Transzygomatic approach with intraoperative neuromonitoring for resection of middle cranial fossa tumors.
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ABSTRACT:
SUBMITTER: Son BC
PROVIDER: S-EPMC3424022 | biostudies-other | 2012 Feb
REPOSITORIES: biostudies-other
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Project description:OBJECTIVE:Define the indications and outcomes for subjects undergoing treatment utilizing the extended middle cranial fossa approach (EMCF). STUDY DESIGN:Retrospective records review. SETTING:University-based tertiary referral center. PATIENTS:Subjects undergoing treatment of posterior cranial fossa (PCF) lesions. INTERVENTION(S):EMCF exposure and treatment of the indicating PCF lesion. MAIN OUTCOME MEASURE(S):Demographic, audiometric, and cranial nerve functioning variables were assessed. RESULTS:Thirty-five subjects who underwent an EMCF exposure were identified over a 12-year period. The most common indication was meningioma (18; 51%) followed by schwannomas (six, 17%), and vascular lesions (five, 14%). Preoperative cranial nerve complaints were common (32, 94%) as were objective cranial nerve abnormalities on physical examination (21; 60%). Preoperative audiometric data from subjects with hearing demonstrated good functioning including pure-tone average (PTA) (21.7?±?15.6?dB HL) and word understanding scores (95.1?±?7.4%). Most (34, 97%) subjects had intact facial nerve function. The average length of stay was 11.6 days (median?=?9). Cranial neuropathies were common postoperatively with 27 (79%) subjects demonstrating some objective cranial nerve dysfunction, the most common of which was trigeminal nerve hypesthesia (21, 61.7%). Subjects with identifiable pre- and postoperative audiometric data and preoperative hearing demonstrated small declines in the four-tone average (16.2?dB) and word recognition scores (22.4%). Two subjects (6%) had new profound hearing loss postoperatively. CONCLUSIONS:The EMCF approach can provide safe and effective exposure of the anterior PCF.
| S-EPMC6719683 | biostudies-literature
Project description:The anatomical features of the temporal bone can vary significantly among different individuals. These variations affect the operative view in middle cranial fossa surgery. We performed 18 middle fossa approaches in 9 cadaveric heads, with detailed morphological analysis, to identify unfavorable situations and reliable systems to avoid complications during surgery. We recorded linear, angular measurements and calculated areas. We performed a computed tomography (CT) scan with analysis of the amount of bone to remove in two temporal bones. We found that the location of the internal auditory canal (IAC) is the keystone of bone removal. We also found accuracy in the system suggested by E. and J. L. Garcia-Ibanez for its identification and that there is a smaller surgical window in female patients (statistically significant) that can be predicted on preoperative imaging studies. Our study also confirms significant individual variability in the mutual relationships of different surgical landmarks. We concluded that surgery of the middle fossa requires detailed understanding of the complex temporal bone anatomy. The surgeon has to be aware of extreme variability of the more commonly used anatomical landmarks. The method to identify the position of the IAC described by E. and J. L. Garcia-Ibanez seems to be the simplest and most reliable. When the surgical strategy includes an anterior petrosectomy, interindividual variability can critically affect the working area, particularly in females. The working area can be estimated on preoperative CT scans through the petrous bone.
| S-EPMC2111136 | biostudies-other
Project description:Background and purposeDAVFs rarely involve the sphenoid wings and middle cranial fossa. We characterize the angiographic findings, treatment, and outcome of DAVFs within the sphenoid wings.Materials and methodsWe reviewed the clinical and radiologic data of 11 patients with DAVFs within the sphenoid wing that were treated with an endovascular or with a combined endovascular and surgical approach.ResultsNine patients presented with ocular symptoms and 1 patient had a temporal parenchymal hematoma. Angiograms showed that 5 DAVFs were located on the lesser wing of sphenoid bone, whereas the other 6 were on the greater wing of the sphenoid bone. Multiple branches of the ICA and ECA supplied the lesions in 7 patients. Four patients had cortical venous reflux and 7 patients had varices. Eight patients were treated with transarterial embolization using liquid embolic agents, while 3 patients were treated with transvenous embolization with coils or in combination with Onyx. Surgical disconnection of the cortical veins was performed in 2 patients with incompletely occluded DAVFs. Anatomic cure was achieved in all patients. Eight patients had angiographic and clinical follow-up and none had recurrence of their lesions.ConclusionsDAVFs may occur within the dura of the sphenoid wings and may often have a presentation similar to cavernous sinus DAVFs, but because of potential associations with the cerebral venous system, may pose a risk for intracranial hemorrhage. Curative embolization through a transarterial or transvenous approach is the primary therapeutic strategy for these lesions. In incompletely embolized patients, exclusion of any refluxing cortical veins is necessary.
