Lista de verificación de tomografía computarizada de hueso temporal y base de cráneo lateral / Checklist of the temporal bone and lateral skull base CT- scan

La tomografía computarizada del hueso temporal es una prueba de imagen fundamental para el diagnóstico y tratamiento de diversas entidades que afectan a esta compleja estructura. La tomografía computarizada permite una representación más detallada de las estructuras óseas que la resonancia magnética, lo que determina que sea la prueba de elección para la planificación de la cirugía otológica.El objetivo de este trabajo es el de elaborar una lista de verificación o checklist que permita al otorrinolaringólogo estudiar y valorar de forma sistemática y organizada las principales estructuras de referencia, variantes anatómicas y cambios posquirúrgicos más frecuentes antes de una cirugía segura.Esta revisión ha sido promovida por la Sociedad Española de Otorrinolaringología y redactada en un formato de lista de verificación dividida en las diferentes regiones del hueso temporal y base de cráneo lateral. (AU)

Computed tomography scan of the temporal bone is a fundamental imaging modality for both the diagnosis and treatment of a wide range of pathologies affecting this complex structure. Temporal bone computed tomography scan provides a more detailed depiction of bone structures, compared with magnetic resonance imaging and, for this reason computed tomography scan is the imaging modality of choice in the planning of otological surgery.The aim of this article is to present a checklist to allow the otolaryngologist to assess systematically and in an organized manner the main anatomical landmarks, anatomical variants, as well as the most common postoperative surgical changes, which can be identified before any safe otological surgery.This revision was promoted by the Spanish Society of Otolaryngology and elaborated in a checklist template divided into the different areas of the temporal bone and the lateral skull base. (AU)

Checklist of the temporal bone and lateral skull base CT-scan.

Computed tomography scan of the temporal bone is a fundamental imaging modality for both the diagnosis and treatment of a wide range of pathologies affecting this complex structure. Temporal bone computed tomography scan provides a more detailed depiction of bone structures, compared with magnetic resonance imaging and, for this reason computed tomography scan is the imaging modality of choice in the planning of otological surgery. The aim of this article is to present a checklist to allow the otolaryngologist to assess systematically and in an organized manner the main anatomical landmarks, anatomical variants, as well as the most common postoperative surgical changes, which can be identified before any safe otological surgery. This revision was promoted by the Spanish Society of Otolaryngology and elaborated in a checklist template divided into the different areas of the temporal bone and the lateral skull base.

Tratamiento quirúrgico de los condrosarcomas de cabeza y cuello / Surgical treatment of head and neck chondrosarcomas

Introducción: Los condrosarcomas de cabeza y cuello adoptan una gran variedad de localizaciones y comportamientos biológicos. Material y método: Se presenta una serie retrospectiva de 17 casos de condrosarcomas de cabeza y cuello tratados quirúrgicamente en nuestro servicio desde 1977 hasta 2006. Resultados: Los condrosarcomas se localizaron en el área nasosinusal (n=6), laringe (n=5), peñasco (n=3), atlas (n=1), espacio parafaríngeo (n=1) y tráquea (n=1). Todos excepto una paciente se sometieron a cirugía con intención radical. El periodo de seguimiento medio fue de 84 meses (mediana, 71 meses). Se produjo recidiva en 6 pacientes con una latencia media de 10 meses. Dos pacientes fallecieron a causa de la enfermedad y dos permanecieron vivos con enfermedad. Los pacientes con condrosarcomas de grado I presentaron menos recidivas que los grados II y III (17% frente a 80%, p=0,029). La supervivencia media estimada a los 5 años fue del 88% siendo estadísticamente significativa la mayor supervivencia en los pacientes con tumores de grado I (p=0,023). En 2 pacientes con condrosarcomas cricoideos la reconstrucción se llevó a cabo mediante la técnica de Rethi-Ward, encontrándose sin evidencia de la enfermedad a los 71 (decanulado) y 145 meses (no decanulado). Los condrosarcomas de la fosa yugular fueron tratados mediante el abordaje infratemporal tipo A modificado. Conclusiones: Los condrosarcomas de cabeza y cuello de bajo grado presentan un buen pronóstico vital. Los de alto grado, pese al tratamiento radical, tienden a la recidiva (AU)

