Background Large and giant medial sphenoid wing meningiomas that are located deeply in the skull base where they are closely bounded by cavernous sinus,optic nerve,and internal carotid artery make the gross resection ...Background Large and giant medial sphenoid wing meningiomas that are located deeply in the skull base where they are closely bounded by cavernous sinus,optic nerve,and internal carotid artery make the gross resection hard to achieve.Also,this kind of meningiomas is often accompanied by a series of severe complications.Therefore,it was regarded as a formidable challenge to even the most experienced neurosurgeons.This study aimed to investigate the clinical features and management experience of patients with large and giant medial sphenoid wing meningiomas.Methods In this study,53 patients （33 female and 20 male,mean age of 47.5 years） with large and giant medial sphenoid wing meningiomas were treated surgically between April 2004 to March 2012,with their clinical features analyzed,management experience collected,and treatment results investigated retrospectively.Results In this study,gross total resection （Simpson Ⅰ and Ⅱ） was applied in 44 patients （83％）.Fifty-three patients had accepted the routine computed tomography scan and magnetic resonance imaging scan as postoperative neuroradiological evaluation.Their performance showed surgical complications of vascular lesions and helped us evaluate patients＇ conditions,respectively.Meanwhile,the drugs resisting cerebral angiospasm,such as Nimodipine,were infused in every postoperative patient through vein as routine.As a result,11 patients （21％） were found to have secondary injury of cranial nerves Ⅱ,Ⅲ,and Ⅳ,and nine patients got recovered during the long-term observing follow-up period.Temporary surgical complications of vascular lesions occurred after surgery,such as cerebral angiospasm,ischemia,and edema;24 patients （45％） appeared to have infarction and dyskinesia of limbs.Overall,visual ability was improved in 41 patients （77％）.No patient died during the process.Conclusions Microsurgical treatment may be the most effective method for the large and giant medial sphenoid wing meningiomas.The surgical strategy should focus 展开更多
Background:Historically sinonasal malignancies were always addressed via open craniofacial surgery for an oncologic resection.Increasingly esthesioneuroblastomas are excised using an exclusively endoscopic approach,ho...Background:Historically sinonasal malignancies were always addressed via open craniofacial surgery for an oncologic resection.Increasingly esthesioneuroblastomas are excised using an exclusively endoscopic approach,however,the rarity of this disease limits the availability of long-term and large scale outcomes data.Objective:The primary objective is to evaluate the treatment modalities used and the overall survival of patients with esthesioneuroblastoma managed with exclusively endoscopic surgery.Methods:In accordance with PRISMA guidelines,PubMed was queried to identify studies describing outcomes associated with endoscopic management of esthesioneuroblastomas.Results:Forty-four out of 2462 articles met inclusion criteria,totaling 399 patients with esthesioneuroblastoma treated with an exclusively endoscopic approach.Seventy-two patients(18.0%)received adjuvant chemotherapy and 331 patients(83.0%)received postoperative radiation therapy.The average age was 50.6 years old(range 6-83).Of the 399 patients,57(16.6%)were Kadish stage A,121(35.2%)were Kadish stage B,145(42.2%)were Kadish stage C,and 21(6.1%)were Kadish stage D.Pooled analysis demonstrated that 66.0%of patients had Hyams histologic GradeⅠorⅡ,while 34.0%of patients had GradeⅢorⅣdisease.Negative surgical margins were achieved in 86.9%of patients,and recurrence was identified in 10.3%of patients.Of those with 5-year follow-up,reported overall survival was 91.1%.Conclusion:Exclusively endoscopic surgery for esthesioneuroblastoma is performed for a wide range of disease stages and grades,and the majority of these patients are also treated with adjuvant chemotherapy or radiation therapy.Reported overall recurrence rate is 10.3%and 5-year survival is 91.1%.展开更多
Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always...Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always be available.One alternative option is a flexible single-layer ASB repair.Initial studies indicate low cerebrospinal fluid leak rates with a single-layer repair.However,the level of frontal lobe support,particularly the propensity for a significant inferior displacement of the frontal lobe,is not known.The goal of this study is to determine the frontal lobe position after single-layer acellular dermal allograft repair in large ASB defects.Study Design:Retrospective cohort study.Setting:Tertiary care medical center.Subjects and Methods:This cohort study compares the frontal lobe position in adults who underwent endoscopic endonasal ASB tumor resection and single-layer cadaveric dermal matrix repair(ASB cohort)with control subjects without intracranial abnormalities(control cohort).The ASB cohort includes subjects with an ASB defect of≥5 cm anterior/posterior and≥1.5 cm wide and who had imaging at least 2 months after surgery.The frontal lobe position is measured on sagittal CT/MRI using a reference line from the base of the sella to the nasion.A value of zero indicates that the inferior-most aspect of the frontal lobe is at the level of the nasion-sellar line.A positive value indicates that the frontal lobe is inferior to the nasion-sellar line.The ASB cohort frontal lobe position is compared with the control cohort using the Mann-WhitneyU test.A priori we set an absolute difference of 5 mm as a clinically significant difference.Results:The ASB cohort includes 47 subjects who are 57%male with an average age of 60 years(range:31-89 years).The most common ASB pathology is esthesioneuroblastoma(n=21)and 81%of the ASB cohort had postoperative radiation.The control cohort includes 20 subjects who are 60%male,with a mean age of 45 years(range:19-74 years).The majority of controls underwent imaging for 展开更多
