[Craniofacial tumors blood supply]. / Krovosnabzhenie kraniofatsial'nykh opukholei.

Because of the spread to different anatomical regions, craniofacial tumors (CFTs) usually receive blood supply from several arterial systems, and CFT removal is often accompanied by abundant blood loss. PURPOSE: The study purpose was to develop an algorithm of diagnostic angiography for planning surgical treatment of CFT patients. MATERIAL AND METHODS: Complex preoperative angiography was performed in 72 patients with craniofacial tumors, aged 10 to 78 years (mean age, 45.5 years), who underwent surgical treatment at the Burdenko Neurosurgical Institute in the period from 2012 to 2015. At the first stage, blood supply to tumors was quantified using SCT perfusion. Then, depending on an assessed degree of tumor vascularization, direct angiography or modern minimally invasive angiographic techniques (3D TOF HR MR angiography, SCT angiography) were applied. RESULTS: In 12 cases of hypervascular tumors, accessible afferents were preoperatively embolized through the external carotid artery, which was accompanied by an increase in the blood supply to tumors via alternative routes of the external and internal carotid arteries. The obtained data were used to plan the surgical approach. A comparative analysis of the SCT perfusion data and the expression level of endothelial markers in histological specimens revealed no significant correlation. CONCLUSION: The study demonstrated the importance of a comprehensive assessment of the blood supply to CFTs in planning of the surgical treatment and enabled the development of algorithms for preoperative angiographic diagnosis, depending on the baseline clinical and radiological data.

Balloon test occlusion with the Doppler velocity guidewire.

Transcranial Doppler ultrasonography is the most commonly used method of cerebrovascular blood flow velocity measurement, but it is subject to certain technical and anatomic limitations. The Doppler velocity guidewire measures blood flow velocity within any vessel during cerebral angiography, overcoming these limitations. We report the first use of this guidewire in the measurement of blood flow velocity during balloon test occlusion, with results similar to simultaneously measured transcranial Doppler ultrasonography. Velocity measurement by Doppler guidewire could be useful in balloon test occlusion for vertebrobasilar circulation, where transcranial Doppler ultrasonography is limited, and provide anatomically specific blood flow velocity measurements in the diagnosis and treatment of stroke and other cerebrovascular diseases.

The cranial bone window model: studying angiogenesis of primary and secondary bone tumors by intravital microscopy.

The successful treatment of primary and secondary bone tumors in a huge number of cases remains one of the major unsolved challenges in modern medicine. Malignant primary bone tumor growth predominantly occurs in younger people, whereas older people predominantly suffer from secondary bone tumors since up to 85% of the most frequently occurring malignant solid tumors, such as lung, mammary, and prostate carcinomas, metastasize into the bone. It is well known that a tumor's course may be altered by its surrounding tissue. For this reason, reported here is the protocol for the surgical preparation of a cranial bone window in mice as well as the method to implant tumors in this bone window for further investigations of angiogenesis and other microcirculatory parameters in orthotopically growing primary or secondary bone tumors using intravital microscopy. Intravital microscopy represents an internationally accepted and sophisticated experimental method to study angiogenesis, microcirculation, and many other parameters in a wide variety of neoplastic and nonneoplastic tissues. Since most physiologic and pathophysiologic processes are active and dynamic events, one of the major strengths of chronic animal models using intravital microscopy is the possibility of monitoring the regions of interest in vivo continuously up to several weeks with high spatial and temporal resolution. In addition, after the termination of experiments, tissue samples can be excised easily and further examined by various in vitro methods such as histology, immunohistochemistry, and molecular biology.

Homonymous hemianopia caused by solitary skull metastasis of hepatocellular carcinoma.

We report a patient who developed a complete left homonymous hemianopia from mass effect of a solitary skull metastasis of hepatocellular carcinoma (HCC). After chemoembolization and resection, the visual field defect improved markedly. This is the first reported case demonstrating this phenomenon in HCC. It supports aggressive treatment of a solitary skull metastasis in this setting.

