1/30. End-to-end anastomosis of the posterior inferior cerebellar artery before excision of a meningioma involving the lower clivus and the foramen magnum. Case report.BACKGROUND: Petroclival and foramen magnum meningiomas sometimes encase the vertebrobasilar arterial system. magnetic resonance imaging can clearly reveal such encasement. The case presented here was of a meningioma involving the lower clivus and the foramen magnum, encasing a lateral segment of the posterior inferior cerebellar artery (pica), despite the fact that no definitive diagnosis of the encasement of the pica was made on preoperative radiological examination. End-to-end anastomosis of the pica was necessary before excision of the tumor. methods: A 55-year-old woman presented with complaints of headache and numbness of the right upper extremity. gadolinium diethylene-thiamine-pentaacetic acid enhanced T1-weighted magnetic resonance (MR) images showed a homogeneously enhanced mass lesion involving the lower clivus and the foramen magnum. Direct surgery was then performed, and the lateral medullary segment of the left pica was found to be encased by the tumor. End-to-end anastomosis was performed using No. 10-0 interrupted monofilament nylon sutures. Total removal of the tumor was performed after completion of the anastomosis. The patient was free of neurological abnormalities and no recurrence of tumor was found during a 2-year follow-up period. CONCLUSIONS: Revascularization is sometimes thought to be required for resection of craniospinal meningiomas even when they do not appear to encase the vertebro-basilar arterial system on preoperative MR imaging and cerebral angiograms. In the present case, dissection of the pica from the tumor was attempted, but was difficult due to tight encasement of the pica by the tumor.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/30. The transmastoid partial labyrinthectomy approach to medial skull base lesions.INTRODUCTION: It has long been thought that surgical disruption of the membranous labyrinth invariably results in sensorineural hearing loss and balance dysfunction. Recent evidence suggests that the inner ear can withstand such manipulation without loss of function. The technique of transmastoid partial labyrinthectomy has recently been described as a means of providing access to lesions of the medial skull base by removing part of the labyrinth and at the same time attempting to preserve hearing and vestibular function of the lateral semicircular canal (LSCC) and otolithic organs. PROCEDURE: An extended cortical mastoidectomy is performed and the posterior and middle cranial fossa dura are exposed widely. The posterior and superior semicircular canals are occluded at their ampullated ends and at the crus commune, and then resected. The LSCC and vestibule are left undisturbed. The petrous apex is removed and the medial end of the internal auditory canal is exposed. Posterior cranial fossa dural flaps are raised allowing access to the brainstem, petro-clival area and cerebellopontine angle. Temporal and suboccipital craniotomies can be performed, as required. RESULTS: Four patients underwent this procedure by a joint Otolaryngological-Neurosurgical team for access to the following lesions: three intra-axial pontine cavernomas and a basilar artery aneurysm. The preliminary hearing and balance results are discussed. CONCLUSIONS: The partial labyrinthectomy approach provides improved access to certain lesions of the medial skull base and requires less brain retraction compared with the retrolabyrinthine approach. It also has the potential to preserve serviceable hearing.- - - - - - - - - - ranking = 5.165470638254keywords = canal (Clic here for more details about this article) |
3/30. Preservation of olfaction in anterior skull base surgery.OBJECTIVES/HYPOTHESIS: In selected unilateral tumors and defects of the anterior skull base, the preservation of contralateral olfaction is achievable through a localized subcranial approach without compromising surgical objectives of resection or repair. STUDY DESIGN: Description of a functional adaptation of anterior skull base surgical techniques through a retrospective patient series. methods: Nine patients underwent anterior skull base surgery for unilateral cribriform plate disease including four malignant and two benign tumors, two encephaloceles, and one iatrogenic cribriform injury with cerebrospinal rhinorrhea. All nine patients consented to a localized subcranial approach to the anterior skull base to preserve the contralateral olfactory nerves. In four patients with benign disease a portion of the ipsilateral nerves was additionally conserved. Postoperative olfaction was assessed objectively with a commercially available smell test. Indications, technique, results, and complications are reported and discussed. RESULTS: All patients had eradication of disease with preservation of functional olfaction CONCLUSIONS: Conservation of olfaction is possible in selected cases of anterior skull base surgery when the lesion is unilaterally confined.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
