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1.
Artigo em Chinês | MEDLINE | ID: mdl-32074744

RESUMO

Objective: To explore the application of endoscopy and clinical effect of endoscopic resection of benign tumor in infratemporal fossa. Methods: The clinical data of 11 patients with benign tumors in infratemporal fossa admitted to the Department of Otorhinolaryngology Head and Neck Surgery and Skull Base Surgery of the Affiliated Hospital of Qingdao University from January 2016 to September 2018 were retrospectively analyzed. There were 6 males and 5 females, with the age ranging from 11 to 63 years old. The main clinical manifestations were pharyngeal foreign body sensation, submaxillary pain, maxillofacial numbness and tongue numbness. Imaging examination showed that the tumor was round and had a clear boundary with the surrounding tissue. All the patients underwent endoscopic surgery. Appropriate surgical approach was selected according to the location of the tumor and its relationship with the internal carotid artery. The endoscopic surgical approaches included trans-oropharyngeal approach in 7 cases, trans-lateral pterygomandibular raphe approach in 1 case and trans-medial pterygomandibular raphe approach in 3 cases. The pathological results, prognosis, complications and relapse of patients were summarized through descriptive statistics. Results: The tumors were completely resected under endoscope in all patients, and there was no significant complication occurred after surgery. The average pain VAS score was 3.1 after surgery and average hospital stay was 5.9 d. The postoperative pathological diagnoses consisted of 6 cases of pleomorphic adenoma, 4 cases of neurilemmoma and 1 case of basal cell adenoma. All patients were followed up regularly from 6 to 39 months without recurrence of tumor. Conclusion: Endoscopic resection of benign tumors in infratemporal fossa has the advantages of minimal damage, rapid recovery, few complications, and definite curative effect, which can be used as an important alternative for surgical treatment of benign tumors.


Assuntos
Endoscopia , Neoplasias da Base do Crânio/cirurgia , Adenoma/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neurilemoma/cirurgia , Estudos Retrospectivos , Adulto Jovem
3.
World Neurosurg ; 133: e275-e280, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31518747

RESUMO

BACKGROUND: The acellular dermal matrix (ADM) and turbinate flap (TF) have been widely used in the reconstruction of skull base defects. However, owing to the lack of reported data, the therapeutic effects have been controversial. The purpose of the present study was to compare the effect of the ADM and TF on cerebrospinal fluid (CSF) rhinorrhea after nasal endoscopic resection of a skull base tumor. METHODS: The data from 46 patients who had undergone nasal endoscopic resection of a skull base tumor and repair of CSF rhinorrhea were retrospectively analyzed. The patients were divided into ADM and TF groups according to the difference in repair materials used. We compared and analyzed the intraoperative information and postoperative outcomes. RESULTS: The operation time, blood loss, defect area, and need for blood transfusion were not significantly different between the ALT and TF groups. The postoperative length of hospital stay (14.33 ± 3.66 vs. 16.76 ± 5.51 days; P = 0.669) and the incidence of complications, including wound infection (1 vs. 0; P = 0.270), intracranial infection (1 vs. 1; P = 0.900), hemorrhage (2 vs. 3; P = 0.788), 15-day CSF leak (1 vs. 2; P = 0.658), and respiratory infection (2 vs. 1; P = 0.450) were comparable between the 2 groups. The 6-month (0 vs. 0; P = 1.000) and 12-month (0 vs. 0; P = 1.000) incidence of recurrence also showed no significant differences. CONCLUSION: The use of the ADM for patients with CSF rhinorrhea showed comparable results in terms of postoperative outcomes compared with the use of TF. ADM could serve as a safe and feasible alternative for endoscopic repair of CSF rhinorrhea after nasal endoscopic resection of skull base tumors.