Middle ear pathology in ancient and modern populations: incudal osteoma.

CONCLUSIONS: Osteomas of the incus were found in surprisingly high numbers in ancient and modern populations. The coexistence of osteoma formation and unique vascularization on the medial surface of the incus alludes to a relationship between the two findings. OBJECTIVE: Osteomas involving the middle ear ossicles are rare. The aim of this study was to compare the incudal pathology of ancient and recent periods using the recent literature. MATERIAL AND METHODS: Pathologies encountered in 1170 human incudes belonging to different populations from ancient and recent periods were studied. Most of the ossicles were found in the middle ear of dry skulls or during dissection. The observations were done with a binocular microscope and a Nikon Profile Projector. RESULTS: A total of 47 incudes (4.01%) presented with a variety of pathologies, osteomas being found in 19 cases (1.62%). The osteomas were noted only on the medial surface of the incus. Other findings, including prominent erosions, multiple nutrient foramina and pitting, were also found on the medial side of the incus. The incidence of osteoma was found to be more common in ancient populations (1.88%) and most prevalent among Bedouins (4.55%).

Hypervascular presentation of multiple myeloma involving the skull, demonstrated on encephaloscintigraphy.

We present two cases of myelomatous involvement of the skull. Correlative studies with routine radiography, angiography, and encephaloscintigraphy were performed. The areas of involvement of the skull were confirmed as autopsy. A mixed pattern of photon-deficient and photon-abundant lesions was noted. The clinician should be aware of such mixed patterns.

Radionuclide cerebral angiographic evaluation of a diploic extracranial meningioma: case report.

A case of a diploic extracranial meningioma whose true vascularity was more significantly defined by radionuclide angiography than by selective contrast angiography is presented. The radionuclide angiogram clearly demonstrated large venous channels draining the tumor.

Effect of ketoprofen in topical formulation on vascular endothelial growth factor expression and tumor growth in nude mice with osteosarcoma.

OST cells, a low metastatic cell line established from human osteosarcoma, were inoculated under the periosteum of the ossa cranii of nude mice. Four weeks later, tumors were percutaneously treated for an additional 4 weeks with a patch containing either placebo or ketoprofen (KP). In the placebo group, OST cells formed osteoid and invaded the cranial bone. Tumor mass weighed 3.54 g. Approximately 85% of cells within the tumor expressed proliferating cell nuclear antigen (PCNA), indicating that they were proliferating with a high mitotic activity. Many feeder vessels were located within the tumor. The majority of tumor cells expressed intensely vascular endothelial growth factor (VEGF). In the KP group, invasion of OST cells into the cranial bone was suppressed and the tumor mass was 47% of that of the placebo group. Approximately 65% of cells within the tumor were PCNA-negative, indicating that their growth was arrested. There were considerably fewer feeder vessels within the tumor in the KP group than in the placebo group. Only a small number of cells expressed VEGF. Based on these findings, we concluded that topical administration of KP to nude mice with osteosarcoma inhibited VEGF expression, reduced the development of feeder vessels for supply of nutrients and oxygen, and suppressed tumor growth.

Preoperative endovascular embolization of craniospinal hemangioblastomas.

PURPOSE: To determine whether hemangioblastomas, highly vascular tumors requiring surgery that is potentially complicated by excessive bleeding, can be embolized safely by using interventional techniques that furnish a more avascular surgical field. METHODS: Nine hemangioblastomas involving either the cerebellum or the spinal cord were embolized preoperatively. In each case the feeding artery was selectively catheterized with a microcatheter and the hypervascular tumor nidus was devascularized with polyvinyl alcohol particles. RESULTS: Two patients who had undergone recent attempts as surgical resection at another institution had repeat surgery after endovascular embolization rendered the tumor nidus avascular. At surgery, the tumor was completely removed in one case and markedly debulked in the other. In all nine cases, blood loss after embolization was reported to be less than expected by experienced surgeons. In addition, manipulation and removal of the tumor was reported to be subjectively easier in these embolized tumors. The embolization procedure caused no permanent complications; however, one patient with a posterior fossa hemangioblastoma and hydrocephalus worsened clinically within 12 hours of embolization. This event was thought to be caused by obstructive hydrocephalus resulting from tumor swelling. Emergency craniotomy, ventricular decompression, and surgical resection of the tumor produced complete resolution of the signs and symptoms. CONCLUSIONS: Our results indicate that preoperative embolization of hemangioblastomas is a safe procedure that is useful in aiding surgical resection of these highly vascular tumors.

