Minimally Invasive Removal of Extra- and Intradural Spinal Tumors Using Full Endoscopic Visualization.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate the clinical efficacy of minimally invasive endoscopic surgery in patients with spinal extradural and intradural-extramedullary tumors. METHODS: This was a study of 15 consecutive patients with spinal extradural or intradural-extramedullary tumors up to 2 levels treated by minimal invasive surgery using a full endoscopic visualization and Caspar's retraction system (for cervical, thoracic, and lumbar tumors) over a 4-year period between January 2015 to April 2019 at a tertiary center. RESULTS: A gross total remove was achieved in all patients (100%), determined by postoperative contrast computed tomography scans and magnetic resonance imaging. There was no postoperative spinal instability. All patients had equal or better neurologic functions after surgery at follow-up. The average preoperative Nurick's grade mean was 1.9 and the postoperative was 1.1. The average preoperative McCormick's grade mean was 2.9 versus 1.3 in the postoperative period. CONCLUSIONS: Selective extradural or intradural-extramedullary tumors well localized and up to 2 levels can be safely and effectively treated by minimally invasive surgery using a full endoscopic visualization and the Caspar's retractor. However, there is insufficient evidence to recommend this approach over the classical or other microsurgical approach described.

Endoscopic versus open surgery in patients with malignant sinonasal tumours and brain invasion. A case series study.

OBJECTIVES: To determine the safety, effectiveness and perioperative costs of endonasal endoscopic approach in brain invasive malignant sinonsal tumours patients. MATERIALS AND METHODS: This was a case series bidirectional study; that included 30 brain invasive malignant sinonsal tumours patients treated by endonasal endoscopic approach (2015-2017) and 53 by open surgery (2010-2015). Propensity score matching was used to compensate the prognostic factors; in a sample of 50 patients (25 per group). Primary response variables was local control and 3-years overall survival. Perioperative cost variables were analyzed. RESULTS: A number of 50 patients were included after matching (25 in each therapeutic group). The age average was 55 years and male proportion was 62%. Squamous cell carcinoma and grade II lesions were the most represented in the sample. Endonasal endoscopic approach reduced surgical time in 1 h 20 min, transfusion needs in 5.5 fold and hospitalization in 19 days; in comparison with open technique. Oncologic control based on surgical free margins, local control, overall survival and progression free survival after three years was higher when the resection was performed endoscopically. Functional status was enhanced and complications diminished by using endoscopic approach. Saving was estimated in $7 355.18 per patient. CONCLUSIONS: Endonasal endoscopic approach represents a safe, effective and economic procedure in selected patients with malignant sinonasal tumors and brain invasion.

Endoscopic retrosigmoid keyhole approach in cerebellopontine angle tumors. A surgical cohort.

INTRODUCTION AND OBJECTIVES: To determine the safety and efficacy of endoscopic keyhole surgery in patients with cerebellopontine angle tumours. MATERIALS AND METHODS: This was a retrospective study of patients with cerebellopontine angled tumours treated by fully endoscopic retrosigmoid keyhole approach in a tertiary centre during a period of four years. Preoperative, transoperative and postoperative variables were analysed. RESULTS: A number of 40 patients were included. The age average was 49.4 years and male/female proportion was 0.4-1. We found 31 vestibular schwannomas (77.5%), five meningiomas (12.5%), two cholesteatomas (5.0%) and two metastases (5.0%). Vestibular schwannomas Hannover type IIIb, IVa and IVb predominated. The surgical resection was total or near-total 92.5% of patients. Hearing preservation rate was 62.5% and acceptable facial function nerve function rate was 80% after six months. Hospital stay was 7.5 days. The total or near total resection and functionally preservation rate was high. Complications were unusual. CONCLUSIONS: Endoscopic retrosigmoid keyhole approach represented a safe and efficient procedure in selected patients with cerebellopontine angle tumours.

Endoscopic versus open surgery in patients with malignant sinonasal tumors and brain invasion. A case series study. / Cirugía endoscópica vs. cirugía abierta en pacientes con neoplasias nasosinusales malignas con invasión cerebral. Estudio de serie de casos.

OBJECTIVES: To determine the safety, effectiveness and perioperative costs of endonasal endoscopic approach in brain invasive malignant sinonsal tumors patients. MATERIALS AND METHODS: This was a case series bidirectional study; that included 30 brain invasive malignant sinonsal tumors patients treated by endonasal endoscopic approach (2015-2017) and 53 by open surgery (2010-2015). Propensity score matching was used to compensate the prognostic factors; in a sample of 50 patients (25 per group). Primary response variables was local control and 3-years overall survival. Perioperative cost variables were analyzed. RESULTS: A number of 50 patients were included after matching (25 in each therapeutic group). The age average was 55 years and male proportion was 62%. Squamous cell carcinoma and grade II lesions were the most represented in the sample. Endonasal endoscopic approach reduced surgical time in 1 hour 20 minutes, transfusion needs in 5.5 fold and hospitalization in 19 days; in comparison with open technique. Oncologic control based on surgical free margins, local control, overall survival and progression free survival after three years was higher when the resection was performed endoscopically. Functional status was enhanced and complications diminished by using endoscopic approach. Saving was estimated in $7 355.18 per patient. CONCLUSIONS: Endonasal endoscopic approach represents a safe, effective and economic procedure in selected patients with malignant sinonasal tumors and brain invasion.