Assuntos
Derme Acelular , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Complicações Intraoperatórias/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Base do Crânio/cirurgia , Retalhos Cirúrgicos , Conchas Nasais/transplante , Adulto , Idoso , Perda Sanguínea Cirúrgica , Rinorreia de Líquido Cefalorraquidiano/etiologia , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Neuroimagem , Duração da Cirurgia , Estudos Retrospectivos
4.
Br J Radiol ; 93(1107): 20190028, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31322969

RESUMO

OBJECTIVE: To assess the radiation-induced optic neuropathy (RION) prevalence, following high dose pencil beam scanning proton therapy (PBSPT) to skull base and head and neck (H&N) tumours. METHODS: Between 1999 and 2014, 216 adult patients, median age 47 years (range, 18-77), were treated with PBS PT for skull base or H&N malignancies, delivering ≥45 GyRBE to the optic nerve(s) (ON) and/or optic chiasma (OC). The median administered dose to the planning target volume was 74.0 GyRBE (range, 54.0-77.4). The median follow-up was 5.3 years (range, 0.8-15.9). RESULTS: RION was observed in 14 (6.5%) patients at a median time of 13.2 months (range, 4.8-42.6) following PBSPT. Most (92.9%) of RION were symptomatic. Most affected patients (11/14; 79%) developed unilateral toxicity. Grade 4, 3, 2 and 1 toxicity was observed in 10, 2, 1 and 1 patients, respectively. On univariate analyses, age (<70 vs ≥70 years; p < 0.0001), hypertension (p = 0.0007) and tumour abutting the optic apparatus (p = 0.012) were associated with RION. OC's V60 GyRBE was of border line significance (p = 0.06). None of the other evaluated OC-ON dose/volume metrics (Dmax, Dmean, V40-60) were significantly associated with this complication. CONCLUSION: These data suggest that high-dose PBS PT for skull base and H&N tumours is associated with a low prevalence of RION. Caution should be however exercised when treating elderly/hypertensive patients with tumours abutting the optic apparatus. ADVANCES IN KNOWLEDGE: This is the first study reporting the risk of developing RION following proton therapy with PBS technique, demonstrating the safety of this treatment.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Doenças do Nervo Óptico/etiologia , Nervo Óptico/efeitos da radiação , Terapia com Prótons/efeitos adversos , Lesões por Radiação/complicações , Neoplasias da Base do Crânio/radioterapia , Adolescente , Adulto , Fatores Etários , Idoso , Análise de Variância , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Hipertensão/complicações , Pessoa de Meia-Idade , Quiasma Óptico/efeitos da radiação , Doenças do Nervo Óptico/epidemiologia , Doenças do Nervo Óptico/patologia , Prevalência , Terapia com Prótons/métodos , Dosagem Radioterapêutica , Radioterapia Adjuvante , Fatores de Risco , Neoplasias da Base do Crânio/patologia , Neoplasias da Base do Crânio/cirurgia , Adulto Jovem
5.
Orv Hetil ; 160(40): 1584-1590, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31565974

RESUMO

Introduction: Malignant tumours of the sinonasal region - including those with invasion of the skull base - necessitate surgical resection. The majority of the cases give an opportunity to perform the procedure via minimally invasive, endoscopic approach, without external, craniofacial surgery. Aim: To assess our clinical experience in treating anterior skull base malignancies, performing minimally invasive endoscopic transcribriform resection. Method: Between February 2015 and July 2017, four male and one female patient underwent minimally invasive, endoscopic skull base procedure. The mean age was 64.6 years (59-70, median: 66). Every surgery was performed via transnasal, endoscopic transcribriform approach. In two cases Kadish C esthesioneuroblastomas, while in one case a T3N0 sinonasal non-differentiated carcinoma, a T1N0 intestinal type adenocarcinoma and a T4N0 squamous cell carcinoma was the indication of surgery, respectively. Results: The mean follow-up time was 22.8 months, between 14 and 46 months. Intraoperative complications did not occur during the procedures. Regarding the postoperative period, liquorrhoea and pneumocephalus occurred in one case. Complications were solved with lumbar drainage. During follow-up, neither residual nor recurrent tumour was observed in our patients. Conclusion: Endoscopic transcribriform resection of the skull base malignancies is a safe and viable alternative to the traditional open approach. Orv Hetil. 2019; 160(40): 1584-1590.