| S-EPMC7965092 | biostudies-literature
Project description:Background and purposeMiddle cranial fossa encephaloceles are an increasingly recognized cause of epilepsy; however, they are also often encountered on neuroimaging in patients with no history of seizure. We characterized the MR imaging features of middle cranial fossa encephaloceles in seizure and nonseizure groups with the hope of uncovering features predictive of epileptogenicity.Materials and methodsSeventy-seven patients with middle cranial fossa encephaloceles were prospectively identified during routine clinical practice of neuroradiology at a tertiary care hospital during an 18-month period. Thirty-five of 77 (45%) had a history of seizure, 20/77 (26%) had temporal lobe epilepsy, and 42/77 (55%) had no history of seizures. Middle cranial fossa encephalocele features on MR imaging were characterized, including depth, area, number, location, presence of adjacent encephalomalacia, and degree of associated parenchymal morphologic distortion. MR imaging features were compared between the seizure and nonseizure groups.ResultsNo significant difference in MR imaging features of middle cranial fossa encephaloceles was seen when comparing the seizure and nonseizure groups. Comparison of just those patients with temporal lobe epilepsy (n = 20) with those with no history of seizure (n = 42) also found no significant difference in MR imaging features.ConclusionsAnatomic MR imaging features of middle cranial fossa encephaloceles such as size, number, adjacent encephalomalacia, and the degree of adjacent parenchymal morphologic distortion may not be useful in predicting likelihood of epileptogenicity.
| S-EPMC7658845 | biostudies-literature
Project description:Objectives Temporal bone encephaloceles are usually encountered in the setting of a congenital defect of the tegmen or as an acquired defect after mastoid surgery. A variety of methods have been described in the literature for rigid reconstruction of tegmen defects. We introduce a new method of repair using orbital floor titanium mesh reconstruction plates to reconstruct the floor of the middle cranial fossa, and evaluate the outcomes, complications, and recurrence rates of temporal bone encephaloceles with this technique. Design Retrospective chart review of consecutively treated patients. Setting Tertiary care academic center. Participants Eight patients with middle cranial fossa skull base defects from January 2007 to February 2011. Main Outcome Measures Outcome measures included resolution of cerebrospinal fluid leak (CSF) and development of postoperative infection. Results One of nine patients had a postoperative CSF (cerebrospinal fluid) leak. There were no long-term complications of CSF leak or infection. Conclusions Titanium mesh is a safe and effective substitute for bone grafts in reconstruction of the middle cranial fossa skull base when rigid reconstruction is required.
| S-EPMC3969440 | biostudies-other
Project description:Background Rates of hearing preservation following surgery via middle fossa craniotomy in patients harboring tumors with unfavorable characteristics are significantly lower than for those patients with "favorable" tumors. Objectives We will present two cases both with unfavorable conditions, which underwent endoscopic-assisted middle fossa craniotomy (MFC) resection of intracanalicular vestibular schwannomas with preserved postoperative hearing. Methods Chart reviews were conducted on both patients. Their presentation, intraoperative details, and techniques, pre- and postoperative audiograms, and facial nerve outcomes are presented. Results Patient A had 5.6 × 6.8 × 13.2 mm intracanalicular tumor with unserviceable hearing (pure tone audiometry [PTA], 41; speech determination score [SDS], 47%; class D) but was blind so hearing preservation was attempted. Postoperative hearing was preserved (PTA, 47; SDS, 60%; class B). Patient B had a 5 mm round intracanalicular tumor immediately adjacent to the vestibule and cochlea without any fundal fluid present. Preoperative audiogram showed serviceable hearing (PTA, 48; SDS, 88%; class B). Postoperatively, aidable hearing was preserved (PTA, 51; SDS, 76%; class C). Conclusion Hearing preservation surgery via MFC can be enhanced with endoscopic-assisted dissection, especially in the lateral internal auditory canal. The superior optical view allows for preservation of cochlear nerve function and removal of residual tumor not otherwise seen on microscopy.
| S-EPMC4726384 | biostudies-other
Project description:Ganglioglioma (GG) is an uncommon primary lesion of the central nervous system that is typically located supratentorially. There are only a few reports of GG arising from the cerebellum. To the best of our knowledge this is the first case of a cerebellar GG with supratentorial extension and a longstanding history before its recognition. In fact, this 29-year-old male presented with an 11-year history of intermittent headaches. A cranial computerized tomography (CT) performed at the onset of his complaints failed to reveal the tumor. After a particularly longstanding cephalalgic episode, the patient underwent a new CT scan that was also negative. However, magnetic resonance (MR) imaging of the brain revealed a space-occupying lesion in the right cerebellar hemisphere with extension to the level of the superior colliculi and pineal recess. The tumor was partially removed through a midline suboccipital craniotomy and supracerebellar approach. Pathological examination of the tumor showed composition of atypical ganglion cells and astrocytes, indicating the diagnosis of cerebellar GG. At last follow-up, 24 months after surgery, the patient reported a marked improvement of his clinical condition with significant reduction of intensity and frequency of the headache. The present report illustrates how cerebellar GG may remain undetectable by CT and may therefore present with a longstanding history and nonspecific signs and symptoms. MR investigation can lead to the proper diagnosis. Even after partial removal the prognosis remains good and remission of the symptoms may be achieved. In this article, we review the literature and summarize the current understanding of infratentorial GGs.