Minimally Invasive 360-Degree Approach to Intraconal Orbital Tumors.

PURPOSE: To evaluate clinically the efficacy of 360-degree minimally invasive endoscopic surgery in patients with orbital intraconal tumors. DESIGN: Retrospective interventional case series. METHODS: A series of consecutive patients with orbital intraconal tumors were treated with minimally invasive surgery using an endonasal endoscopic approach or an anterior endoscopic orbitotomy over a 5-year period between January 2015 and January 2020 at the National Institute of Oncology and Radiobiology of Cuba. RESULTS: In 22 patients, the mean age was 52.3 ± 11 years (range 18-71 years) with a female to male ratio of 1.8:1. Visual loss was present in 3 patients and proptosis was present in 19 patients. The most common diagnosis was cavernous hemangioma (72.7%) followed by orbital sheet meningioma (9.1%). The lower-inner (type II) location was the most usual, followed by the lower-outer (type IV). A gross total resection was achieved in 95.5% of patients. In only 1 case with an orbital pseudotumor was the resection subtotal because of the fibrous consistency, irregularity, and adherences to the medial rectus muscle. All patients with visual loss improved to normal visual function after surgery at follow-up and orbital proptosis recovered in all patients with these symptoms. Both immediate and long-term morphologic and aesthetic results were good in all patients. CONCLUSION: The minimally invasive 360-degree surgical approach with a full endoscopic visualization can be safe and efficient in patients with select orbital intraconal tumors. Optic nerve location constitutes the main aspect in the surgical approach selection. A large case series is necessary to standardize this surgical philosophy.

Endoscopic retrosigmoid keyhole approach in cerebellopontine angle tumors. A surgical cohort. / Keyhole endoscópico retrosigmoideo en tumores del ángulo pontocerebeloso. Resultados de una serie.

INTRODUCTION AND OBJECTIVES: To determine the safety and efficacy of endoscopic keyhole surgery in patients with cerebellopontine angle tumors. MATERIALS AND METHODS: This was a retrospective study of patients with cerebellopontine angled tumors treated by fully endoscopic retrosigmoid keyhole approach in a tertiary center during a period of four years. Preoperative, transoperative and postoperative variables were analyzed. RESULTS: A number of 40 patients were included. The age average was 49.4 years and male/female proportion was 0.4-1. We found 31 vestibular schwannomas (77.5%), five meningiomas (12,5%), two cholesteatomas (5,0%) and two metastases (5.0%). Vestibular schwannomas Hannover type IIIb, IVa and IVb predominated. The surgical resection was total or near-total 92.5% of patients. Hearing preservation rate was 62.5% and acceptable facial function nerve function rate was 80% after six months. Hospital stay was 7.5 days. The total or near total resection and functionally preservation rate was high. Complications were unusual. CONCLUSIONS: Endoscopic retrosigmoid keyhole approach represented a safe and efficient procedure in selected patients with cerebellopontine angle tumors.

Características clínicas y patológicas de los tumores orbitarios / Clinical and pathological characteristics of orbital tumors

Objetivo: describir las características clínico-patológicas de los tumores orbitarios. Métodos: se realizó un estudio descriptivo y retrospectivo de serie de casos en el Instituto de Oncología y Radiobiología desde enero del año 2011 a diciembre de 2017. La muestra se conformó con 241 pacientes sometidos a cirugía de la órbita y fue caracterizada según la edad, el sexo, el origen y la naturaleza de la lesión, el diagnóstico histopatológico y los abordajes quirúrgicos utilizados. Resultados: el 52,7 por ciento de la muestra estudiada fue del sexo masculino; el 36,5 por ciento se encontró en el grupo de 60 a 79 años. El 62,7 por ciento de los casos correspondió a tumores malignos, el 51,9 por ciento a lesiones primarias de la órbita y el 26,6 por ciento a linfoma No Hodgkin. Las lesiones secundarias originadas en los párpados representaron el 58,7 por ciento y el carcinoma epidermoide el 56,5 por ciento. Hubo 11 casos correspondientes a metástasis; las de mama representaron el 72,7 por ciento. El abordaje anterior transpalpebral fue utilizado en el 54,8 por ciento de los casos. Conclusiones: los tumores orbitarios se presentan con mayor frecuencia a partir de los 40 años de edad y con predominio del sexo masculino. Las lesiones malignas son más frecuentes, así como las primarias de la órbita, donde el linfoma No Hodgkin representa el mayor número de casos. Los párpados son la principal estructura de origen de las lesiones secundarias, y el carcinoma epidermoide es la variedad histopatológica predominante. Las metástasis de mama son las que más afectan el espacio orbitario. La vía de abordaje fundamental es la anterior transpalpebral (transeptal), seguido de la exenteración orbitaria(AU)