Assuntos
Endoscopia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Neoplasias dos Seios Paranasais/cirurgia , Neoplasias da Base do Crânio/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Recidiva Local de Neoplasia , Neuroendoscopia/efeitos adversos , Neoplasias dos Seios Paranasais/patologia , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/patologia , Resultado do Tratamento
6.
Radiologe ; 59(12): 1080-1087, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31628501

RESUMO

CLINICAL ISSUE: Knowledge of skull base anatomy is essential for recognizing the pathological conditions affecting the skull base structures (including cranial nerves and cerebral vasculature), for correct interpretation of their presentation on imaging studies, and finally for proper planning of surgical skull base approaches. PURPOSE OF THE ARTICLE: The main goal of the following work is to present a brief recapitulation of the regular skull base anatomy (with a focus on the bony structures) and based on this, to provide an overview of the most commonly used neurosurgical skull base approaches (illustrated using radiological case presentations). DIAGNOSTIC WORK-UP: Already at the step of the preoperative workup, the suitable radiological technique and proper choice of technical parameters for image acquisition lays the foundation for a successful surgical procedure and for the reliable assessment of operative results. CONCLUSION: Each radiologist should be familiar with basic principles of neurosurgical approaches and operative techniques used in skull base surgery and with their appearance in postoperative images.


Assuntos
Imagem por Ressonância Magnética , Neoplasias da Base do Crânio , Base do Crânio/anatomia & histologia , Nervos Cranianos , Humanos , Procedimentos Neurocirúrgicos , Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia
7.
World Neurosurg ; 132: 363-367, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541760

RESUMO

BACKGROUND: The flexion of the skull base (basal angle [BA]) is the inclination between the anterior fossae and the basilar ramp of the occipital and sphenoid bones. An increased BA, termed platybasia, is usually associated with basilar invagination. BA reference values in the magnetic resonance imaging (MRI) era and the diagnosis of platybasia are of clinical importance. The transnasal approach has been the surgical technique of choice to remove the odontoid process in cases of ventral brainstem compression in patients with platybasia. The knowledge of normal BA values has been influenced by technological image acquisitions. The aim of this study was to determine the normal BA values in normal subjects in the MRI era. METHODS: For the determination of normal BA values, the literature reporting these values in normal individuals was reviewed and a meta-analysis of pertinent studies was performed. RESULTS: A total of 8 articles were included in this study, evaluating a total of 667 individuals. A summary measure of the results was obtained. The data obtained in this analysis provided a final basal angle value of 116.5 degrees (95% confidence interval, 104.39-128.7). The normal basal angle ranges between 104 and 129 degrees. CONCLUSION: Platybasia can be defined as a value >129 from the basal angle.


Assuntos
Imagem por Ressonância Magnética/métodos , Procedimentos Neurocirúrgicos/métodos , Platibasia/diagnóstico por imagem , Platibasia/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Humanos , Valores de Referência
8.
J Nippon Med Sch ; 86(4): 248-253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484881

RESUMO

Tumors of the skull base, such as meningiomas, tend to recur. With progress in free vascularized flap surgery, an increasing number of studies are investigating skull base reconstruction with free flaps after tumor removal. In this report, we discuss the results of second free flap surgery after skull base reconstructive surgery. We retrospectively analyzed data from patients treated at our center during the period from 2013 through 2017. All four patients identified had skull base anaplastic meningioma and had undergone radiotherapy. In all cases, the flap and donor blood vessel were sourced from sites that differed from those used in the previous surgeries. No complications developed, such as cerebrospinal fluid leakage, meningitis, wound infection, wound hemorrhage, or flap necrosis. Because the first flap was found to be unviable, it was difficult to preserve and was removed. Essential points in preventing complications are anchoring at the appropriate site, pinprick testing of the created flap, and use of multilayered countermeasures to prevent cerebrospinal fluid leakage.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Adulto , Imagem de Difusão por Ressonância Magnética , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade , Reoperação , Neoplasias da Base do Crânio/diagnóstico por imagem , Resultado do Tratamento
9.
Artigo em Chinês | MEDLINE | ID: mdl-31434382

RESUMO

Draf type Ⅱb/Ⅲ frontal sinus surgery has been widely used in clinical practice. They can obtain a wide operating space and sufficient drainage pathways. However, the mucosa around the frontal sinus ostium was removed during the surgery, resulting in bone exposure, and sinus ostium stenosis or atresia may occur after the operation. In recent years, rhinologists at home and abroad have applied various mucosal flaps to cover the exposed bone around the frontal sinus orifice after Draf Ⅱb/Ⅲ frontal sinus surgery, in order to reduce scar formation and bone hyperplasia along with the incidence of frontal sinus ostium stenosis or atresia after surgery. Satisfactory results have been achieved. The article reviews the application of mucosal flap technique in Draf Ⅱb/Ⅲ frontal sinus surgery, in order to promote the clinical research and technical development of this technique in China.


