Endoscopic Approach to Remove Intra-extracranial Tumors in Various Skull Base Regions: 10-year Experience of a Single Center / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Some problems have been found in the usually adopted combined approach for the removal of intra-extracranial tumors in skull base. Herein, we described a pure endoscopic transnasal or transoral approach (ETA) for the removal of intra-extracranial tumors in various skull base regions.</p><p><b>METHODS</b>Retrospectively, clinical data, major surgical complications, pre- and postoperative images, and follow-up information of a series of 85 patients with intra-extracranial tumors in various skull base regions who were treated by surgery via ETA in our skull base center during the past 10 years were reviewed and analyzed.</p><p><b>RESULTS</b>Gross total tumor removal was achieved in 80/85 cases (94.1%) in this study. All 37 cases with tumors in anterior skull base and all 14 cases with tumors in jugular foramen received total tumor removal. Thirteen and three cases with tumors in clivus received total and subtotal tumor removal, respectively. Total and subtotal tumor removal was performed for 16 cases and 2 cases in lateral skull base, respectively. The complications in this study included: cerebrospinal fluid leakage (n = 3), meningitis (n = 3), and new cranial nerve deficits (n = 3; recovered in 3 months after surgery). In the follow-up period of 40-151 months (median: 77 months), seven patients (8.8%) out of the 80 cases of total tumor removal experienced recurrence.</p><p><b>CONCLUSIONS</b>Complete resection of intra-extracranial growing tumors in various skull base regions can be achieved via the pure ETA in one stage in selected cases. Surgical procedure for radical removal of tumors is feasible and safe.</p>

An analysis of surgical outcome and influencing factors in patients of congenital basilar invagination with atlantal-axial dislocation: report of 120 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the surgical outcome and its influencing factors in patients of congenital basilar invagination (BI) with atlanto-axial dislocation (AAD).</p><p><b>METHODS</b>From May 2004 to August 2010, 120 patients who had BI with AAD were surgically treated with direct posterior intraoperative distraction-reduction and fixation technique, 93 patients were successfully followed up by means of questionnaire survey, telephone and clinical evaluation. Pre- and postoperative dynamic cervical X-rays, computed tomographic scans, 3-dimentional reconstruction views and magnetic resonance imaging were performed. Pre- and postoperative Japanese Orthopaedic Association (JOA) score, distance between odontoid tip and Chamberlain's line and atlantodental interval were measured to evaluate the surgical result. Statistical analysis was performed by means of paired t test and Pearson Correlation analysis.</p><p><b>RESULTS</b>There were 93 cases were followed up for 24-99 months with an average of 46.5 months. Until the final follow-up, clinical symptoms were improved in 79 patients (84.9%), and were stable in 7 patients (7.5%) and deteriorated in 4 patients (4.3%). Three patients died postoperatively (3.2%). Patients without intramedullary signal intensity change (ISIC) had better surgical outcome. Patients with compression from anterior odontoid tip and posterior bone margin of occipital foramen had the worst surgical outcome (F = 3.987, P < 0.01). Overall, good decompression and bone fusion were shown on postoperative image in 87 patients (93.5%). There were 3 deaths in this series because of basilar artery thrombosis, posterior fossa hematoma and unknown reasons each.</p><p><b>CONCLUSIONS</b>The direct posterior intraoperative distraction-reduction and fixation technique is an effective simple and safe method for the treatment of BI with AAD. Anterior compression from odontoid tip and posterior compression from bone margin of occipital foramen-atlantal posterior arch play important roles in its developing mechanism. ISIC on MRI is a predictive factor for the worse surgical outcome.</p>

Early experience of resection of meningiomas in anterior skull base with intra-extracranial extension via a pure endoscopic endonasal approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The early experience of treating anterior skull base meningiomas with intra-extracranial extension via pure endoscopic endonasal approach (EEA) was presented, the safety, feasibility and preliminary treatment outcomes were investigated.</p><p><b>METHODS</b>Eight patients with intra-extradural meningiomas who were admitted from October 2006 to October 2010 were operated on via EEA in one stage in Xuanwu hospital. In this study, the operative technique was described, the degree of resection, complications and the early clinical outcomes were discussed.</p><p><b>RESULTS</b>The complete resection of meningiomas with intra-extracranial extension was achieved in all patients using EEA in one stage. Preoperative visual symptoms were improved or resolved in all cases who presented with preoperative visual complaints. No patient in our series experienced a new neurological deficit after surgery or recurrence and death related meningiomas in the follow-up period (33-75 months). One patient experienced postoperative cerebrospinal fluid leak, delayed meningitis and secondary hydrocephalus which responded to therapy. After treatment, the patient was cure.</p><p><b>CONCLUSION</b>Our limited experience indicates that EEA is feasible and safe for the complete resection of anterior skull base meningiomas with intra- and extracranial extension in one stage in selected cases.</p>

Surgery for jugular foramen schwannomas via a pure endoscopic transoral approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report a new approach, endoscopic transoral approach for the resection of jugular foramen schwannoma.</p><p><b>METHODS</b>Nine patients with jugular foramen schwannoma (three males and six females, ranging in age from 15 to 61 years old) were treated by direct surgery via a pure endoscopic transoral approach to the jugular foramen. Eight patients complained of hypoglossal nerve palsy with hemiatrophy of the tongue; six cases complained of vagus nerve palsy. Three cases complained of glossopharyngeal nerve palsy, one case complained of facial nerve palsy and hearing loss.</p><p><b>RESULTS</b>The nerves in this area were preserved and radical intracapsular removal of the tumor was performed via endoscopic transoral approach in the nine cases. Tumor removal, as assessed by intraoperative endoscopic inspection, postoperative magnetic resonance imaging and clinical evaluation, revealed all tumors were completely removed. One patient suffered from temporary swallowing difficulties and temporary right vagus palsy 1 day after surgery. There were no others intraoperative and postoperative complications. All patients were followed up for 4 - 29 months, no recurrences were occurred in all these patients and the muscle bulk, motor and the pre-postoperative swallowing function, the vagus palsy, the facial nerve palsy and hearing loss had improved in these patients.</p><p><b>CONCLUSION</b>The endoscopic transoral approach and intracapsular removal of the tumor provided for successful minimally invasive surgery in the jugular foramen schwannomas.</p>