4/30. Intraspinal clear cell meningioma: diagnosis and management: report of two cases.OBJECTIVE AND IMPORTANCE: Intraspinal clear cell meningioma is a rare morphological variant of meningioma. Only 13 case reports are found in the literature; therefore, no management strategy has been defined for this tumor type. This article describes two patients, reviews the literature, and proposes a treatment plan for clear cell meningioma. CLINICAL PRESENTATION: Two female patients, 22 months and 8 years of age, respectively, presented with localized neck and leg pain that limited their ability to walk. magnetic resonance imaging revealed intradural tumors, a cervical intramedullary neoplasm in the younger patient, and a cauda equina tumor in the older child. INTERVENTION: Both patients underwent radical resection of their intradural tumor. Both tumors, however, recurred shortly (5 and 6 mo) after the initial operation. During the second operation, a radical removal was performed on each patient. Both patients received adjuvant radiotherapy. In addition, the younger patient developed posterior fossa metastasis 20 months after intraspinal surgery. CONCLUSION: Intraspinal clear cell meningiomas are very uncommon tumors. The clinical course in our two patients supports the reported 40% recurrence rate within 15 months. These tumors also can disseminate within the central nervous system. We recommend serial imaging studies every 3 months. For recurrent tumors, we recommend localized radiation therapy after reoperation.- - - - - - - - - - ranking = 7keywords = spinal (Clic here for more details about this article) |
5/30. carcinoma of temporal bone, base of the skull: diagnosis by needle aspiration cytology.We report on a 68-yr-old male with a destructive bone lesion involving the temporal bone at the skull base extending to surrounding osseous structures and the infratemporal fossa, defined by needle aspiration cytology as carcinoma in association with inflammatory reaction, bacterial type, and bone destruction. The technique of the aspiration, which was performed by a cytopathologist directing a spinal needle into the region of the destroyed temporal bone as outlined in the radiographs of prior magnetic resonance imaging (MRI), is discussed. The application of this technique in the cytologic sampling of deeper lesions usually of soft or osseous tissues not accessible to ordinary fine-needle aspiration is presented. There is also a brief discussion of neoplastic lesions involving the temporal bone at the skull base and the anatomic concerns in sampling lesions in this difficult-to-approach region of the body.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
6/30. Transoral transclival approach for intradural lesions using a protective bone baffle to block cerebrospinal fluid pulse energy--two case reports.The transoral transclival approach for the treatment of intradural lesions of the clivus is often associated with serious complications such as cerebrospinal fluid (CSF) leakage and meningitis. CSF pulse energy may be the most significant factor in CSF leakage and meningitis, but a bone baffle can block such CSF pulse energy. A 64-year-old female presented with sudden onset of severe headache. She had subarachnoidal hemorrhage due to a rupture of the vertebral-posterior inferior cerebellar artery aneurysm. A 66-year-old female complaining of occipitalgia and numbness of the extremities had a foramen magnum meningioma. Both patients were treated via the transoral transclival route with a protective bone baffle, obtained from the iliac bone, securely fixed in the bone window to protect the repaired dura from injury by CSF pulse energy. Neither patient showed CSF leakage or meningitis, and the period of continuous lumbar CSF drainage was only 7 days. The transoral transclival approach with a bone baffle is still very effective in selected cases.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
7/30. Dural reconstruction with fascia, titanium mesh, and bone screws: technical note.OBJECTIVE: After the resection of cranial base tumors, there may not be enough free dural margin left for reconstruction after involved bone and dura have been removed. In such a situation, dural reconstruction becomes a problem. We propose a new technique of dural closure in such cases. methods: A fascial graft is prepared from either fascia lata, abdominal fascia, pericranium, or temporal fascia and is trimmed to a size slightly larger than that of the dural defect. The fascial graft is placed over the dural defect and affixed to the underlying bone with a piece of titanium mesh, titanium screws, or both. The graft is then reinforced with fibrin glue. RESULTS: This method of dural reconstruction has been used in five patients with basal meningiomas. Three were in the petromastoid area, and two were in the planum-ethmoid area. None of these patients experienced postoperative cerebrospinal fluid leak, and none experienced any complications related to the reconstruction. CONCLUSION: This technique of dural reconstruction can be used in selected cases of basal tumors without enough free dural margin to sew into a fascial graft.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
