (70 cm2 or more) of complex geometric shapes (bifrontal or involving supraorbital ridges) that are associated with significant cutaneous contracture or soft tissue loss are challenging to reconstruct. We have treated 10 patients with complex cranial defects through a staged approach. Reconstructing the defect involved several steps. Before each surgery, we constructed a craniofacial prosthesis from polymethyl methacrylate to fit the patient's individual defect. When indicated, adjacent skin was expanded with a subcutaneous tissue expander. Finally, we carried out a cranioplasty and placed the prosthesis. Operative closure of the defect was facilitated by microplate and screw fixation...
Parapharyngeal Space Tumors: The Infratemporal Fossa Approach - Shahinian, H.; Dornier, C.; Fisch, U.
Tumors of the parapharyngeal space, although mostly benign in their histopathology, present a challenge to the surgeon due to the limited access. Multiple approaches have been described in the literature for the extirpation of these tumors. The usual anatomic division of the parapharyngeal space into prestyloid and poststyloid spaces does not help the clinician determine which approach to use for a specific tumor. We have reviewed our 10-year experience at the University of Zurich. The usual presentation of the patients and the histopathologic characteristics of their tumors are compared. The radiological evaluation of these patients, their perioperative course, and complications...
Locating the Internal Auditory Canal during the Middle Fossa Approach: An Alternative Technique - Jackler, Robert K.; Gladstone, Hayes B.
Options for the surgical exposure of the internal auditory canal (IAC) include the translabyrinthine, retrosigmoid, and middle fossa approaches. Of the three, the anatomical reference points to the IAC are most subtle when it is exposed from above. The classically described methods for localizing the canal during the middle fossa approach direct the surgeon's attention initially towards the lateral extremity of the canal, a location where the margin for error is at its minimum. The cochlea, semicircular canals, and geniculate ganglion of the facial nerve are all positioned in close proximity to the fundus of the canal. An approach which...
Facial Nerve Monitoring under Neuromuscular Blockade - Hester, T. Oma; Hasan, Akbar; McDonnell, Francis; Valentino, Joseph; Jones, Raleigh
The characteristics of facial nerve electromyography at various levels of neuromuscular blockade are unclear. Partial blockade is well known to facilitate anesthetic safety and management. However, the use of neuromuscular blockage in many skull base procedures is avoided to allow intraoperative facial nerve monitoring.
Head and Neck Squamous Cell Carcinoma Metastatic to the Orbital Apex - Day, Terry A.; Hoasjoe, Denis K.; Hebert, Richard L.; Gonzalez, Enrique; Shockley, William; Stucker, Fred J.; Nanda, Anil
Primary squamous cell carcinoma of the head and neck most commonly metastasizes to the lymph nodes, lung, bone, and liver. Many other rare sites of metastatic disease have been reported. To date, metastatic squamous cell carcinoma of the head and neck to the orbital apex has not been described. Presented are two cases, one tonsil and one parotid primary with metastatic disease to the orbital apex. Many tumors have been found to metastasize to the eye and orbit, but head and neck neoplasms are rarely reported. A review of the literature is presented in addition to the detailed case reports...
Lateral Orbital/Anterior Midfacial Degloving Approach for Nasopharyngeal Angiofibromas with Cavernous Sinus Extension - Browne, J. Dale; Messner, Anna H.
A case of nasopharyngeal angiofibroma removed through a modified lateral approach for an infratemporal fossa resection is reported. This modification involved removing the bone of the lateral orbital apex and posterior middle fossa to expose the dura and periorbita and, when combined with a midfacial degloving approach, provided full access to the tumor abutting the cavernous sinus extradurally while preserving middle ear function.
Posterior Fossa Meningioma: Surgical Strategy - Saleh, Essam A.; Taibah, Abdel Kader; Achilli, Vittorio; Aristegui, Miguel; Mazzoni, Antonio; Sanna, Mario
Posterior fossa meningioma is the second most common tumor in the cerebellopontine angle. It has a higher rate of postoperative morbidity and mortality compared to acoustic neuroma. Forty posterior fossa meningioma patients managed in our centers were reviewed. Thirty-nine patients were managed surgically with 42 surgical procedures. The approaches used were the translabyrinthine approach in 18 patients (43%), the modified transcochlear in 11 cases (26%), the petro-occipital transsigmoid in 5 cases (12%), the suboccipital in 4 cases (10%), the petro-occipital trassigmoid transcervical in 2 cases (5%), the petro-occipital transsigmoid transtentorial in 1 case (2%), and a subtemporal transtentorial for another...
Faciohypoglossal Anastomosis: Does the Morphology of the Facial Nerve Affect the Functional Result? - Buckley, Graham; Felix, Heidi; Fisch, Ugo
We report the results of a histological study of facial nerve specimens obtained at the time of faciohypoglossal anastomosis. We examined sections from 24 patients using light and electron microscopy in order to determine the extent of the degenerative process with time and its relationship to the functional results of the anastomosis. We graded the histological features associated with degeneration, regeneration, and fibrosis on an ordered nominal scale from 0 to 3 and correlated them with duration of facial palsy and postoperative facial function. There was no histological evidence of increasing collagenosis or fibrosis with duration of facial palsy, and...
