Endolymphatic Sac Tumour: A Case Report and Review of the Literature

Introduction Endolymphatic sac tumor (ELST) is a slow-growing, low-grade, locallyinfiltrative tumor arising from the endolymphatic sac/duct, which is located in the posterior part of the petrous temporal bone. It may be sporadic in origin, or may be associated with Von-Hippel Lindau (VHL) syndrome. Case description A 40-year-old female patient with an ELST without VHL syndrome who was treated successfully by microsurgical extirpation of the tumor. Discussion We discuss the radiological features and the histopathology of this rare tumor and review the relevant literature. Conclusion The case herein reported adds to the previously-reported cases of this rare tumor.

Clinical application of combined infratemporal fossa approaches for internal carotid artery in petrous bone reconstruction for large lateral skull base tumors / 中华耳鼻咽喉头颈外科杂志

Objective: By summarizing the technical points and therapeutic outcomes of combing infratemporal fossa approach (IFA) and internal carotid artery (ICA) reconstruction for the colossal skull base tumor invading ICA in petrous bone, the clinical application value was discussed. Methods: Five patients (2 males, 3 females,aging from 27 to 55 years old) who received surgeries between July 2015 and May 2017 for lateral skull base pathology involved petrous ICA using technique combined IFA and pre-reconstruction, were reviewed. Results: Among the five patients, three were paraganglioma of head and neck, one was carotid aneurysms, and one was recurrent adenoid cystic carcinoma (ACC). The median tumor size in the largest cross-section was 60 mm × 51 mm (range, 28 mm × 22 mm-72 mm × 58 mm). Complete excision was achieved with IFA and ICA reconstruction. The median blood loss volume was 1 000 ml (range, 600-2 500 ml). Four cases showed no new long-term neurologic sequelae, while one showed hemiplegia due to graft vessel occlusion. Except for the one with ACC having facial nerve cut, others achieved good facial nerve function of HB grade Ⅰ to Ⅱ during 3 to 12 months, follow-up. No tumor recurrence was observed over the median duration of follow-up for above 36 months (range, 36-58 months). Conclusion: For lesions involved superior part of ICA, which is unable to separate from ICA, IFA and ICA reconstruction can achieve complete excision.

Síndrome de Eagle: relato de caso / Eagle Syndrome: a case report

A síndrome de Eagle é uma condição rara e com etiologia ainda não bem estabelecida, a qual se deve ter bastante suspeição para seu correto tratamento. Seu tratamento deve ser definido em conjunto com o paciente, seja ele conservador ou cirúrgico, sempre levando em consideração as expectativas do paciente, além da maior expertise do profissional na modalidade escolhida para o tratamento. Neste artigo, apresentamos uma paciente de 35 anos atendida no Hospital Felício Rocho, discutindo os diversos aspectos da doença, inclusive a modalidade de tratamento escolhida para o caso.

Eagle syndrome is a rare condition, and its etiology has not yet been well established and its correct treatment is uncertain. Its treatment must be defined together with the patient, be it conservative or surgical, always taking into consideration the patient's expectations, in addition to a solid professional expertise in the modality chosen for the treatment. In this article, we present the case of a 35-year-old patient who was admitted to the Felício Rocho Hospital and discuss the various aspects of the disease, including the treatment modality chosen for the case.

Accesos quirúrgicos a los meningeomas petroclivales: indicaciones, complicaciones y resultados / Surgical approaches for petroclival meningiomas: indications, complications and results

Introducción: Los meningeomas de la región petroclival son responsables de cerca del 13 por ciento de los meningeomas de la base del cráneo. El promedio de edad de los pacientes que los presentan es aproximadamente 45 años En la mayoría de los casos existe extensión a la región paraselar. Material y Métodos: Los autores realizan una revisión crítica de la literatura, presentando los posibles accesos quirúrgicos e sus indicaciones, efectividad e posibles complicaciones. Resultados: Los accesos quirúrgicos para la región petroclival pueden ser: petroso, vía petrosa combinada anterior y posterior, vía presigmoidea combinada supra e infratemporal, órbito-zigomático infratemporal, retrosigmoideo intradural, suprameatal, pterional, retromastoideo, subtemporal y vía combinada retromastoidea-subtemporal. Discusión y Conclusiones: Una valoración neuro-radiológica precisa que permita escoger un abordaje quirúrgico apropiado juntamente con avances en la técnica microquirúrgica y propuestas de nuevos accesos, son factores que han contribuido al progreso significativo en el tratamiento quirúrgico de los meningeomas petroclivales.

