Perfusion-weighted imaging in vestibular schwannoma: the influence that cystic status and tumor size have on perfusion profiles / Perfusão por ressonância magnética em schwannoma vestibular: influência do tamanho e estádio cístico no perfil da perfusão

Abstract Objective: The perfusion profile of vestibular schwannomas (VSs) and the factors that influence it have yet to be determined. Materials and Methods: Twenty patients with sporadic VS were analyzed by calculating parameters related to the extravascular extracellular space (EES)—the volume transfer constant between a vessel and the EES (Ktrans); the EES volume per unit of tissue volume (Ve); and the rate transfer constant between EES and blood plasma (Kep)—as well as the relative cerebral blood volume (rCBV), and by correlating those parameters with the size of the tumor and its structure (solid, cystic, or heterogeneous). Results: Although Ktrans, Ve, and Kep were measurable in all tumors, rCBV was measurable only in large tumors. We detected a positive correlation between Ktrans and rCBV (r = 0.62, p = 0.031), a negative correlation between Ve and Kep (r = -0.51, p = 0.021), and a positive correlation between Ktrans and Ve only in solid VSs (r = 0.64, p = 0.048). Comparing the means for small and large VSs, we found that the former showed lower Ktrans (0.13 vs. 0.029, p < 0.001), higher Kep (0.68 vs. 0.46, p = 0.037), and lower Ve (0.45 vs. 0.83, p < 0.001). The mean Ktrans was lower in the cystic portions of cystic VSs than in their solid portions (0.14 vs. 0.32, p < 0.001), as was the mean Ve (0.37 vs. 0.78, p < 0.001). There were positive correlations between the solid and cystic portions for Ktrans (r = 0.71, p = 0.048) and Kep (r = 0.74, p = 0.037). Conclusion: In VS, tumor size appears to be consistently associated with perfusion values. In cystic VS, the cystic portions seem to have lower Ktrans and Ve than do the solid portions.

Resumo Objetivo: O perfil de perfusão do schwannoma vestibular (SV) não tem sido estudado, nem os fatores que o influenciam. Materiais e Métodos: Vinte pacientes com SV esporádico foram analisados usando Ktrans, Ve, Kep e rCBV e correlacionados com tamanho e estádio cístico. Resultados: Ktrans, Ve e Kep foram medidos em todos os casos. rCBV só foi possível em tumores grandes. Ktrans e rCBV estavam correlacionados positivamente (r = 0,62, p = 0, 0 31 ) . Ve e Kep estavam negativamente correlacionados (r = -0,51, p = 0,021). Ktrans estava correlacionado positivamente com Ve em SVs sólidos (r = 0,64, p = 0,048). Em SVs pequenos, Ktrans foi menor (0,13 vs 0,029, p < 0,001), Kep foi maior (0,68 vs 0,46, p = 0,037) e Ve foi menor (0,45 vs 0,83, p < 0,001) que nos SVs grandes. Ktrans e Ve foram menores dentro dos cistos que nas porções solidas dos SVs císticos (0,14 vs 0,32, p < 0,001; 0,37 vs 0,78, p < 0.001, respectivamente). Foi encontrada correlação positiva em Ktrans (r = 0,71, p = 0,048) e Kep (r = 0,74, p = 0,037) entre as áreas sólidas e císticas. Conclusão: Nos SVs, o tamanho está consistentemente associado com os valores da perfusão. Nos SVs císticos, as porções císticas parecem ter valores menores de Ktrans e Ve do que nas porções sólidas.

Effect of the multidisciplinary diagnosis and treatment nursing on postoperative psychological state and quality of life in patients with lateral skull base tumor / 中国实用护理杂志