Objective: describe the clinicopathological characteristics of orbital tumors. Methods: a retrospective descriptive case-series study was conducted at the National Institute of Oncology and Radiobiology from January 2011 to December 2017. A sample of 241 patients undergoing orbital surgery was characterized according to age, sex, origin and type of lesion, histopathological diagnosis and surgical procedures used. Results: 52.7 percent of the study sample was male and 36.5 percent was in the 60-79 age group. 62.7 percent of the cases were malignant tumors, 51.9 percent were primary orbital lesions, and 26.6 percent were non-Hodgkin lymphomas. Secondary lesions originating in the eyelids represented 58.7 percent, and epidermoid carcinomas 56.5 percent. Eleven cases were metastases, 72.7 percent were of the breast type. The anterior transpalpebral approach was used in 54.8 percent of the cases. Conclusions: orbital tumors are more common as of age 40 with a predominance of the male sex. Malignant lesions are more frequent, as well as primary orbital lesions, of which the largest number of cases are non-Hodgkin lymphomas. The eyelids are the main structure of origin of secondary lesions, and epidermoid carcinoma is the prevailing histopathological variety. Breast metastases are the type most commonly affecting the orbital area. The main approach is anterior transpalpebral (transeptal), followed by orbital exenteration(AU)

Brain Metastases in Havana Cancer Patients.

INTRODUCTION: Cancer is a major public health problem worldwide and in Cuba. Approximately one third of cancer patients develop a brain metastasis. Despite this, epidemiological studies are scarce, internationally and in Cuba; published research is mainly limited to autopsy studies and hospital case series. OBJECTIVE: Characterize patients with brain metastases residing in Habana del Este Municipality, Havana, Cuba, with respect to demographics, metastasis location and primary tumor site. METHODS: A retrospective descriptive study was carried out with data for all patients with histologically confirmed cancer diagnosed in 2014 and registered in primary health care in Habana del Este Municipality. Diagnostic reports from computed tomography and/or magnetic resonance imaging were used to identify patients with brain metastases. Study variables were age, sex, skin color, number and location of brain metastases, control of primary tumor, and presence of extracranial metastases. Percentages were calculated and presented in tables. RESULTS: We identified 832 cancer patients in the Habana del Este population of 181,473 (prevalence 458.5 per 100,000 population). Among patients with cancer, 27.6% (230/832) had brain tumors, among which 83% (191/230) were brain metastases and 17% (39/230) primary tumors, a ratio of 4.9:1. Brain metastases appeared in 23% (191/832) of cancer patients (prevalence 105.2 per 100,000 population). Among patients with brain metastases, 48.2% (92/191) were aged 41-60 years and 61.3% (117/191) were female sex. The majority, 59.7% (114/191) had multiple metastases. The most frequent primary tumor location was the breast (40.8%, 78/191), followed by the lung (31.9%; 61/191); 46.8% (211/451) of brain metastases were in the parietal lobe. CONCLUSIONS: Brain metastases are more prevalent in this Cuban municipality than reported in other countries, but they constitute a higher proportion of cancer cases than seen in other population-based studies. The study's results underline the importance of detecting brain metastasis early, to permit timely interventions to improve quality of life and survival. CONTRIBUTION OF THIS RESEARCH: This is the first epidemiological study of brain metastases in Cuba and one of the few carried out internationally.

Endoscopic Treatment of Sphenoid Sinus Mucocele: Case Report and Surgical Considerations.

INTRODUCTION: The paranasal sinuses mucoceles are benign expansive cystic lesions that occur rarely in the sphenoid sinus and contain mucous material enclosed by cylindrical pseudostratified epithelium. OBJECTIVE: To report one case of sphenoid sinus mucocele that occurred with headache and was submitted to surgical treatment through endonasal endoscopy approach. CASE REPORT: 59-year-old male patient with history of increasing frontoorbital, bilateral, fluctuating headache and exophthalmos. There was no other associated clinical abnormality. Computed Tomography (CT) and Magnetic Resonance Image (MRI) scans confirmed an expansive mass of sphenoid sinus, suggesting mucocele. The patient was submitted to endonasal endoscopic surgery with posterior ethmoidotomy, large sphenoidotomy, and marsupialization of the lesion. CONCLUSION: Mucoceles of the sphenoid sinus are a very rare condition with variable clinical and radiological presentation. Surgical treatment is absolutely indicated and early treatment avoids visual damage that can be permanent. Endonasal endoscopic approach with drainage and marsupialization of sphenoid sinus, using a transnasal corridor, is a safe and effective treatment modality.