Assuntos
Seio Frontal/cirurgia , Membrana Mucosa/transplante , Doenças dos Seios Paranasais/cirurgia , Retalhos Cirúrgicos , China , Endoscopia , Humanos , Neoplasias da Base do Crânio/cirurgia , Resultado do Tratamento
10.
J Craniofac Surg ; 30(8): e755-e757, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449204

RESUMO

A 78-year-old woman with progressive worsening vertigo and new onset of diplopia. Neurological examination revealed bilateral abducens nerve paralysis and gait disturbance with truncal ataxia. Neuroimaging revealed a mass lesion within the clivus with brain stem compression. The patient was operated with provisional diagnosis of clivus chordoma by neuro-navigation-guided extended endoscopic endonasal approach. Subtotal resection of the tumor was achieved with no intra- or postoperative complications. Histopathologic examination revealed intraosseous meningioma (WHO grade I). To the authors' best knowledge this is the first case reporting clivus site of intraosseous meningioma.


Assuntos
Cordoma/cirurgia , Fossa Craniana Posterior/diagnóstico por imagem , Diagnóstico Diferencial , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Neoplasias da Base do Crânio/cirurgia , Idoso , Cordoma/complicações , Cordoma/diagnóstico , Fossa Craniana Posterior/patologia , Diplopia/complicações , Feminino , Neoplasias de Cabeça e Pescoço , Humanos , Neuroimagem , Complicações Pós-Operatórias , Neoplasias da Base do Crânio/complicações , Neoplasias da Base do Crânio/diagnóstico
11.
World Neurosurg ; 129: 24-27, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426253

RESUMO

OBJECTIVE: Pediatric endoscopic endonasal surgery represents a still-growing discipline to approach complex skull base lesions and is characterized by unfavorable anatomical conditions. Children have very small nostrils and narrow rhinosinusal corridors, which could lead more easily to accidental injury to the nasal structures. We describe the use of a peel-away catheter introducer sheath as an innovative and minimally invasive technique to further reduce surgical trauma to the nasal mucosa and structures in pediatric rhinoneurosurgery. METHODS: From January 2009 to December 2018, the peel-away sheath technique was used in 6 pediatric endoscopic procedures for biopsy and/or removal of skull base tumors. RESULTS: The endoscopic technique with the use of the peel-away catheter allowed clear visualization of the surgical field during the whole course of the procedure and good surgical maneuverability. The use of the peel-away sheath did not prolong the surgical operation time and provided a good working channel. No intraoperative or postoperative major complications were observed. No nasal short-term complications were registered in all patients. CONCLUSIONS: The use of a peel-away catheter introducer sheath technique represents a valid adjunct in the endoscopic pediatric skull base surgery repertoire. It can help in avoiding inadvertent surgical traumas to the sinonasal structures, especially by residents and junior surgeons. This could potentially reduce postoperative nasal morbidity.


Assuntos
Neuroendoscopia/instrumentação , Neoplasias da Base do Crânio/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural/instrumentação
12.
World Neurosurg ; 131: 321-327, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31284052

RESUMO

Deep-seated cerebral lesions have fascinated and frustrated countless surgical innovators since the dawn of the microneurosurgical era. To determine the optimal approach, the microneurosurgeon must take into account the characteristics and location of the pathological lesion as well as the operator's range of technical expertise. Increasingly, microneurosurgeons must select between multiple operative corridors that can provide access to the surgical target. Innovative trajectories have emerged for many indications that provide more flexible operative angles and superior exposure but result in longer working distances and more technically demanding maneuvers. In this article, we highlight 4 innovative surgical corridors and compare their strengths and weaknesses against those of more conventional approaches. Our goal is to use these examples to illustrate the following principles of microneurosurgical innovation: (1) discover more efficient and flexible exposures with superior working angles; (2) ensure maximal early protection of critical neurovascular structures; and (3) effectively handle target pathology with minimal disruption of normal tissues.