Objective:To explore the application effect of the multidisciplinary diagnosis and treatment nursing in improving postoperative anxiety and depression and quality of life in patients with lateral skull base tumor, so as to provide a constructive template for the multidisciplinary diagnosis and treatment nursing.Methods:This was a prospective cohort study design. A total of 100 patients who underwent lateral skull base tumor surgery in Shandong Second Provincial General Hospital from January 2021 to April 2022 were selected as the research objects. The patients were divided into observation group and control group by random digits table method with 50 cases in each group. The control group was given routine nursing care after operation of lateral skull base tumor and routine follow-up management. The observation group received the multidisciplinary diagnosis and treatment nursing on the basis of the control group. The intervention time was 3 months. The psychological state and quality of life of the two groups before and after intervention were evaluated by Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Short Form Health Questionnaire (SF-36).Results:There was no significant difference in SAS, SDS, and SF-36 scores before intervention between the two groups ( P>0.05). The scores of SAS, SDS and SF-36 after the intervention were (44.58 ± 5.61), (41.66 ± 8.48), (75.66 ± 13.65) points in the observation group, and (50.86 ± 4.91), (45.80 ± 9.32), (68.43 ± 14.34) points in the control group, there were statistically significant differences between the two groups( t values were -5.95, -2.32, 2.58, all P<0.05). Conclusions:The multidisciplinary diagnosis and treatment nursing can significantly improve anxiety, depression and quality of life of patients with lateral skull base tumor after surgery.

Tumores de nariz y senos paranasales en pacientes pediátricos: experiencia de un hospital pediátrico de cuarto nivel en Bogotá, Colombia, 2013-2018 / Nasal and Paranasal Sinus Tumours in the Pediatric Population: Experience from a Pediatric Hospital in Bogotá, Colombia, 2013 ­ 2018

Introducción: los tumores en la cavidad nasal y los senos paranasales son un problema serio en la población pediátrica, principalmente por la inespecificidad de los síntomas que lleva a que pasen de meses a años antes de la sospecha de una patología neoplásica, con un impacto en la calidad de vida del paciente y su entorno. Al sospechar de la presencia de un tumor nasosinusal se requiere la realización de imágenes diagnósticas como la resonancia magnética y la tomografía computarizada de los senos paranasales. Cuando se tiene un diagnóstico etiológico, siempre se debe realizar un abordaje multidisciplinario. Materiales y métodos: realizamos un estudio retrospectivo de corte transversal de la cohorte de pacientes con tumores de nariz y senos paranasales atendidos en un hospital pediátrico de cuarto nivel en Bogotá, Colombia, entre 2013-2018. Resultados: se incluyeron un total de 54 pacientes con tumores malignos y benignos de nariz y senos paranasales, la mayoría fueron hombres con un promedio de edad de ocho años. Generalmente se presentaron con síntomas nasosinusales, el principal fue obstrucción nasal en el 80 % de los pacientes. El diagnóstico mas común fue craneofaringioma en un tercio de los pacientes, seguido por angiofibroma nasofaríngeo y linfoma de Burkitt. Conclusión: es importante conocer los síntomas y características clínicas de los pacientes pediátricos con tumores nasofaríngeos. Por esta razón, se considera importante presentar la casuística y características de los tumores de nariz y senos paranasales recogida durante 5 años, en un hospital pediátrico de cuarto nivel en la ciudad de Bogotá, Colombia

Introduction: Tumors in the nasal cavity and paranasal sinuses in children is a serious problem in the pediatric population, mainly due to the non-specificity of the symptoms that leads to years or months passing before the suspicion of a neoplastic pathology. With an important impact in quality of life not only in the patient but also in its family environment. When suspecting a sinonasal tumor, diagnostic images such as magnetic resonance and computed tomography of the paranasal sinuses are required. When you have an etiological diagnosis always do a multidisciplinary approach. Methods: We conducted a cross-sectional study of the cohort of patients that had been diagnose with tumors of the nasal cavity or paranasal sinuses in a fourth level pediatric hospital in Bogota, Colombia between 2013 - 2018. Results: 54 patients were included, the majority of them were men, with an average age of eight years. They mainly presented with nasal symptoms, the main one being nasal obstruction in 80% of patients. The most common diagnosis was cranipharyngioma in one third of the patients, followed by nasopharyngeal angiofibroma and Burkitt lymphoma. Conclusion: We present this article with the objective of presenting the tumors of nose and paranasal sinuses casuistry collected during 5 years in a fourth level pediatric hospital in the city of Bogotá and the imaging characteristics for the diagnosis of these are reviewed with some clinical cases as examples.