Introduction: Head and neck chondrosarcomas may adopt different locations and biological behaviour. Material and method: We present a retrospective clinical series of 17 chondrosarcomas surgically treated in our Department from 1977 until 2006. Results: Chondrosarcomas were located in the nasosinusal area (n=6), larynx (n=5), petrous bone (n=3), atlas (n=1), parapharyngeal space (n=1) and trachea (n=1). All patients except for one underwent surgery with radical intention. The mean follow-up period was 84 months (median, 71 months). Six patients developed recurrent disease with a mean latency of 10 months. Two patients died due to the disease and two remained alive with evidence of tumour. Patients with grade I chondrosarcomas presented less recurrent disease than those with grade II or III chondrosarcomas (17% versus 80%, P=0.029). The estimated 5-year survival was 88% with the better survival of patients with grade I chondrosarcomas reaching statistical significance (P=0.023). In 2 patients with cricoid chondrosarcomas, the reconstruction was carried out using the Rethi-Ward technique, and they were without evidence of disease at 71 months (with no cannula) and 145 months (with cannula). Chondrosarcomas of the jugular foramen were treated using a modified infratemporal type A approach. Conclusion: Low grade head and neck chondrosarcomas have a good prognosis while high grade chondrosarcomas tend to recur, despite radical surgical treatment (AU)

Tratamiento de los cordomas de clivus / Surgical treatment of clival chordomas

Introducción: Los cordomas de clivus son neoplasias benignas con una alta tasa de recurrencia y mortalidad. La dificultad para conseguir una resección total y su naturaleza infiltrativa les confieren esta agresividad. Material y método: Se presenta una serie retrospectiva de 8 casos tratados quirúrgicamente en nuestro servicio desde 1993 hasta 2006. Resultados: Los 8 pacientes fueron sometidos a un total de 14 procedimientos quirúrgicos, de los que 6 fueron abordajes anteriores (5 transmandibulares), 2 subtemporales-preauriculares, 2 extremolateral transcondíleos y 2 transcocleares. En 7 pacientes, la intención fue curativa. En 2 casos fue preciso realizar la cirugía de forma secuencial, en dos tiempos. Se consiguió la resección total en el 58% de los procedimientos. El seguimiento medio fue de 40 meses. Dos pacientes fallecieron como consecuencia de recidiva local, un paciente falleció durante el postoperatorio y otro paciente falleció por causas no relacionadas con el tumor. Discusión: La baja incidencia de los cordomas de clivus dificulta la elaboración de estudios randomizados acerca de su manejo. El tratamiento de elección es la cirugía, complementado con radioterapia en casos seleccionados. Preferimos emplear el abordaje transmandibular, combinándolo con extremolateral transcondíleo, en el caso de afectación condilar. Para extensiones laterales, optamos por el abordaje subtemporal-preauricular o vías transpetrosas. Las nuevas modalidades radioterápicas permiten el tratamiento eficaz de los remanentes tumorales. Conclusiones: Los abordajes extradurales implican regiones anatómicas familiares para el otorrinolaringólogo. Es imprescindible conocer las limitaciones de cada abordaje, a fin de evitar morbilidades innecesarias y resecciones incompletas (AU)