Surgical Anatomy of the Extended Middle Cranial Fossa Approach - Arìstegui, Miguel; Cokkeser, Yasar; Saleh, Essam; Naguib, Maged; Landolfi, Mauro; Taibah, Abdel; Sanna, Mario
The extended middle cranial fossa approach includes removal of the petrous bone from its subtemporal surface in order to expose widely the internal auditory canal and the posterior fossa dura around its porus while preserving all the important and closely related anatomical structures. We have dissected 25 temporal bones and five fresh cadavers in order to define the limits of this approach. Measurements were obtained between the different structures to find reliable angles and distances that could guide working in this area. A new method of identification of the internal auditory canal is discussed based on the measurements taken.
Vagal Nerve Monitoring during Parapharyngeal Space Tumor Removal - Leonetti, John P.; Mokarry, Victor P.; Fan, Zhaomin; Warf, Patricia; Hudson, Elizabeth
The vagus nerve innervates the intrinsic and extrinsic laryngeal musculature as well as the complex pharyngeal plexus. Acute paralysis of this nerve results in dysfunctional speech, deglutition, and airway protection. These untoward effects, which lead to additional infectious and aerodigestive complications, may arise following manipulation of the vagus nerve during the surgical removal of a variety of neoplasms found in the parapharyngeal space.
The Extreme Lateral Transcondylar Approach to Aneurysms of the Vertebrobasilar Junction, the Vertebral Artery, and the Posterior Inferior Cerebellar Artery - Rohde, Veit; Schaller, Carlo; Hassler, Werner
The unilateral suboccipital craniotomy is the commonly performed approach to aneurysms of the vertebrobasilar junction, the vertebral artery, and the posterior inferior cerebellar artery (PICA). Many of these aneurysms are placed anterior or anterolateral to the brain stem, necessitating brain stem retraction for adequate exposure. Small dorsolateral enlargement of the foramen magnum, partial resection of the occipital condyle, and removal of the jugular tubercle allow access to the neurovascular structures ventral to the medulla without retraction of the neuroaxis. This extreme lateral transcondylar approach was performed in 20 patients with aneurysms of the vertebrobasilar junction, the vertebral artery, and the...
Microsurgical Removal of Olfactory Groove Meningiomas via the Pterional Approach - Schaller, Carlo; Rohde, Veit; Hassler, Werner
Commonly used frontobasal approaches for microsurgical removal of olfactory groove meningiomas have certain disadvantages, such as late exposure of the neurovascular complex located dorsal to the tumor, namely, the internal carotid artery, middle cerebral artery, anterior cerebral artery, and the optic nerves. In addition, the frontal sinuses are frequently opened and there can be compression of the frontal lobes from significant spatula pressure. We report our experience with the pterional approach for these tumors in 28 patients. All patients presented with hyposmia/anosmia; 20 had personality changes and 8 had visual deficits. At surgery, after dissection of the sylvian fissure, the...
Malignant Vestibular Schwannoma - Gruber, B.; Petchenik, L.; Williams, M.; Thomas, C.; Luken, M.G.
A 61-year-old woman underwent a translabyrinthine resection of a right intracanulicular acoustic neuroma, which had been detected in the work-up of sudden hearing loss. At the time of surgery, the tumor was roughly twice as large as indicated by the magnetic resonance scan taken only 2 months previously. The tumor eroded the vertical and transverse crests and extended well into the cerebellopontine angle. It was impossible to distinguish the facial nerve proximal to the geniculate ganglion. All visible tumor was resected, along with the facial nerve. Histological evaluation showed a highly cellular tumor, with many mitoses and areas of necrosis,...
Highly Selective Infusions of Supradose Cisplatin for Cranial Base Malignancies - Robbins, K. Thomas; Pellitteri, Phillip K.; Harris, Jeffrey P.; Hanchett, Catherine; Kerber, Charles; Vicario, Daniel
Treatment results for malignant skull base lesions may be improved with combined modality therapy. Using a novel drug infusion technique that capitalizes on the pharmacodynamic cisplatin-neutralizing properties of thiosulfate, 14 patients (6 untreated, 8 recurrent) received cisplatin (120 to 200 mg/m2 for 1 to 4 weeks × 2-4 cycles) as part of a multimodality treatment program. Histology included squamous cell carcinoma, 11 patients (8 upper aerodigestive tract, 3 cutaneous); sarcoma, 2 patients (malignant fibrous histiocytoma, synovial cell sarcoma); and salivary gland cancer, 1 patient. The lesions involved the lateral skull base (12 patients) and the anterior (2 patients).
Intercavernous Venous Communications in the Human Skull Base - Aquini, Mauro Guidotti; Marrone, Antonio Carlos Huf; Schneider, Felipe Luis
The intercavernous communications of the skull base were studied in 32 sphenoid blocks using electrolytic decalcification techniques, vascular filling, x-rays, and serial anatomical sections. In this study four intercavernous connections were found: anterior intercavernous sinus (AIS), posterior intercavernous sinus (PIS), inferior intercavernous sinus (IIS), and basilar plexus (BP). The AIS was present in 100% of the cases, with diameters ranging from 0.57 mm to 5.43 mm; in 17 cases (53.12%) it took up the whole anterior wall of the hypophyseal fossa. The PIS was also detected in 100% of the cases, and its diameters ranged from 0.71 mm to 4.14...