The application of Chinese version of anterior skull base questionnaire (ASBQ) in patients with anterior and middle skull base tumors / 中华耳鼻咽喉头颈外科杂志

Objective@#To develop the Chinese version of anterior skull base questionnaire(ASBQ) and to verify its application in patients with anterior and middle skull base tumors.@*Methods@#The following steps were finished including getting the permission from the author of the original English scale, translating and back-translating, tentative test, discussing the consequence and cultural debugging. From October 2016 to December 2018, 51 patients with skull base tumors from Xuanwu Hospital and China-Japan Friendship Hospital were enrolled as an experimental group, aged from 24 to 70 years old, with 19 males and 32 females, which included 27 patients with anterior skull base tumor and 24 patients with middle skull base tumor. From December 2016 to January 2018, 46 healthy volunteers were selected as a control group, aged from 18 to 36 years old, including 26 females and 20 males. The subjects in the test group and the control group were rigorously tested with official manuscripts and judged whether the manuscript was applicable. The SPSS 22.0 statistical software was used to analyze the data of the test group, the anterior skull base group, the middle skull base group and the control group to evaluate the performance of the scale.@*Results@#Both the rate of the recovery and efficiency in experimental group, anterior skull base group and middle skull base group were 100%, with the average time of completion of (8.7±3.2), (11.2±4.0) and (7.3±2.1) min, respectively in each group. The r value of test-retest reliability was 0.96, 0.99 and 0.97 in experimental group, anterior skull base group and middle skull base group, with the split-half reliability coefficient of 0.91, 0.90 and 0.96, with the entire scale Cronbach′s coefficient of 0.91, 0.95 and 0.93, respectively. The content validity and the construct validity of the scale were good enough, and the criteria validity was-0.483,-0.509 and -0.489 in experimental group, anterior skull base group and middle skull base group. The scale could well distinguish the difference of the quality of life between the preoperative and postoperative patients in experimental group and the middle skull base group. The difference of the quality of life in anterior skull base group was not found between preoperative and postoperative patients.@*Conclusion@#The Chinese version of ASBQ has good reliability and validity, which is suitable for a wide range of Chinese patients with anterior and middle skull base tumors to assess their quality of life.

Extirpation of primary malignancies in the pterygopalatine and infratemporal fossa via modified maxillary swing approach / 中华口腔医学杂志

Five patients with primary malignancies in the pterygopalatine fossa (PPF) and infra temporal fossa (ITF) were enrolled in this retrospective study between January 2012 and January 2018. After malignancies proven by biopsy and evaluation with CT and MRI scan, all patients received modified maxillary swing (MMS) approach for extirpation of malignant tumors in the PPF and ITF under general anesthesia. En bloc resection with wide surgical margins was successfully performed in all cases. Negative margins were observed in 4 cases and positive margins were found in one patient with adenoid cystic carcinoma who received postoperative radiotherapy. The most common complication was facial numbness. During the follow-up period (range 12 to 57 months), one patient suffered from recurrence while others did not. The advantages of MMS include wide surgical field, full exposure and easy manipulation. The MMS approach is expected to become an standard method for monobloc resection of malignancies in the PPF and ITF.

Progress in the application of 3D printing in endoscopic surgery for skull base neoplasms / 肿瘤研究与临床

The location of the skull base neoplasms are very deep, and the operation is unpredictable. The advent of skull base endoscopic technology has opened up a new surgical path for skull base neoplasms, but it also puts forward higher requirements for preoperative real-time images and detailed pathological anatomy. Obviously, traditional imaging techniques cannot keep up with it. 3D printing is a new stereoscopic rendering technology developed in recent years and applied to the medical field. It can seamlessly integrate, transform and reconstruct multi-modal imaging data such as CT/CT angiography/magnetic resonance imaging of patients into a three-dimensional model. The three-dimensional model is not only stereoscopic, intuitive, but also can display the complex anatomy of the skull base neoplasms and its surroundings point-to-point, and it can also be operated under the preoperative simulated endoscopic operation, so that the endoscopic surgery plan of the skull base neoplasms is more personalized and precise. It will undoubtedly further improve the total tumor resection rate and reduce the surgical side injury. This article reviews the application and progress of current 3D printing technologies in the field of endoscopic surgery of skull base neoplasms.