Surgical strategy of petrous meningiomas surgery

Petrous meningiomas are benign lesions, their total surgical excision is the only method for complete cure. However their excision is confronted by deep location and critical anatomical relation and exact site of origin from the petrous bone. This study was conducted to plan a surgical strategy based on site of attachment of the lesion in the petrous bone. Twelve cases were studied preoperatively by neuro-imaging especially magnetic resonance imaging [MRI] to classify the types of petrous meningiomas. All cases were studied operatively and postoperatively for the extent of the tumour removal, clinical status, follow up and histopathological verification. A radical surgical removal was achieved in eight patients [66.6%], subtotal removal in two cases [16.665%] and incomplete removal in another two cases [16.6%]. Complete surgical excision of the petrous meningiomas can be planned preoperatively depending on exact site of attachment to the petrous bone. There were four different zones on the surface of the petrous bone on which different types of surgical approaches can be used to achieve a better result as regards the safety of the patient and the radical excision of the lesions

Petrous apex region. Surgical anatomy, lesions, and operative techniques

The author describes the anatomy of the region of the petrous apex giving emphasis to the limits of surgical resection. The cochlea, located at the apex of the angle formed by the intersection of a line along the sphenopetrosal groove and a line from the facial hiatus to the internal auditory canal, has to be protected to preserve hearing. Surgical approaches can be divided in the posterior presigmoid approach that provides exposure to the posterior petrous bone and upper two thirds of the clivus, and the anterior subtemporal approach that provides exposure to the trigeminal ganglion, petrous carotid artery, Meckel's cave, and posterior cavernous sinus. Opening of Meckel's cave provides additional space for medial and inferior resection of the petrous apex. Two illustrative cases of primary petrous apex lesions are presented to demonstrate the surgical exposure obtained with each approach

Avaliaçäo do acesso petroso para os meningeomas petroclivais / Evaluation of petrosal approach for the petroclival meningiomas

Foi realizado o estudo anatômico do acesso petroso, em ambos os lados, de 20 segmentos cefálicos e 10 crânios e analisados os resultados do tratamento cirúrgico através do acesso petroso de 10 pacientes com meningeoma petroclival. As dificuldades essenciais desse acesso estao relacionadas com a preservaçao dos seios venosos durais e da veia Labbé com a retraçao do lobo temporal e do hemisfério cerebelar. Algumas técnicas alternativas mostraram-se úteis na superaçao dessas dificuldades: 1) a realizaçao do acesso retrolabiríntico, antes da craniotomia, ajuda a prevenir a lesao dos seios venosos durais envolvidos; 2) a extensao da craniotomia nos sentidos têmporo-occipital e têmporo-anterior, respectivamente, permite diminuir a retraçao sobre o hemisfério cerebelar e o lobo temporal e possibilita um afastamento mais seguro do lobo temporal; 3) a realizaçao da tentoriotomia, sem retraçao do lobo temporal, evita a tensao demasiada sobre a veia de Labbé. O estudo anatômico e os resultados obtidos na presente casuística comprovam que o acesso petroso possibilita ampla via de abordagem à regiao petroclival, permitindo remoçao completa dos meningeomas petroclivais com mínima morbidade e mortalidade.

Evoluçäo do acesso petroso para os meningeomas petroclivais / Evolution of the petrosal approach for petroclival meningiomas

Os autores fazem ampla revisao dos acessos combinados que foram utilizados para abordar as lesoes petroclivais, desde a era de Cushing até os tempos atuais. A ressecçao dos miningeomas petroclivais representam grande desafio e sao considerados como o protótipo de uma lesao petroclival. A revisao da literatura revelou que houve correlaçao entre os acessos combinados e o período em que foram utilizados para abordar as lesoes petroclivais. O acesso petroso oferece uma ampla via à regiao petroclival, possibilitando uma remoçao completa dos meningeomas petroclivais com mínima morbidade e mortalidade. O acesso petroso representa o resultado final da associaçao de idéias pré-existentes descritas anteriormente.

Bases anatômicas do acesso petroso / Anatomical landmarks of petrosal approach

Sob técnica microcirúrgica, foram dissecadas 10 cabeças cadavéricas, permitindo o estudo de 20 regiöes petroclivais e as estruturas nervosas e vasculares envolvidas neste acesso. Medidas referentes a distâncias em milimetros entre o ângulo sinodural e a veia de Labbé e entre a origem e a emergência dos VII, VIII, IX, X e XI nervos cranianos, seus orifícios e envoltórios durais foram tomados antes e após "drilagem" do osso temporal. A veia de Labbé desemboca no seio transverso a uma distância segura do ângulo sinodural. No material estudado, a distância minima entre estes pontos foi de 11,0 mm. A distância média entre a emergência dos VII e VIII nervos cranianos e o meato acústico interno foi de 11,5 mm à direita e 11,8 mm à esquerda. Após "drilagem" do osso temporal, a distância média foi de 15,41 mm à direita e 16,0 mm à esquerda. Para os IX, X e XI nervos cranianos, a distância média foi de 11,92 mm à direita e 11,43 mm à esquerda antes da "drilagem", e 14,21 mm à direita e 15,37 mm à esquerda depois da "drilagem". Estes resultados confirmam o ganho em campo cirúrgico, através do acesso petroso a regiâo petroclival

Aneurisma gigante da carótida interna na porçäo petrosa / Giant aneurysm of the internal carotid in the petrous portion

Os autores relatam um caso de aneurisma gigante da carótida interna, porçäo petrosa, com expansäo intracraniana, em paciente de 55 anos com hipoestesia tátil e dolorosa no território de V2 e V3, paralisia completa do VI nervo e hipoacusia acentuada, todos à esquerda. Foi feita abordagem direta, com ressecçäo total do aneurisma, fechamento da carótida interna no pescoço, ligadura, tamponamento e extirpaçäo do aneurisma na regiäo petrosa, com evoluçäo satisfatória. A revisäo da literatura pertinente ao assunto mostrou tratar-se de patologia rara