Extreme lateral supracerebellar infratentorial approach: how I do it.

BACKGROUND: The extreme lateral supracerebellar infratentorial (ELSI) approach was initially proposed to treat lesions of the posterolateral surface of the pons principally cavernomas. The versatility of the approach allowed its use for other pathologies like gliomas, aneurysms, epidermoids, and meningiomas. METHOD: We describe here the ELSI approach along with its advantages and limits in comparison with other surgical approaches for the treatment of meningiomas of the petroclival region. CONCLUSION: ELSI is a versatile approach that allows access to the anterolateral brainstem surface including extensions to the midbrain diencephalic junction when needed. ELSI compares favorably to other surgical alternatives with respect to the approach-related morbidity, while allowing adequate access to treat the pathology.

Chiari I malformation: surgical technique, indications and limits.

BACKGROUND: Chiari malformation type I (CM-I) is a rare disease characterised by herniation of cerebellar tonsils below the foramen magnum with associated anomalies of posterior fossa. We describe here the surgical technique, indications and limits of surgical treatment. METHOD: The authors describe the surgical technique, including: posterior fossa decompression, opening of the foramen of Magendie and duraplasty in case of CM-I. CONCLUSIONS: Posterior fossa decompression plus duraplasty is a safe and effective procedure for patients with CM-I malformation.

A systematic review of the primary squamous cell carcinoma of the external auditory canal: survival outcome based on T-staging and proposal of a new classification.

OBJECTIVE: This study aimed to provide a systematic review on survival outcome based on Pittsburgh T-staging for patients with primary external auditory canal squamous cell carcinoma. METHOD: This study was a systematic review in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines performed until January 2018; pertinent studies were screened. Quality of evidence was assessed using the grading of recommendation, assessment, development and evaluation working group system. RESULTS: Eight articles were chosen that reported on 437 patients with external auditory carcinoma. The 5-year overall survival rate was 53.0 per cent. The pooled proportion of survivors at 5 years for T1 tumours was 88.4 per cent and for T2 tumours was 88.6 per cent. For the combined population of T1 and T2 cancer patients, it was 84.5 per cent. For T3 and T4 tumours, it was 53.3 per cent and 26.8 per cent, respectively, whereas for T3 and T4 tumours combined, it was 40.4 per cent. Individual analysis of 61 patients with presence of cervical nodes showed a poor survival rate. CONCLUSION: From this review, there was not any significant difference found in the survival outcome between T1 and T2 tumours. A practical classification incorporating nodal status that accurately stratifies patients was proposed.