Historical development of the treatment of skull base tumours

Abstract

SurgeryRadiotherapy History a b s t r a c t Surgery has evolved greatly over the last decades thanks to the more sophisticated and conservative surgical approaches and also thanks to the progress of diagnostic imaging.An added value is represented by the increased experience of the professionals and the close multidisciplinarity of the procedures including neurosurgeons, otolaryngologists and maxillo-facial surgeons. One of the most recent developments is the endoscopic surgery allowing for more conservative and cosmetically satisfactory outcomes.Radiation therapy has greatly changed over the last decades thanks to the technology advances related both to the availability of new imaging modalities and techniques of radiation delivery. Delivery of radiation evolved from three-dimensional conformal techniques to stereotactic and intensity-modulated radiation therapy. Particle therapy has the potential to further improve in the near future thanks to the progress of technology. Proton therapy allows for optimization of dose deposition in the target with lesser dose in the healthy tissues and ion therapy, currently using carbon ions, has been more recently introduced with the advantage of more effective treatments in case of less radio-sensitive tumours thanks to a higher biological effectiveness.A relevant concept that can significantly improve the results is that of interaction and integration of different disciplines not only within the surgical field. The cooperation between surgeons of various disciplines, radiation oncologists and medical oncologists together with professionals from other disciplines, such as pathology and radiology is nowadays required in an effort to customize and optimize the treatment in each single patient.

Current Management and Image Review of Skull Base Chordoma: What the Radiologist Needs to Know

“…[ 22 ] These early surgical techniques achieved poor GTR of tumors; however, the advent of advanced imaging and modern radiotherapy reduced LR rates in skull base chordomas. [ 22 , 23 ]…”

Intraoperative assessment of skull base tumors using stimulated Raman scattering microscopy

“…One group of tumors that poses many challenges is skull base tumors which include meningiomas, pituitary adenomas, schwannomas, hemangiopericytomas, chordomas, various types of sarcomas, carcinomas, and metastases among other entities 3 . Skull base tumors face unique challenges due to their low occurrence, presence in deep locations, proximity to critical neurovascular structures, and extension beyond anatomic boundaries 4 . Accurate intraoperative tissue diagnosis is essential during skull base tumor surgery to maximize tumor removal, as a non-resected tumor can lead to recurrence, treatment failure, and overall poor outcome 5 .…”

Surgical treatment of acoustic neuroma: Outcomes and indications

“…Surgery for acoustic neuroma has developed over the years with a corresponding reduction in intraoperative and perioperative morbidity, and better preserved facial nerve and hearing functions. 1 The goal of surgery today is complete removal of the tumor with no further morbidity. When investigating the outcome of surgery, the main bias is represented by the "human factor": although the surgical techniques involved in various approaches to the internal * Corresponding author at: Otolaryngology Unit, Padua University, via N. Giustiniani 2, 35128 Padova, Italy.…”