Introduction: Clival chordomas are benign neoplastic tumors displaying high morbidity and mortality rates. The difficulties involved in obtaining a total resection and its infiltrative nature explain this aggressiveness. Material and method: We present a retrospective clinical series of 8 surgically treated cases of clival chordomas at our department from 1993 to 2006. Results: All 8 patients underwent a total of 14 surgical procedures, 6 of which were anterior approaches (5 transmandibular), 2 subtemporal-preauricular, 2 from the transcondylar lateral edge and 2 transcochlear. In 7 patients the surgery was performed with curative intent. In 2 cases it was necessary to perform the surgery sequentially, in two steps. Total resection was achieved in 58% of patients. Average follow up was 40 months. Two patients died due to local recurrence, one patient died in the postoperative period and another died due to causes which were not related with the tumor. Discusion: The low incidence of clival chordomas makes it difficult to carry out random clinical studies of its management. The treatment of choice is surgery, supplemented by radiotherapy in selected cases. We prefer to use the transmandibular approach, combined with transcondylar lateral edge approach when the occipital condyle is infiltrated. For lateral extensions, we use the subtemporal-preauricular or transpetrosal approaches. New radiotherapy modalities provide an effective treatment of tumoural residues. Conclusions: Extradural approaches imply anatomical regions which are familiar for otolaryngologists. Specific knowledge about the limitations of each approach is essential in order to avoid unnecessary morbidity and incomplete resections (AU)

[Surgical treatment of clival chordomas]. / Tratamiento de los cordomas de clivus.

INTRODUCTION: Clival chordomas are benign neoplastic tumors displaying high morbidity and mortality rates. The difficulties involved in obtaining a total resection and its infiltrative nature explain this aggressiveness. MATERIAL AND METHOD: We present a retrospective clinical series of 8 surgically treated cases of clival chordomas at our department from 1993 to 2006. RESULTS: All 8 patients underwent a total of 14 surgical procedures, 6 of which were anterior approaches (5 transmandibular), 2 subtemporal-preauricular, 2 from the transcondylar lateral edge and 2 transcochlear. In 7 patients the surgery was performed with curative intent. In 2 cases it was necessary to perform the surgery sequentially, in two steps. Total resection was achieved in 58% of patients. Average follow up was 40 months. Two patients died due to local recurrence, one patient died in the postoperative period and another died due to causes which were not related with the tumor. DISCUSSION: The low incidence of clival chordomas makes it difficult to carry out random clinical studies of its management. The treatment of choice is surgery, supplemented by radiotherapy in selected cases. We prefer to use the transmandibular approach, combined with transcondylar lateral edge approach when the occipital condyle is infiltrated. For lateral extensions, we use the subtemporal-preauricular or transpetrosal approaches. New radiotherapy modalities provide an effective treatment of tumoural residues. CONCLUSIONS: Extradural approaches imply anatomical regions which are familiar for otolaryngologists. Specific knowledge about the limitations of each approach is essential in order to avoid unnecessary morbidity and incomplete resections.

[Surgical treatment of head and neck chondrosarcomas]. / Tratamiento quirúrgico de los condrosarcomas de cabeza y cuello.

INTRODUCTION: Head and neck chondrosarcomas may adopt different locations and biological behaviour. MATERIAL AND METHOD: We present a retrospective clinical series of 17 chondrosarcomas surgically treated in our Department from 1977 until 2006. RESULTS: Chondrosarcomas were located in the nasosinusal area (n=6), larynx (n=5), petrous bone (n=3), atlas (n=1), parapharyngeal space (n=1) and trachea (n=1). All patients except for one underwent surgery with radical intention. The mean follow-up period was 84 months (median, 71 months). Six patients developed recurrent disease with a mean latency of 10 months. Two patients died due to the disease and two remained alive with evidence of tumour. Patients with grade I chondrosarcomas presented less recurrent disease than those with grade II or III chondrosarcomas (17% versus 80%, P=0.029). The estimated 5-year survival was 88% with the better survival of patients with grade I chondrosarcomas reaching statistical significance (P=0.023). In 2 patients with cricoid chondrosarcomas, the reconstruction was carried out using the Rethi-Ward technique, and they were without evidence of disease at 71 months (with no cannula) and 145 months (with cannula). Chondrosarcomas of the jugular foramen were treated using a modified infratemporal type A approach. CONCLUSION: Low grade head and neck chondrosarcomas have a good prognosis while high grade chondrosarcomas tend to recur, despite radical surgical treatment.