The considerable diversity in middle cranial fossa (MCF) structures and the inadequacy of established surgical references significantly impact the surgical management of vestibular schwannomas, resulting in a higher chance of complications. Our contention is that cranial morphology has an impact on the MCF's form, the temporal bone pyramid's angle, and the comparative positioning of the internal acoustic canal. Through the application of photo-modeling, dissection, and three-dimensional analysis, the skull base structures were investigated in the context of 54 embalmed cadavers and 60 magnetic resonance images of the head and neck. Employing cranial index as a criterion, the specimens were divided into three groups – dolichocephalic, mesocephalic, and brachycephalic – for a comparative study of variables. The brachycephalic group exhibited the largest measurements for the superior border of the temporal pyramid (SB), the apex to squama separation, and the width of the MCF. The angle subtended by the SB axis and the acoustic canal's axis ranged from 33 to 58 degrees, achieving its maximum within the dolichocephalic group and displaying its smallest value in the brachycephalic one. The angle between the pyramid and the squama exhibited a reversed distribution, prominently featuring in the brachycephalic group. Shape of the MCF, temporal pyramid, and IAC is a consequence of cranial phenotype expression. Data from this article empowers specialists to locate the IAC in vestibular schwannoma cases, relying on the distinctive anatomical features of each individual skull.
Within the nasal cavity and paranasal sinuses, a variety of malignant tumors exist, with adenoid cystic carcinoma (ACC), a cancer originating from salivary glands, being quite prevalent. The histological source of such tumors definitively prohibits their primary presence inside the skull cavity. This study's objective is to report cases of intracranial ACC, unaccompanied by any other primary tumors, after a comprehensive and exhaustive diagnostic process. A multifaceted approach encompassing electronic medical record review and manual searching was deployed to locate cases of intracranial arteriovenous malformations (AVMs), treated at the Endoscopic Skull Base Centre Athens, Hygeia Hospital, Athens, between 2010 and 2021. All cases included in the study had a minimum follow-up period of three years. Patients were selected if a thorough diagnostic assessment unearthed no evidence of a primary nasal or paranasal sinus tumor and no extension of the ACC. Every patient's course of treatment encompassed endoscopic surgical procedures carried out by the senior author, which were then complemented by radiotherapy (RT) and/or chemotherapy. Illustrative cases of arteriovenous malformations (AVMs) were identified in three distinct anatomical locations: one involving the clivus, another the cavernous sinus, and a third the pterygopalatine fossa; one further case showcased orbital AVMs with involvement of both the pterygopalatine fossa and the cavernous sinus; and a final case exemplified cavernous sinus AVMs extending into Meckel's cave and the foramen rotundum. Subsequently, each patient underwent radiation therapy with either a proton or carbon-ion beam. The exceedingly rare clinical entity of primary intracranial ACCs presents uniquely, demanding careful diagnostic evaluations and sophisticated management approaches. The development of an international web-based database, encompassing detailed tumor reports, would be highly advantageous.
A significantly rare and challenging form of sinonasal malignancy, sinonasal mucosal melanoma (SNMM), often indicates a poor prognosis. Complete surgical resection is the standard intervention, however, the inclusion of adjuvant therapy remains a point of contention. In essence, our knowledge of this condition's clinical presentation, its development, and the optimal treatment options remains inadequate, and progress in improving its management has been slow in recent years. selleck chemicals llc Our international, multicenter, retrospective review encompassed 505 SNMM cases, gathered from 11 institutions across the United States, the United Kingdom, Ireland, and continental Europe. Data regarding clinical presentation, diagnosis, treatment, and subsequent clinical outcomes were examined. Recurrence-free survival at one, three, and five years reached 614%, 306%, and 220%, respectively. Concurrently, overall survival was 776%, 492%, and 383%, respectively. In contrast to diseases restricted to the nasal passages, involvement of the sinuses is associated with markedly reduced survival rates; consequently, the stratification of T3 stage proved highly predictive (p < 0.0001), suggesting a possible need to adjust the current TNM staging system. A statistically significant survival advantage was seen in patients who underwent adjuvant radiotherapy, contrasted with those having surgery alone; the hazard ratio [HR] was 0.74, with a 95% confidence interval [CI] of 0.57-0.96 and a p-value of 0.0021. Longer survival times were observed in patients with recurrent or persistent disease, with or without distant metastasis, treated with immune checkpoint blockade (hazard ratio=0.50, 95% confidence interval=0.25-1.00, p=0.0036). The presented conclusions stem from the most extensive SNMM cohort analysis to date. This study demonstrates the possible usefulness of stratifying T3 stage according to sinus involvement, and promising data emerges concerning immune checkpoint inhibitors for treating recurring, persistent, or metastatic disease, with important implications for designing future clinical studies.
