Lateral cervical approach for resection of cervical dumbbell-shape neurogenic tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To study the indication and character of the lateral-cervical approach for treating dumble-shape neurogenic tumors in cervical spine.</p><p><b>METHODS</b>Retrospectively review the clinical data of 14 dumble-shape neurogenic tumors in cervical spine, from October 2005 to October 2011. Among them 8 were males and 6 were females, range from 11 to 60 years old. The maximum tumor diameter range from 3.0 to 8.0 cm, with an average of 4.8 cm; the intraspinal tumor diameter range from 1.3 to 3.8 cm, with an average of 2.1 cm. According to Asazuma classification, 9 cases were type IIc, 2 cases were type IIIb, 2 cases were type IV, 1 case was type VI. Involving the neck segment C(1)-C(2) in 1 case, C(2)-C(3) in 1 case, C(3)-C(4) in 2 cases, C(4)-C(5) in 2 cases, C(5)-C(6) in 3 cases, C(6)-C(7) in 4 cases and C(2)-C(4) in 1 case. All cases performed surgery with general anethesia. The head and neck surgeon performed surgery with lateral cervical approach, in the space between the anterior and the medius scalenus, exposed the transverse process and the intervertebral foramen as the anatomy marker, resected the extraspinal tumor part. The neurosurgery expanded the intervertebral foramen, and resected the intraspinal tumor with microscope, and repaired the dura. Then head and neck surgeon closed the wounds.</p><p><b>RESULTS</b>Pathology proved 3 neurolimmoas and 11 Schwannomas, 12 cases received gross total resection, 2 cases received subtotal resection, the average blood loss during operation was 292 ml, the average operation time was 129 minutes, the average stay in hospital days was 7.1 days. The vertebral artery were exposed in 2 cases, and no vertebral artery injury occurred, there were 3 cases dissect the cervical nerve roots. No cerebrospinal fluid leakage, hematoma, newly branchial plexus injury, sympathic nerve injury or tracheal edema occurred. In 3 to 24 months, with an average of 13.5 months follow-up period, 2 cases with subtotal resection had no tumor progression, and 12 cases with gross total resection had no tumor recurrence.</p><p><b>CONCLUSIONS</b>Lateral-cervical approach is minimal invasive, easily to perform and recovery fine. It can be adopt for Asazuma type IIc, IIIb and IV tumors which not grow over the midline in spine and expand to deep layer of the deep cervical fascia out spine.</p>

Free tissue transfer for skull base reconstruction of advanced oncological defects / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the results and the indications of free flaps in the skull base reconstruction.</p><p><b>METHODS</b>A retrospective review was performed of 25 free flaps reconstructions for skull base tumor ablation defects between March of 1999 and March of 2009. There were 9 latissimus dorsi flaps, 6 rectus abdominis flaps, 4 deep inferior epigastric artery perforator flaps, 3 anterolateral thigh flaps, 2 radial forearm flaps and 1 fibular flap. The defects were classified as cranial bone (100%), dura (40%), brain (12%), sino-nasal cavity (52%), mucosa (56%) and skin (80%).</p><p><b>RESULTS</b>Twenty-three of 25(92%) free flaps survived. One total flap failure and 1 partial flap failure occurred. Five patients (20%) had central nervous system related postoperative complications which including 1 mortality, 2 central nerve system infection and 2 cerebrospinal fluid fistula.</p><p><b>CONCLUSIONS</b>Free flaps transfer is a reliable reconstruction technique for cranial base surgery. This provides a solution to the select advances disease otherwise surgical contraindications. Free flap is the choice for reconstruction of advanced oncological defects, especially when skin and mucosa are violated.</p>

Cooperation management by head and neck surgery and neurosurgery for skull base tumors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To present the experience and advantage of cooperation management by head and neck surgery and neurosurgery for communicating skull base tumors.</p><p><b>METHODS</b>A review of 54 communicating skull base tumors (benign tumor 21, malignant tumor 33) cooperation resection by head and neck surgery and neurosurgery from July 2005 to July 2008 in the Cancer Hospital of Chinese Academy of Medical Sciences was presented. The tumor originated in the anterior skull base in 19 cases, originated in the lateral skull base in 12, in the central skull base in 17, and in the posterior skull base in 6.</p><p><b>RESULTS</b>All procedures were conducted in a single stage by a multidisciplinary team. Total resection of tumor was achieved in 45 cases, and subtotal resection was achieved in 9. There was no operative death. There were 2 cases postoperative hemorrhage. All cases except 3 were followed up with a period of 8 to 43 months (median, 19.1 months for benign tumor and 21.0 months for malignant tumor). Three patients with malignant tumor were lost. Twelve cases of malignant tumor and one case of benign tumor recurred postoperatively. Nine patients with malignant tumor had died (one of these died from heart trouble). Three-year disease-free survival rates and overall survival rates of malignant tumor were 52.7% and 53.0%, respectively.</p><p><b>CONCLUSIONS</b>It suggested that a special operative team constituted of head and neck surgeon and neurosurgeon may improve the outcome of the difficult skull base tumors.</p>