Giant cranial hemangiopericytoma: MR and angiographic findings.

The authors detail the MR and angiographic findings of a very large hemangiopericytoma in the skull of a 63-year-old woman. Angiography showed a marked tumor blush with early draining veins; MR showed heterogeneously increased T2 signal intensity and enhancement with gadolinium secondary to the richly vascularized tumor.

Devascularization of craniofacial tumors by percutaneous tumor puncture.

PURPOSE: To present and evaluate a devascularization technique for hypervascular tumors of the head and neck by direct tumor puncture. METHODS: Tumor puncture was performed percutaneously or via natural orifices (nose and mouth). In one case, an intrasellar tumor was embolized via a transseptosphenoidal surgical approach. The embolization material used was NBCA, lipiodol, and tungsten in the majority of tumors (14 out of 17) and alcohol for 3 metastases of the calvarium. We used this technique to embolize 10 nasopharyngeal fibromas, 4 tumors of the calvarium (3 metastases and 1 hemangiopericytoma), 1 intrasellar hemangiopericytoma, and 2 glomus tumors. Reflux of blood was obtained in every case after direct puncture of the tumor. Direct injection of contrast agent into the tumor revealed local parenchymography followed by local and regional venous drainage without extravasation. RESULTS: Total devascularization was obtained in 14 cases, and devascularization greater than 90% was obtained in 3 cases. Thirteen tumors were totally resected without requiring blood transfusion. During surgery, the limits of the exsanguinated tumor were very well defined in every case by the black staining induced by tungsten. Of the 4 tumors embolized but not operated on (3 metastases and 1 glomus tumor), 2 metastases needed retreatment after 6 and 8 months of remission, respectively. The other metastasis is still in remission after 3 months, and the volume of the glomus tumor decreased by 80% remains unchanged after 8 months. CONCLUSION: This technique was initially used to devascularize tumors with difficult or dangerous intravascular access, but in view of the hemodynamic and surgical results obtained, we believe that the indications for this technique can be extended to hypervascular tumors accessible to conventional embolization.

Intratumoral embolization of intracranial and extracranial tumors: technical note.

A new technique of intratumoral embolization is described. An intratumoral injection of N-butylcyanoacrylate is performed either perioperatively by direct puncture of the tumor or preoperatively through the nose or through the skin. The indications for this technique are hypervascularized tumors, such as juvenile angiofibroma, hemangiopericytoma, or paraganglioma. This technique has been applied in 21 patients with excellent results in terms of devascularization.

Endolymphatic sac tumor: staged endovascular-neurosurgical approach.

Endolymphatic sac tumors are rare, low-grade adenocarcinomas of the petrous bone. These tumors are highly vascularized and surgical removal is often challenging. We present a staged endovascular-neurosurgical approach consisting of stent-assisted angioplasty of the petrous carotid, selective endovascular embolization and surgical removal.

Intratemporal carotid artery bypass in resection of a base of skull tumor.

Tumors of the skull base with carotid artery involvement have heretofore required carotid ligation or been deemed inoperable. Two case reports are presented in which en bloc resection of malignant base of skull tumors included removal of a portion of the internal carotid artery. In the first case, the tumor was primarily in the parapharyngeal space and extended to the base of skull. Partial temporal bone resection was carried out to obtain exposure for carotid reconstruction. The second case involved an en bloc temporal bone resection for a recurrent, malignant, mixed tumor that had invaded the carotid canal. Revascularization was achieved in both cases by an autogenous, saphenous vein graft. The patients suffered no postoperative ischemic neurologic sequelae. These are the first known cases of a carotid bypass with distal anastomosis to the intratemporal portion of the internal carotid artery for a malignant base of skull neoplasm. The authors propose this procedure as an alternative to carotid ligation during surgery of tumors of the skull base requiring carotid resection.