Surgical interventions on ventral and ventrolateral craniocervical junction lesions present some of the most daunting neurosurgical challenges. The far lateral approach (and its variations), the anterolateral approach, and the endoscopic far medial approach constitute three surgical methods for approaching and removing lesions in this zone. Examining the surgical anatomy of three craniocervical junction skull base approaches, and reviewing associated surgical cases, this study will elucidate indications and potential complications of each method. In each of the three surgical approaches, standard microsurgical and endoscopic instruments were utilized for the cadaveric dissections. Key surgical steps and the relevant anatomy were meticulously recorded. This report details six patients with meticulously collected pre-, intra-, and postoperative imaging and video documentation, followed by a comprehensive discussion. fee-for-service medicine From our institutional perspective, all three strategies are demonstrably safe and effective when applied to a substantial range of neoplastic and vascular disorders. For selecting the optimal approach, it is imperative to analyze unique anatomical characteristics, the shape and size of the lesion, and the complexities of tumor biology. By preoperatively assessing surgical corridors through 3D visualizations, the most effective surgical path can be defined. A full 360-degree perspective of the craniovertebral junction's anatomy is essential for executing a secure surgical strategy for treating ventral and ventrolateral lesions, with one of three access points.
Employing a minimally invasive strategy, the endoscopic-assisted supraorbital approach (eSOA) is used to extract anterior skull base meningiomas (ASBMs). This study, a large, retrospective, and long-term evaluation from a single institution, examines eSOA for ASBM resection, further elucidating its indications, surgical nuances, potential complications, and ultimate outcomes. Our investigation, encompassing a 22-year period, focused on the data of 176 patients having ASBM surgery done through the eSOA. Assessment of meningiomas included those located in the tuberculum sellae (65 cases), anterior clinoid (36), olfactory groove (28), planum sphenoidale (27), lesser sphenoid wing (11), optic sheath (7), and lateral orbitary roof (2). Urban biometeorology Meningioma surgery demonstrated a median duration of 335142 hours, with a significant extension in the case of olfactory groove (OG) and anterior cranial fossa (AC) meningiomas (p < 0.05). The goal of complete resection was reached in 91% of the patients treated. Procedure-related complications included hyposmia (74% prevalence), supraorbital hypoesthesia (51%), cerebrospinal fluid fistula (5%), orbicularis oculi paresis (28%), visual disturbances (22%), meningitis (17%), and a combined hematoma and wound infection rate of 11%. One patient's untimely demise was attributed to an intraoperative carotid injury, whereas another patient died due to a pulmonary embolism. A median observation period of 48 years demonstrated a tumor recurrence rate of 108%. Twelve cases required a second surgical procedure (10 through the previous SOA and 2 through the pterional approach), in contrast to two cases that received radiotherapy and five that adopted a wait-and-see strategy. Long-term disease control and high rates of complete resection are characteristic of the eSOA approach to ASBM resection. Neuroendoscopy is indispensable for improving the outcome of tumor resection, thereby lessening the extent of brain and optic nerve retraction. Limited surgical maneuverability within the small craniotomy, especially when encountering extensive or firmly attached lesions, may result in prolonged surgical duration and present potential limitations.
The Model for End-stage Liver Disease-Sodium (MELD-Na) score, designed for the prognosis of chronic liver disease, has proven predictive of outcomes across diverse procedures. Otolaryngology's utilization of this concept has seen limited study. This study aims to investigate the association between liver health, determined by the MELD-Na score, and the risk of complications during ventral skull base surgical procedures. Data from the National Surgical Quality Improvement Program database facilitated the identification of patients who had ventral skull base procedures performed between 2005 and 2015. To determine if there is an association between elevated MELD-Na scores and postoperative complications, univariate and multivariate analyses were applied. Laboratory values for MELD-Na score calculation were available for 1077 patients undergoing ventral skull base surgery.