Assuntos
Malformações Arteriovenosas Intracranianas/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Craniotomia/métodos , Humanos , Ilustração Médica , Pinealoma/cirurgia , Neoplasias da Base do Crânio/cirurgia
13.
J Laryngol Otol ; 133(6): 501-507, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31271349

RESUMO

OBJECTIVE: Prompted by a recurring skull base multidisciplinary team debate on the necessity of securing a definitive tissue diagnosis before initiating treatment for lesions of the orbital apex, a review of anterior skull base procedures over an 11-year period was undertaken. METHODS: Data collected prospectively on cases from 2006 to 2017 were analysed. Presenting symptoms, imaging and histology findings, outcomes, complications, and impact on treatment were evaluated. All surgery was carried out endoscopically with the aid of image guidance. RESULTS: Twenty-one patients undergoing endoscopic orbital apex and/or optic canal biopsy were included. The mean patient age was 49 years. Five malignant tumours were identified, five benign tumours, seven infective cases (two tuberculosis and five fungal) and two cases of immunoglobulin G4 related disease. Two patients had non-diagnostic biopsies (one lesional) and were treated successfully as Tolosa-Hunt syndrome cases. CONCLUSION: A successful diagnosis was achieved in nearly all cases without adverse impact, other than one cerebrospinal fluid leakage case. Management was directly influenced by the outcome in all cases.


Assuntos
Biópsia Guiada por Imagem/métodos , Imagem Tridimensional , Órbita/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia , Adulto , Fatores Etários , Idoso , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/patologia , Cavidade Nasal/cirurgia , Órbita/diagnóstico por imagem , Órbita/patologia , Medição da Dor , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Neoplasias da Base do Crânio/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
Artigo em Russo | MEDLINE | ID: mdl-31339496

RESUMO

AIM: Transorbital neuroendoscopic surgery is a new skull base surgery technique that uses the orbit as an artificial corridor to the anterior and middle skull base. The space is created between the periorbita and orbital walls by their additional resection and gentle traction of the orbital contents. Skull base structures are reached using cosmetic incisions. The major advantages of transorbital endoscopic approaches include their variety, possibility of their combination, and access to the central and lateral skull base lesions. The aim of this study was to analyze the primary results of transorbital endoscopic biopsy and resection of skull base lesions, which were performed at the N.N. Burdenko National Medical Research Center for Neurosurgery (Moscow, Russia). MATERIAL AND METHODS: In 2017-2018, the authors operated on 12 patients with skull base lesions using transorbital endoscopic approaches. The series included ten female and two male patients. The patient's age varied between 24 and 78 years. All patients were admitted for the first time. Half of them underwent biopsy, while the other half underwent tumor resection. The upper-lateral transorbital approach with an eyebrow incision was used in most (8/12) patients; the retrocaruncular approach was used in two cases; the lateral retrocanthal approach was applied in one case; the upper-medial approach with an eyebrow incision was used in one patient. RESULTS: The histological diagnosis was established in all six biopsies: 3 pseudotumors, 2 WHO Grade I meningiomas, and 1 clear-cell kidney cancer. Tumor resection was successful in 5 out of 6 patients; repeated surgery was required in one patient. In one case, the transorbital approach was combined with the transnasal one for treatment of supraorbital mucocele. One patient developed a persistent neurological deficit (dysfunction of the fifth and sixth nerves) after upper-lateral transorbital surgery. There were no poor cosmetic results in the series. CONCLUSION: Transorbital neuroendoscopic surgery needs an interdisciplinary approach and a sufficient amount of surgical experience. Surgical skills setting includes microsurgical and endoscopic tumor resection, harvesting and positioning of free and vascularized grafts for skull base reconstruction and prevention of postoperative enophthalmos, and facial incisions and their cosmetic closure. Implementation of new local vascularized flaps may significantly improve the results of transorbital endoscopic procedures and extend the spectrum of indications.


Assuntos
Neoplasias da Base do Crânio , Biópsia , Feminino , Humanos , Masculino , Base do Crânio , Neoplasias da Base do Crânio/diagnóstico , Neoplasias da Base do Crânio/cirurgia
15.
Otolaryngol Clin North Am ; 52(5): 875-890, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31353137

RESUMO

Although there have been many advances in new tools and procedures for endonasal sinus surgery in children, the management and care for pediatric chronic rhinosinusitis has remained relatively unchanged. However, there have been advances in skull base surgery and tumor removal and new knowledge about perioperative concerns in children. This article discusses the role and risks of endoscopic sinus surgery, the use of balloon sinuplasty in children, management of complicated rhinosinusitis, and advances in skull base tumors and choanal atresia repair.