文摘Background Large and giant medial sphenoid wing meningiomas that are located deeply in the skull base where they are closely bounded by cavernous sinus,optic nerve,and internal carotid artery make the gross resection hard to achieve.Also,this kind of meningiomas is often accompanied by a series of severe complications.Therefore,it was regarded as a formidable challenge to even the most experienced neurosurgeons.This study aimed to investigate the clinical features and management experience of patients with large and giant medial sphenoid wing meningiomas.Methods In this study,53 patients （33 female and 20 male,mean age of 47.5 years） with large and giant medial sphenoid wing meningiomas were treated surgically between April 2004 to March 2012,with their clinical features analyzed,management experience collected,and treatment results investigated retrospectively.Results In this study,gross total resection （Simpson Ⅰ and Ⅱ） was applied in 44 patients （83％）.Fifty-three patients had accepted the routine computed tomography scan and magnetic resonance imaging scan as postoperative neuroradiological evaluation.Their performance showed surgical complications of vascular lesions and helped us evaluate patients＇ conditions,respectively.Meanwhile,the drugs resisting cerebral angiospasm,such as Nimodipine,were infused in every postoperative patient through vein as routine.As a result,11 patients （21％） were found to have secondary injury of cranial nerves Ⅱ,Ⅲ,and Ⅳ,and nine patients got recovered during the long-term observing follow-up period.Temporary surgical complications of vascular lesions occurred after surgery,such as cerebral angiospasm,ischemia,and edema;24 patients （45％） appeared to have infarction and dyskinesia of limbs.Overall,visual ability was improved in 41 patients （77％）.No patient died during the process.Conclusions Microsurgical treatment may be the most effective method for the large and giant medial sphenoid wing meningiomas.The surgical strategy should focus
文摘Background:Historically sinonasal malignancies were always addressed via open craniofacial surgery for an oncologic resection.Increasingly esthesioneuroblastomas are excised using an exclusively endoscopic approach,however,the rarity of this disease limits the availability of long-term and large scale outcomes data.Objective:The primary objective is to evaluate the treatment modalities used and the overall survival of patients with esthesioneuroblastoma managed with exclusively endoscopic surgery.Methods:In accordance with PRISMA guidelines,PubMed was queried to identify studies describing outcomes associated with endoscopic management of esthesioneuroblastomas.Results:Forty-four out of 2462 articles met inclusion criteria,totaling 399 patients with esthesioneuroblastoma treated with an exclusively endoscopic approach.Seventy-two patients(18.0%)received adjuvant chemotherapy and 331 patients(83.0%)received postoperative radiation therapy.The average age was 50.6 years old(range 6-83).Of the 399 patients,57(16.6%)were Kadish stage A,121(35.2%)were Kadish stage B,145(42.2%)were Kadish stage C,and 21(6.1%)were Kadish stage D.Pooled analysis demonstrated that 66.0%of patients had Hyams histologic GradeⅠorⅡ,while 34.0%of patients had GradeⅢorⅣdisease.Negative surgical margins were achieved in 86.9%of patients,and recurrence was identified in 10.3%of patients.Of those with 5-year follow-up,reported overall survival was 91.1%.Conclusion:Exclusively endoscopic surgery for esthesioneuroblastoma is performed for a wide range of disease stages and grades,and the majority of these patients are also treated with adjuvant chemotherapy or radiation therapy.Reported overall recurrence rate is 10.3%and 5-year survival is 91.1%.
文摘Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always be available.One alternative option is a flexible single-layer ASB repair.Initial studies indicate low cerebrospinal fluid leak rates with a single-layer repair.However,the level of frontal lobe support,particularly the propensity for a significant inferior displacement of the frontal lobe,is not known.The goal of this study is to determine the frontal lobe position after single-layer acellular dermal allograft repair in large ASB defects.Study Design:Retrospective cohort study.Setting:Tertiary care medical center.Subjects and Methods:This cohort study compares the frontal lobe position in adults who underwent endoscopic endonasal ASB tumor resection and single-layer cadaveric dermal matrix repair(ASB cohort)with control subjects without intracranial abnormalities(control cohort).The ASB cohort includes subjects with an ASB defect of≥5 cm anterior/posterior and≥1.5 cm wide and who had imaging at least 2 months after surgery.The frontal lobe position is measured on sagittal CT/MRI using a reference line from the base of the sella to the nasion.A value of zero indicates that the inferior-most aspect of the frontal lobe is at the level of the nasion-sellar line.A positive value indicates that the frontal lobe is inferior to the nasion-sellar line.The ASB cohort frontal lobe position is compared with the control cohort using the Mann-WhitneyU test.A priori we set an absolute difference of 5 mm as a clinically significant difference.Results:The ASB cohort includes 47 subjects who are 57%male with an average age of 60 years(range:31-89 years).The most common ASB pathology is esthesioneuroblastoma(n=21)and 81%of the ASB cohort had postoperative radiation.The control cohort includes 20 subjects who are 60%male,with a mean age of 45 years(range:19-74 years).The majority of controls underwent imaging for