Colocación endoscópica por vía occipital de catéteres ventriculares permanentes: nota técnica / Endoscopic access to occipital lateral ventricle using permanent catheters: technical note

El siguiente trabajo constituye una nota técnica sobre un nuevo proceder endoscópico de colocación de catéteres ventriculares permanente a través del cuerno occipital. Se colocaron 20 catéteres permanentes utilizando el sistema DECK con un endoscopio Hopkins II de 30°, diámetro 2,7 mm y longitud 30 cm, con vainas y canales de trabajos. La posición del catéter fue evaluada por tomografía de cráneo realizada a las 24 horas de la cirugía, obteniéndose una posición a (óptima) en el 95 por ciento de los casos, con una distancia promedio de 10,5 cm desde la tabla externa del hueso occipital al cuerno frontal. En ninguno de los casos disfuncionó el sistema derivativo y un solo paciente presentó como complicación un hematoma del lecho quirúrgico.

The following papers is a technical note about a new endoscopic access to lateral ventricle through occipital horn to place ventricles catheters, 20 patient was operated using Deck System of endoscopy with lens of 30 grades, 2,7 mm of diameter and 30 cm of larger, sheets and working canals including. CT scan was performing 24 hours after surgery and optimal position was obtained in 95 percent. Median distance from occipital bon to frontal horn of the ventricles was 10,5 cm. Any patient present dysfunction of the system and only one patient had a hematoma of the surgical area.

Tratamiento multimodal e individualizado a pacientes con metástasis encefálica / Multimodal and individualized treatment for patients with brain metastases

Introduction: The treatment of Brain Metastases is palliative and it is ignored the ideal therapeutic combination, constituting this a controversial topic. Objective: To determine the results of the treatment to patient with Brain Metastases according to different modalities. Method: It was carried out a prospective cohort study between april 2010 to april 2013 in the National Institute of Oncology and Radiobiology. It was designated as universe the total of patient with diagnosis of Brain Metastases of primary tumor assisted in consultation of Neurosurgery. The Fischer exact test was used to correlate qualitative variables and the Kaplan Meier curvesto estimate the survival. Results: It was obtained a sample of 42 patients and 84 lesions. The age average was of 53,1 years. The primary lesions prevailed in lung and breast. The used modalities were: Surgery-Whole Brain Radiation Therapy (20 lesions), Whole Brain Radiation Therapy alone (29 lesions), Radiosurgery alone (21 lesions) and Surgery alone (9 lesions). Conclusions: The combinations of Radiosurgery-Whole Brain Radiation Therapy and Surgery-Radiosurgery associated to a better local control. The treatment with Whole Brain Radiation Therapy didn't associate to a better distance control. The overall survival to the 6 months was of 91 percent and to the 12 months of 57 percent. A bigger survival was observed in patient with controlled primary illness and absence of extracraneal metastases. The Surgery presents the biggest number of complications.

Introducción: El tratamiento de la Metástasis Encefálica es paliativo y se desconoce la modalidad o combinación terapéutica óptima, constituyendo éste un tema controvertido. Objetivo: Determinar los resultados del tratamiento a pacientes con Metástasis Encefálica según diferentes modalidades. Método: Se realizó un estudio de cohorte prospectivo durante el período abril de 2010 a abril de 2013 en el Instituto Nacional de Oncología y Radiobiología. Se designó como universo el total de pacientes con diagnóstico de Metástasis Encefálica de neoplasia primaria conocida atendidos en consulta de Neurocirugía. Se utilizó el test exacto de Fischer para correlacionar variables cualitativas y las curvas de Kaplan Meier para estimar la supervivencia. Resultados: Se obtuvo una muestra de 42 pacientes y 84 lesiones. El promedio de edad fue de 53,1 años. Predominaron las lesiones primarias en pulmón y mama. Las modalidades más utilizadas fueron: Cirugía-Radioterapia Holocraneal (20 lesiones), Radioterapia Holocraneal sola (29 lesiones), Radiocirugía sola (21 lesiones) y la Cirugía sola (9 lesiones). Conclusiones: Las combinaciones de Radiocirugía-Radioterapia Holocraneal y Cirugía-Radiocirugía se asociaron a un mejor control local. El tratamiento con Radioterapia Holocraneal no se asoció a un mejor control a distancia. La supervivencia global a los 6 meses fue del 91 por ciento y a los 12 meses del 57 por ciento. Se observó una mayor supervivencia en pacientes con enfermedad primaria controlada y ausencia de metástasis extra craneal. La Cirugía presentó el mayor número de complicaciones.