[Dynamic computer tomographic for tumours of the facial skeleton (author's transl)]. / Dynamische Computertomographie bei Gesichtsschädeltumoren.

Serial computer tomography after intravenous bolus injection of contrast provides information concerning the vascularity of tumours in the facial skeleton. In addition the relationship of the tumour to the major vessels and their displacement or compression can be demonstrated. This provides information additional to the ordinary computer tomogram, so that neoplasms of the facial skeleton can be shown at various stages and their extent determined. A requirement for the use of serial CT is a scanner with a short scan time and scan interval.

[Pre-operative embolisation of vascular tumours in the head (author's transl)]. / Die präoperative Embolisation gefässreicher Tumoren des Kopfes

Trans-vascular, pre-operative embolisation in order to reduce blood flow was carried out with excellent results in a patient with a naso-pharyngeal fibroma, and with relatively good results in a patient with a pterion meningioma. This technique can be carried out following the diagnostic angiogram through the same catheter; it reduces operative blood loss, improves haemostasis and the surgeon's view of the operative field. The method can be used simply and without risk in any case where the tumour blood supply is derived exclusively or predominantly from branches of external carotid artery.

Cavernous hemangioma of the skull. Case report and review of the literature.

Osseous hemangiomas are rare skeletal tumors that constitute 0.7% of all osseous neoplasms. The most common site is the vertebral column while involvement of the calvarium is extremely rare accounting for 0.2% of all bone neoplasm. The authors present a case of a 35-years-old man who was admitted with right parietal swelling and review the gross appearance, pathogenesis, histopathology, radiological features and treatment of this neoplasm.

Endolymphatic sac tumour. A case report.

We present the case of a patient with an endolymphatic sac tumour (ELST). This rare tumour entity has only recently been defined and despite a well characterized clinical appearance misdiagnosis as jugular paraganglioma is frequent. A 68-year-old woman was admitted to our Neurosurgical Department with a mass lesion extending from the left temporal bone to the cerebello-pontine angle (CPA). Radiological features were high vascularization, contrast enhancement and destruction of the os petrosum. After preoperative angiographic embolization the tumour was removed in two surgical interventions, first via a lateral suboccipital approach and second by petrosectomy. The lesion proved to be a typical endolymphatic sac tumour by a synopsis of histological, radiological and clinical features. ELST should be taken into consideration in patients with mass lesions in the cerebellopontine angle destroying the petrous bone and resembling paraganglioma. Since slow growth rate and lack of metastases are particular features of ELST, complete resection of the tumour results in long survival times without adjuvant chemo- or radiotherapy.

Interventional neuroradiology of lesions of the skull base.

Preoperative embolization has been incorporated definitively into the multidisciplinary therapy strategy for lesions of the skull base. Clinical and anatomic knowledge of the pathology of the skull base, as well as experience with embolization, is the basis for therapeutic success. Clinical knowledge will lead to adequate patient selection, whereas profound anatomic knowledge and mastery of endovascular techniques will avoid predictable complications. Provided these conditions are taken into consideration, embolization of lesions of the skull base yields convincing therapeutic and technical results. Preoperative embolization of skull base tumors should not be associated with mortality or morbidity because most of these diseases are histologically benign and the interventional procedure is done as a preoperative step and not as a curative one. Major complications such as cerebral stroke, blindness, or cranial nerve palsies are results of the application of inappropriate techniques or of poor evaluation of angiographic findings, and should be avoided in the majority of cases. Minor complications are related to inadvertent occlusion of cutaneous, muscular, or osseous branches of the ECA. They are sometimes unavoidable and may include pain, skin necrosis, and trismus. Nevertheless, state-of-the-art external carotid embolization should--in skilled hands--have a permanent morbidity below 1% and no mortality.