Surgical management of skull base tumors

Rangel-Castilla, Leonardo; Russin, Jonathan J.; Spetzler, Robert F.

doi:10.1016/j.rpor.2014.09.002

Cited by 33 publications

(38 citation statements)

References 60 publications

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“…3,4,[11][12][13][14][15] In 1997 Dolenc 16 This study represented a milestone in the CS surgery. Mainly basing on this positive experience new and amazing improvements in the microsurgical technique have been made.…”

Section: Surgical Managementmentioning

confidence: 99%

The cavernous sinus meningiomas’ dilemma: Surgery or stereotactic radiosurgery?

Fariselli

Biroli

Signorelli

et al. 2016

Reports of Practical Oncology & Radiotherapy

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Despite the advances in techniques and technologies, the management of cavernous sinus (CS) meningiomas still remains a challenge for both neurosurgeons and radiation oncologists. On the other hand, the improvement of the anatomical knowledge and the microsurgical techniques together with diffusion of radiosurgery are currently changing the treatment strategy, opening new perspectives to the patients which are suffering from such lesions. The authors reviewed here the literature data. A multidisciplinary treatment algorithm is also proposed.

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Section: Surgical Managementmentioning

confidence: 99%

The cavernous sinus meningiomas’ dilemma: Surgery or stereotactic radiosurgery?

Fariselli

Biroli

Signorelli

et al. 2016

Reports of Practical Oncology & Radiotherapy

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“…The technique for resection of anterior skull base meningiomas is well documented in literature. [14][15][16][17] Various corridors and techniques may be employed; however, there are general considerations that we would like to outline here. The approach to complex anterior skull base meningiomas mandates adequate modular bony removal to achieve sufficient exposure of the tumor and surrounding region to minimize brain retraction and control neurovascular structures.…”

Section: Surgical Techniquementioning

confidence: 99%

The Role of 3D Tractography in Skull Base Surgery: Technological Advances, Feasibility, and Early Clinical Assessment with Anterior Skull Base Meningiomas

Chakravarthi

Fukui

Monroy-Sosa

et al. 2020

J Neurol Surg B Skull Base

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Objective The aim of this study is to determine feasibility of incorporating three-dimensional (3D) tractography into routine skull base surgery planning and analyze our early clinical experience in a subset of anterior cranial base meningiomas (ACM). Methods Ninety-nine skull base endonasal and transcranial procedures were planned in 94 patients and retrospectively reviewed with a further analysis of the ACM subset. Main Outcome Measures (1) Automated generation of 3D tractography; (2) co-registration 3D tractography with computed tomography (CT), CT angiography (CTA), and magnetic resonance imaging (MRI); and (3) demonstration of real-time manipulation of 3D tractography intraoperatively. ACM subset: (1) pre- and postoperative cranial nerve function, (2) qualitative assessment of white matter tract preservation, and (3) frontal lobe fluid-attenuated inversion recovery (FLAIR) signal abnormality. Results Automated 3D tractography, with MRI, CT, and CTA overlay, was produced in all cases and was available intraoperatively. ACM subset: 8 (44%) procedures were performed via a ventral endoscopic endonasal approach (EEA) corridor and 12 (56%) via a dorsal anteromedial (DAM) transcranial corridor. Four cases (olfactory groove meningiomas) were managed with a combined, staged approach using ventral EEA and dorsal transcranial corridors. Average tumor volume reduction was 90.3 ± 15.0. Average FLAIR signal change was –30.9% ± 58.6. 11/12 (92%) patients (DAM subgroup) demonstrated preservation of, or improvement in, inferior fronto-occipital fasciculus volume. Functional cranial nerve recovery was 89% (all cases). Conclusions It is feasible to incorporate 3D tractography into the skull base surgical armamentarium. The utility of this tool in improving outcomes will require further study.