8/30. Posterior cranial fossa dermoid in association with craniovertebral and cervical spinal anomaly: report of two cases.Two patients, a 12-year-old girl and an 8-year-old boy, with congenital craniovertebral anomaly and klippel-feil syndrome also had a posterior cranial fossa dermoid. The association of these two discrete pathological lesions in the same individual is extremely rare. As both lesions are related to an embryological disorder, issues regarding the possible stage of dysgenesis are analyzed. The treatment options in such cases are discussed.- - - - - - - - - - ranking = 4keywords = spinal (Clic here for more details about this article) |
9/30. Isolated hypoglossal nerve palsy due to skull base metastasis from breast cancer.We describe a 44-year-old woman who presented with an isolated unilateral hypoglossal nerve paralysis caused by a skull base metastasis from breast cancer. The patient had a modified radical mastectomy followed by local radiotherapy and adjuvant chemotherapy. Fourteen months later she presented with difficulty in speaking. physical examination revealed an isolated left hypoglossal nerve paralysis. The MRI scan showed a mass lesion involving the left occipital condyle extending into hypoglossal canal.- - - - - - - - - - ranking = 1.7218235460847keywords = canal (Clic here for more details about this article) |
10/30. Complex tumors of the glomus jugulare: criteria, treatment, and outcome.OBJECT: Tumors of the glomus jugulare are benign, slow-growing paragangliomas. Their natural history, surgical treatment, and outcome have been well addressed in the recent literature; however, there remains a subgroup of complex tumors--multiple, giant, malignant, neuropeptide-secreting lesions, and those treated previously by an intervention with an adverse outcome--that is high risk, presents surgical challenges, and is associated with treatment controversy. In this article the authors report on a series of patients with complex glomus jugulare tumors and focus on treatment decisions, avoidance of complications, surgical refinements, and patient outcomes. methods: In this retrospective study, the patient population was composed of 11 male and 32 female patients (mean age 47 years) with complex tumors of the glomus jugulare who were treated by the senior author within the past 20 years. These include 38 patients with giant tumors, 11 with multiple paragangliomas (seven bilateral and four ipsilateral), two with tumors that hypersecreted catecholamine, and one with a malignant tumor. Six patients had associated lesions: one dural arteriovenous malformation, one carotid artery (CA) aneurysm, two adrenal tumors, and two other cranial tumors. All but one patient presented with neurological deficits. Cranial nerve deficits, particularly those associated with the lower cranial nerves, were the prominent feature. Twenty-eight patients underwent resection in an attempt at total removal, and gross-total resection was achieved in 24 patients. Particularly challenging were cases in which the patient had undergone prior embolization or CA occlusion, after which new feeding vessels from the internal CA and vertebrobasilar artery circulation developed. The surgical technique was tailored to each patient and each tumor. It was modified to preserve facial nerve function, particularly in patients with bilateral tumors. Intrabulbar dissection was performed to increase the likelihood that the lower cranial nerves would be preserved. Each tumor was isolated to improve its resectability and prevent blood loss. No operative mortality occurred. In one patient hemiplegia developed postoperatively due to CA thrombosis, but the patient recovered after an endovascular injection of urokinase. In four patients a cerebrospinal fluid leak was treated through spinal drainage, and in five patients infection developed in the external ear canal. Two of these infections progressed to osteomyelitis of the temporal bone. There were two recurrences, one in a patient with a malignant tumor who eventually died of the disease. CONCLUSIONS: Despite the challenges encountered in treating complex glomus jugulare tumors, resection is indicated and successful. Multiple tumors mandate a treatment plan that addresses the risk of bilateral cranial nerve deficits. The intrabulbar dissection technique can be used with any tumor, as long as the tumor itself has not penetrated the wall of the jugular bulb or infiltrated the cranial nerves. Tumors that hypersecrete catecholamine require perioperative management and malignant tumors carry a poor prognosis.- - - - - - - - - - ranking = 3.7218235460847keywords = canal, spinal (Clic here for more details about this article) |
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