Assuntos
Procedimentos Cirúrgicos Nasais/tendências , Seios Paranasais/cirurgia , Rinite/cirurgia , Sinusite/cirurgia , Cateterismo/métodos , Criança , Atresia das Cóanas/cirurgia , Doença Crônica , Endoscopia/métodos , Humanos , Neoplasias da Base do Crânio/cirurgia , Tomografia Computadorizada por Raios X
17.
World Neurosurg ; 131: e116-e127, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31323403

RESUMO

BACKGROUND: The aim of our study was to compare the health care utilization and outcomes after surgery for anterior cranial fossa skull base meningioma (AFM), middle cranial fossa skull base meningioma (MFM), and posterior cranial fossa skull base meningioma (PFM) across the United States. METHODS: We queried the MarketScan database using International Classification of Diseases, Ninth Revision and Current Procedural Terminology 4, from 2000 to 2016. We included adult patients who had at least 24 months of enrollment after the surgical procedure. The outcome of interest was length of hospital stay, disposition, complications, and reoperation after the procedure. RESULTS: A cohort of 1191 patients was identified from the database. Less than half of patients (43.66%) were in the AFM cohort, 32.24% were in the MFM cohort, and only 24.1% were in the PFM cohort. Patients who underwent surgery for PFM had longer hospital stay (P = 0.0009), high complication rate (P = 0.0011), and less likely to be discharged home (P = 0.0013) during index hospitalization. There were no differences in overall payments at 12 months and 24 months among the cohorts. There was no significant difference in 90-day median payments among the groups ($66,212 [AFM] vs. $65,602 [MFM] and $71,837 [PFM]; P = 0.198). Male gender, commercial insurance (compared with Medicare), and higher comorbidity scores (score 3 compared with score 0) were associated with higher 90-day payments in the PFM cohort. CONCLUSIONS: Overall payments (at 12 months and 24 months) and 90-day payments were not different among the cohorts. Patients with PFM had longer hospital stay and higher complication rate and were less likely to be discharged home with higher utilization of outpatient services at 12 months and 24 months.


Assuntos
Utilização de Instalações e Serviços/economia , Tempo de Internação/estatística & dados numéricos , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/economia , Complicações Pós-Operatórias/epidemiologia , Mecanismo de Reembolso , Neoplasias da Base do Crânio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fossa Craniana Anterior , Fossa Craniana Média , Fossa Craniana Posterior , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Complicações Pós-Operatórias/economia , Reoperação/economia , Estados Unidos , Adulto Jovem
18.
J Craniofac Surg ; 30(8): 2313-2314, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283643

RESUMO

Surgical access to tumors involving the midline skull base remains a considerable challenge for surgeons. Various surgical approaches for treating these tumors like transnasal, transantral, and endoscopic approaches sometimes have anatomical limitations. This paper describes a transoral approach with a Lefort I osteotomy that allows a great visualization, not only to the center of the skull base but also the infratemporal fossa. This technique may be used for the surgical resection of extracranial and intracranial benign tumors, and non-neoplastic intradural pathology, which does not require dural resection. The authors will review proper patient selection, surgical exposure, operative procedure, and complications.


Assuntos
Fossa Craniana Anterior/cirurgia , Fossa Craniana Média/cirurgia , Neoplasias da Base do Crânio/cirurgia , Craniotomia/métodos , Humanos , Osteotomia , Procedimentos Cirúrgicos Reconstrutivos
19.
J Neurooncol ; 144(1): 65-77, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31240525