Chordomas: Histopathological Study in View of Anatomical Location

BACKGROUND: Chordomas are aggressive bone tumors that have a predilection for the axial skeleton including the skull base and spinal/sacral bones. However, the histopathological and clinical differences between skull base chordoma (SBC) and sacral/spinal chordoma (SC) are unclear as previous studies have been focused on patient prognosis and treatment outcome. This study aimed to evaluate the clinicopathologic features and prognosis of chordoma according to its location. METHODS: Patients with chordomas were enrolled, and the histopathologic features were compared according to the tumor location. RESULTS: A total of 52 patients were enrolled. SBCs had more abundant chondroid matrix and diffuse growth pattern, while SCs had non-chondroid, myxoid matrix and a lobulating pattern, typical of chordoma. Old age and residual tumors were risk factors for shorter overall survival in SBCs. The chondroid matrix was an independent risk factor for shorter disease-free survival in the overall population. CONCLUSION: Chordomas have different histopathologic features depending on the anatomical location.

Application of three-dimensional printing technology in the surgical treatment of nasal skull base tumor / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the application value of three dimensional (3D) printing technique in the surgical treatment of nasal skull base tumor.@*Methods@#Seven patients with complicated skull base tumors admitted in Department of Otorhinolaryngology Head and Neck Surgery and Department of Neurosurgery of Tianjin HuanHu Hospital from Mar. 2017 to Feb. 2018 were selected. According to three sets of DICOM data of patients obtained from enhanced spiral CT scanning, navigation MRI scanning and CT angiography (CTA) magnetic navigation, data information of skull, blood vessel and tumor were extracted and reconstructed with different segmentation methods. The assembly and integration were achieved in the same coordinate system to form 3D visual composite virtual models. Combined with 3D printing technology, 3D visual composite virtual models were substantialized, and were applied for preoperative surgical strategy making and intraoperative reference.@*Results@#Virtual models of the nasal skull base of 7 patients were reconstructed successfully and 3D 1∶1 entity models were produced. The models demonstrated the relationship among the skull, tumors, and adjacent blood vessels.Seven cases were successfully performed.@*Conclusion@#3D virtual model of composite nasal skull base and its dissection model based on 3D printing technology can guide the medical staff to develop and perfect the operation scheme.

Rare primary proximal epithelioid sarcoma in skull base: clinical analysis of four cases / 中华耳鼻咽喉头颈外科杂志

Objective@#To report the clinical and pathological features of primary proximal epithelioid sarcoma (PES) in skull base.@*Methods@#The clinical and pathological features of four cases of PES in skull base from Sanbo Brain Institute of Capital Medical University and Kunming Sanbo Brain Institute were analysed retrospectively.@*Results@#Three cases was female, and one male, the age ranged from 46 to 52 years.All cases occurred in skull base, and sellar region was the main site of involvement.Under the microscope, the tumor cells characterized by epithelioid cell changes, with or without rhabdoid tumor cells.Mitotic figure was active.Immunohistochemical staining showed that AE1/AE3, EMA and CD34 were variously expression in tumor cells.INI-1 protein was lost in all cases.Three cases were detected by FISH, and INI1 (22q11.2) gene locus was absent in them.Three patients died less than 3 months after surgery, and case 4 was under treatment after five months of surgery.@*Conclusions@#Primary PES in skull base mostly occurs in sellar region and its clinical prognosis is poor.It features with epithelioid/rhabdoid tumor cells with lack granuloma structure as distal ES.It has epithelial and mesenchymal differentiation characteristics.CD34 is always positive.INI1 gene deletion and protein loss expression are characteristic molecular alteration of PES.

El papel de la cirugía endoscópica endonasal en el manejo de tumores malignos de senos paranasales y base del cráneo: Indicaciones, ventajas y limitaciones / The role of endoscopic endonasal surgery in the management of malign sinonasal and skull base tumors: Indications, advantages and limitations

Los recientes avances en el campo de cirugía endoscópica endonasal (CEE) han permitido disminuir la morbilidad de los abordajes abiertos tradicionales, mejorando o al menos igualando los resultados oncológicos y funcionales que hemos visto en estos procedimientos en el manejo de tumores malignos de senos paranasales y base del cráneo. El manejo oncológico de estas patologías complejas se beneficia de un abordaje multidisciplinario, en donde la decisión quirúrgica se basa en el estadio del tumor, localización, histología y relación con estructuras vecinas. La adecuada y cuidadosa selección de pacientes para este tipo de técnicas es esencial para lograr resultados exitosos. Este artículo pretende hacer una revisión narrativa y, exponer las indicaciones que utilizamos en nuestra institución para elegir cada uno de estos abordajes.

