Introduction: The use of surgical resection for large anterior skull base (ASB) tumors and sinonasal malignancies with intracranial extension will result in a large skull base defect. Reconstruction of large ASB defects using traditional techniques is high risk and may lead to postoperative cerebral spinal fluid (CSF) leakage, meningitis, and an increase in mortality rate. The use of a pedicled double flap technique to reconstruct the ASB defect may decrease complications. This study presents the clinical outcomes of patients who underwent double flap reconstruction techniques after resection of their sinonasal malignancies with significant intracranial extension at Cho Ray hospital in Vietnam.
Methods: The case series study was conducted at Cho Ray hospital from September 2010 to September 2020. All patients with large sinonasal malignancies that invaded intracranially underwent transnasal endoscopic surgery and subfrontal craniotomy. Reconstruction of large skull base defects (>2 cm) were followed up by using the pedicled double flaps technique. This study was performed in line with the principles of the Declaration of Helsinki. Approval of the study was granted by the Independent Ethics Committee of Cho Ray Hospital (Date: March 3, 2014/No: 11/BVCRHĐĐĐ).
Results: During September 2010 to September 2020, there were 75 patients who underwent a modified multilayer, double flap reconstruction technique after the resection of their ASB tumor. Skull base defects were commonly seen along the horizontal plate of the ethmoid bone and the ethmoid roof (98.6%). Large skull base defects (>2 cm) accounted for 81.3% of cases. Overall, the risk of postoperative CSF leakage and meningitis after double flap repair was considerably low. Of all participants, only 1 experienced postoperative CSF leakage and 1 experienced postoperative meningitis. Despite the complications, these patients improved significantly and remained stable.
Conclusion: The use of double vascularized pedicled flaps may decrease the incidence of postoperative CSF leakage and meningitis. This technique is an effective method for the reconstruction of ASB tumors with large defects.
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http://dx.doi.org/10.1097/SCS.0000000000008976 | DOI Listing |
J Neurosurg
January 2025
Departments of1Neurological Surgery.
Objective: Tumor consistency, or fibrosity, affects the ability to optimally resect meningiomas, especially with recent trends evolving toward minimally invasive approaches. The authors' team previously validated a practical 5-point scale for intraoperative grading of meningioma consistency. The impact of meningioma consistency on surgical management and outcomes, however, has yet to be explored.
View Article and Find Full Text PDFNeurosurg Rev
January 2025
Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
Stereotactic radiosurgery (SRS) and radiotherapy (SRT) have gained prominence as both adjuvant and primary treatment options for patients with skull base tumors that are either inoperable or present as residual or recurrent lesions post-surgery. The object of the current study is to evaluate the safety and efficacy of robotic-assisted SRS and SRT across various skull base pathologies. The study was conducted under PRISMA guidelines and involved a comprehensive evaluation of databases, including PubMed, Scopus, Embase, Web-of-Science, and the Cochrane Library.
View Article and Find Full Text PDFOtolaryngol Head Neck Surg
January 2025
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
Objective: To validate the use of neural radiance fields (NeRF), a state-of-the-art computer vision technique, for rapid, high-fidelity 3-dimensional (3D) reconstruction in endoscopic sinus surgery (ESS).
Study Design: An experimental cadaveric pilot study.
Setting: Academic medical center.
Laryngoscope
January 2025
Department of Otology and Skull Base Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
Objective: Endolymphatic sac tumors (ELSTs), as rare low-grade neoplasms, are primarily treated with surgery. This study analyzes the characteristics of tumor-infiltrating leukocytes (TILs) in ELSTs and their relationships with clinical features to explore the potential for immunotherapy in ELSTs.
Methods: Clinical data and tumor specimens of 10 ELSTs patients who underwent surgery were retrieved.
Cureus
December 2024
Department of Ophthalmology, Hospital University Kebangsaan Malaysia, Kuala Lumpur, MYS.
We report a rare case of a missed intracavernous internal carotid artery dissecting aneurysm occurring as a complication of the base of skull fracture with severe brain injury causing acute cavernous sinus syndrome with permanent vision loss. A 31-year-old Myanmar lady had an alleged motor vehicle accident and suffered severe traumatic brain injury with multiple intracranial bleeds, multiple facial bone and base of skull fractures, and limb fractures. At one week post-trauma, she had severe right eye proptosis with vision loss, ophthalmoplegia, chemosis, and high intraocular pressure.
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