| S-EPMC2039715 | biostudies-other
Project description:Background Zygomatic osteotomy, an adjunct to middle cranial fossa (MCF) surgical approaches, improves the superior-inferior angle of approach and minimizes temporal lobe retraction. However, a decision-making algorithm for selective use of the zygomatic osteotomy and the impact of the zygomatic osteotomy on surgical complications have not been well documented. Objective We described an algorithm for deciding whether to use a zygomatic osteotomy in MCF surgery and evaluated complications associated with a zygomatic osteotomy. Methods A retrospective review of MCF cases over 11 years at our academic tertiary referral center was conducted. Demographic variables, tumor characteristics, surgical details, and postoperative complications were extracted. Results Of the 87 patients included, 15 (17%) received a zygomatic osteotomy. Surgical trajectory oriented from anterior to posterior (A-P) was significantly correlated with the use of the zygomatic osteotomy. Among the cases approached from A-P, we found (receiver-operating characteristic curve) that the cut-off tumor size that predicted a zygomatic osteotomy was 30 mm. Of the 87 cases included, 15 patients had a complication. The multivariate logistic regression model failed to reveal any significant correlation between complications and zygomatic osteotomies. Conclusions We found that the most important factor determining the use of a zygomatic osteotomy was anticipated trajectory. A-P approaches were most highly correlated with zygomatic osteotomy. Within those cases, a lesion size cut-off of 30 mm was the secondary predicting factor of zygomatic osteotomy use. The odds of suffering a surgical complication were not significantly increased by use of zygomatic osteotomy.
| S-EPMC6534730 | biostudies-literature
Project description:BackgroundThe endoscopic transnasal approach has been proven to have advantages on the removal of the tumors in pterygopalatine fossa (PPF) and infratemporal fossa (ITF). Herein, this study aimed to describe a modified approach for resection of the tumors in these areas, both in cadaveric specimen and clinical patients.MethodsThe 20 adult cadaveric specimens and five patients with tumors in PPF and ITF were enrolled in this study. For the cadaveric specimens, ten were simulated anterior transmaxillary approach and ten were performed modified endoscopic transnasal transmaxillary approach. The exposure areas were compared between two groups and main anatomic structure were measured. Surgery was operated in the five patients with tumors of PPF and ITF to verify the experience from the anatomy. Perioperative management, intraoperative findings and postoperative complications were recorded and analyzed.ResultsThe modified endoscopic transnasal transmaxillary approach provided as enough surgical exposure and high operability to the PPF and ITF as the anterior transmaxillary approach did. The diameter of maxillary artery in the PPF was 3.77 ± 0.78 mm (range: 2.06-4.82 mm), the diameter of middle meningeal artery in the ITF was 2.79 ± 0.61 mm (range: 1.54-3.78 mm). Four patients who suffered schwannoma got total removal and one of adenocystic carcinoma got subtotal removal. The main complications were facial numbness and pericoronitis of the wisdom tooth. No permanent complication was found.ConclusionsWith the widespread use of neuroendoscopy, the modified endoscopic transnasal transmaxillary approach is feasible and effective for the resection of tumors located in PPF and ITF, which has significant advantages on less trauma and complications to the patients.
| S-EPMC6595853 | biostudies-literature
Project description:BackgroundEn bloc resection of malignancies in the pterygopalatine fossa (PPF) poses critical challenges. Using the modified maxillary-swing (MMS) approach, we achieved monobloc removal of primary malignancies in this region. This study provides a detailed account of the surgical techniques and indications used.MethodsWe enrolled seven patients with primary malignancies in the PPF during a period from January 2012 to January 2019 in this retrospective study. After malignancies were confirmed by biopsy as well as evaluation with computed tomography (CT) and magnetic resonance imaging (MRI) scans, all of the patients underwent MMS surgery under general anesthesia to extirpate these tumors. We performed regular postoperative follow-up using CT and MRI scans.ResultsEn bloc resection was successfully performed in all cases. We observed negative margins in six cases and positive margins in one patient with adenoid cystic carcinoma, who received postoperative radiotherapy. The most common complication was facial numbness. During the follow-up period (range, 6-69 months), one patient suffered from recurrence, while the others did not.ConclusionThe advantages of the MMS include a wide surgical field, full exposure, and easy manipulation. We expect this approach to become an alternative to the monobloc resection of malignancies in the PPF that involve the infratemporal fossa, maxillary sinus, nasal cavity, orbit, or oral cavity.
| S-EPMC7682189 | biostudies-literature