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“…A su vez, como sabemos, la elección óptima del abordaje quirúrgico también dependerá del proceso patológico en cuestión (1,2,3) . Los abordajes quirúrgicos tradicionales al ápex orbitario incluyen, entre otros, orbitotomías laterales y craneotomías con componente orbitario, ambos procedimientos muy invasivos y con significativa morbilidad si los comparamos a los empleados en los abordajes quirúrgicos endoscópicos (4,5,6,7,1,8) . Además de los clásicos, otros tipos de abordajes posibles a esta región son los endoscópicos tansetmoidales y transmaxilares.…”

Section: Introductionunclassified

Anatomía endoscópica de la unidad estructural Fisura orbitaria inferior - Músculo de Müller en la Junción órbito selar medial y su importancia quirúrgica

Battista

Torres²,

Keller

et al. 2017

Rev Fac Cien Med Univ Nac Cordoba

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Resumen:Antecedentes: Las enfermedades que afectan la órbita representan un desafío quirúrgico, en particular las que comprometen el ápex orbitario. Una vía óptima de acceso quirúrgico proporciona la mejor exposición permitiendo identificar ciertas estructuras anatómicas claves llamadas reparos anatómicos. Objetivo: Describir la anatomía endoscópica de la unidad estructural Fisura Orbitaria Inferior / Músculo de Müller a nivel del ápex orbitario generando así un nuevo reparo anatómico endoscópico. Material y método: Análisis descriptivo óseo de la fisura orbitaria inferior (FOI) en cráneos secos, disección y estudio bajo técnica endoscópica de 6 cabezas fijadas en formol y coloreadas; finalmente se tomaron distancias y ángulos a forámenes relacionados con el ápex orbitario a 10 cráneos secos. El análisis estadístico se realizó con el programa estadístico SPSS 17,0 (SPSS, Inc., Chicago, IL). Resultado: En todas las disecciones endoscópicas se pudo identificar la unidad fisura orbitaria inferior-músculo de Müller y también verificar su íntima relación con el ápex orbitario. Morfométricamente el foramen óptico y el foramen redondo mayor están a una distancia promedio de 65.19mm y 60.16mm respectivamente. Los ángulos promedio del FO fue de 13.32 grados y del FRM de19.31 grados. Hallamos correlación significativa entre CO. y el FRM sólo en el hemicráneo izquierdo, (Tau b de Kendall 0.69, P=0.006). No se encontraron diferencias anatómicas (o morfológicas) significativas entre lados. Conclusión: bajo técnica endoscópica la unidad Fisura Orbitaria Inferior-Músculo de Müller (FOI-MM) es un reparo anatómico constante, útil y seguro que permite el reconocimiento del ápex orbitario y sus áreas contiguas. Palabras clave: base de cráneo; anatomía; endoscopía; órbita Abstract:Background: Diseases of the orbit represent a surgical challenge, particularly those compromising the orbital apex. Optimal surgical access should provide the best possible exposure, allowing to identify certain key anatomical structures, called landmarks. Objective: Describe the endoscopic anatomy of the structural unit formed by the Inferior Orbital Fissure (IOF) and the Müller's muscle (MM) at the orbital apex (OA), thus generating a new endoscopic anatomical landmark. Materials and methods: A bone-descriptive analysis of the IOF in dry craniums, was followed by dissection and endoscopic study of six heads (twelve sides), colored and fixed in formaldehyde. In ten dry craniums (twenty sides), distances and angles of OA foramina were measured (optic foramen [OF] and foramen rotundum [FR]). Statistical analysis was performed with SPSS 17.0 statistical software (SPSS, Inc. Chicago, IL). Results: The structural unit IOF-MM was identified in all endoscopic dissections, verifying its intimate relationship with the OA. From the morpho-metric standpoint, OF and FR were found at an average distance of 65.19 mm and 60.16 mm, respectively. The average angle of the OF was 13.32 degrees, whereas the one for FR was 19.31 degrees. We found a significant correlation b...

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Surgical management of skull base tumors

Abstract: Background: Over the last two decades, the treatment of skull base tumors has evolved

Cited by 33 publications

References 60 publications

The cavernous sinus meningiomas’ dilemma: Surgery or stereotactic radiosurgery?

The cavernous sinus meningiomas’ dilemma: Surgery or stereotactic radiosurgery?

The Role of 3D Tractography in Skull Base Surgery: Technological Advances, Feasibility, and Early Clinical Assessment with Anterior Skull Base Meningiomas

Anatomía endoscópica de la unidad estructural Fisura orbitaria inferior - Músculo de Müller en la Junción órbito selar medial y su importancia quirúrgica

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