RESUMO

BACKGROUND: Chordoma is a rare refractory neoplasm that arises from the embryological remnants of the notochord, which is incurable using any multimodality therapy. Vascular endothelial growth factor (VEGF) is a potent activator of angiogenesis that is strongly associated with the tumor-immune microenvironment. These factors have not been elucidated for chordomas. METHODS: To evaluate the characteristics of vascular and tumor cells in chordoma, we first analyzed the expression of VEGF receptor (VEGFR) 1, VEGFR2, CD34, and Brachyury in a cell line and 54 tumor tissues. Patients with primary skull base chordomas were divided into the following two groups as per the tumor growth rate: patients with slow progression (SP: < 3 mm/year) and those with rapid progression (RP: ≥ 3 mm/year). Thus, the expressions of VEGF-A, VEGFR 1, and VEGFR2 on tumor cells; tumor infiltrative immune cells, including regulatory T cells (Tregs) and tumor-associated macrophages (TAMs); and immune-checkpoint molecules (PD-1/PD-L1) were analyzed with the clinical courses, especially in a comparison between the two groups. RESULTS: In chordomas, both VEGFR1 and VEGFR2 were strongly expressed not only on vascular endothelial cells, but also on tumor cells. The recurrent cases showed significantly higher VEGFR1 expressions on tumor cells than the primary cases. The expression of VEGF-A was significantly higher in RP than that in SP group. The numbers of CD163+ TAMs and Foxp3+ Tregs were higher in RP than that in SP group. CONCLUSIONS: Expression of VEGFR1 and VEGFR2 on tumor cells and immunosuppressive tumor-microenvironment were related to tumor growth in patients with chordomas.


Assuntos
Biomarcadores Tumorais/metabolismo , Cordoma/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias da Base do Crânio/patologia , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Adolescente , Adulto , Idoso , Antígenos CD34/metabolismo , Cordoma/metabolismo , Cordoma/cirurgia , Feminino , Proteínas Fetais/metabolismo , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/metabolismo , Recidiva Local de Neoplasia/cirurgia , Prognóstico , Neoplasias da Base do Crânio/metabolismo , Neoplasias da Base do Crânio/cirurgia , Proteínas com Domínio T/metabolismo , Adulto Jovem
20.
World Neurosurg ; 131: e12-e22, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31226453

RESUMO

BACKGROUND: Parasellar meningiomas involving the cavernous sinus and Meckel's cave pose a management challenge because of invasion around neurovascular structures and the pituitary gland. The management options range from aggressive resection to focused radiotherapy alone. We present a strategy for these tumors that includes endonasal bony decompression, partial tumor removal, and stereotactic radiotherapy (SRT) in select cases. METHODS: The tumor location, previous treatments, cranial neuropathies, pituitary dysfunction, tumor control rates, use of stereotactic radiosurgery, SRT, and complications were retrospectively evaluated. RESULTS: Twenty patients (age range, 43-81 years; 65% women; 90% with World Health Organization grade I; median follow-up, 57 months; 14 without previous debulking and RT; 6 with previous debulking and RT) underwent endonasal bony decompression and partial tumor removal. The most common tumor locations were cavernous sinus (95%), Meckel's cave (95%), sella (75%), petroclival (60%), and optic canal/orbit (30%). Three patients with large meningiomas underwent staged transcranial and endonasal debulking. Of the 14 patients without previous debulking and RT, 11 had undergone postoperative SRT, with tumor shrinkage in 3 (27%). At the last follow-up examination, for these 14 patients and the 6 patients who had undergone previous surgery and RT, tumor control was 100% and 33% (P < 0.001) and the cranial neuropathies had improved in 57% and 33%, respectively. Major complications occurred in 2 patients: a permanent sixth cranial nerve palsy and cerebrospinal fluid leakage requiring reoperation. CONCLUSIONS: Endonasal bony decompression and selective tumor removal, followed by SRT, appears to be a reasonable treatment option for most previously untreated parasellar meningiomas. For patients who have undergone previous debulking and RT, new targeted treatment strategies are needed.


Assuntos
Seio Cavernoso/cirurgia , Procedimentos Cirúrgicos de Citorredução/métodos , Descompressão Cirúrgica/métodos , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neuroendoscopia/métodos , Neoplasias da Base do Crânio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Seio Cavernoso/diagnóstico por imagem , Doenças dos Nervos Cranianos/etiologia , Feminino , Humanos , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/radioterapia , Meningioma/complicações , Meningioma/diagnóstico por imagem , Meningioma/radioterapia , Pessoa de Meia-Idade , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural , Doenças da Hipófise/etiologia , Complicações Pós-Operatórias/epidemiologia , Radiocirurgia , Estudos Retrospectivos , Neoplasias da Base do Crânio/complicações , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/radioterapia
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