Recent advances in the field of endoscopic endonasal surgery (EES) have allowed us to reduce morbidity and to improve the oncological and functional outcomes observed when the traditional open approaches for management of malign sinonasal and skull base tumors are carried out. Oncologic care of these complex pathologies benefits from the inclusion of a multidisciplinary approach where the surgical decision is based on the tumor stage, location, relation with neighboring structures and histology. A careful and adequate patient selection constitutes the key to obtain successful outcomes. The objective of this paper is to perform an narrative review of the current literature and to present the benefits, limitations and the indications of endoscopic approach in our institute.

Paracondylar-lateral cervical approach for resection of jugular foramen schwannomas: a retrospective analysis of 15 cases / 中华外科杂志

Objective@#To explore the effects of paracondylar-lateral cervical approach for resection of the jugular foramen schwannoma(JFS).@*Methods@#A total of 15 patients with JFS operated via the paracondylar-lateral cervical approach between December 2011 and March 2016 at Department of Neurosurgery in Xiangya Hospital of Central South University were retrospectively analyzed. There were 7 males and 8 females, aging from 22 to 77 years with a mean age of (41.9±15.8) years.There were 12 patients who accepted primary surgery, 3 patients who accepted secondary surgery. There were 10 patients with tinnitus or hearing loss, 8 patients with dysphagia, 9 patients with hoarseness, 7 patients with tongue hemiparesis, 8 patients with ataxia, 1 patient with Pyramidal signs, 2 patients with facial hypesthesia or pain, 1 patient with facial paresis. According to Samii JFS grading system, 2 patients were type B, 4 were type C and 9 were type D. All patients were followed-up through outpatient and telephone by MRI in 3, 9, 12 months postoperation.@*Results@#Gross total removal of tumors were achieved in 14 patients and subtotal removal in 1 patient. Two patients had new hoarseness, 2 had new dysphagia and 3 had more serious dysphagia, 1 patient had more serious facial paresis after the operation. There were 2 patients with intracranial infection, 2 with pneumonia, 1 with subcutaneous effusion, 1 with cerebrospinal fluid rhinorrhea, 5 with gastric intubation during perioperative period. There were no death, intracranial hematoma and decreased hearing patients. All patients were followed up, the follow-up time were 3 to 33 months with a mean of (26.9±11.2) months. Till to the latest follow up, dysphagia improved in 2 cases, hoarseness and tongue hemiparesis improved in 3 cases, hearing loss and tinnitus improved in 9 cases, balance function improved in 7 cases, facial hypesthesia and pain improved in 2 cases, pyramidal signs disappeared in 1 case, facial nerve function improved to normal in 1 case. There was no recurrence and progressed case.@*Conclusion@#Paracondylar-lateral cervical approach is an alternative approach for both intracranial and extracranial JFS.

Endoscopic transmaxillary approach in resection of lateral skull base tumor / 肿瘤研究与临床

The resection of lateral skull base tumour has always been a crucial and difficult aspect of skull base surgery.Its operation development has experienced several evolutionary phases,including unaided eye-surgery which could result in huge trauma,microsurgery and completely endoscopic surgery.At present,the endoscopic technique known for its panoramic visibility,minimal invasion and extensive scope of operation,has opened up a brand new perspective for the lateral skull base tumour surgery.Currently,the approach of lateral skull base tumour endoscopic surgery can be generalized as endoscopic transmaxillary approach (ETA).And based on different pathways and methods to expose the maxillary sinus,ETAs can be divided into three,endonasal transmaxillary approach(ENTA),endoscopic sublabial transmaxillary approach (ESTA) and combined approach,while ENTA includes ipsilateral endonasal transmaxillary approach (IENTA),prelacrimal recess approach (PRA),contralateral endonasal transseptal approach (CENTA) and transnasal Denker approach.In this paper,on the basis of the summarization of ETAs related historical evolution,anatomical studys and clinical researches,the merit and demerit of all sorts of ETAs are compared and analyzed.We hope this review could act as a reference for selecting the personalized endoscopic surgery approach of lateral skull base tumour.

A clinical experience of endoscopic treatment for benign and malignant tumors of skull base / 天津医药

Objective To summarize the surgical skills and experience of skull base surgery by endoscopic treatment. Methods A total of 8 cases with benign and malignant tumors were treated in our hospital from August 2014 to December 2016, including orbital region, sellar region, clivus, pterygopalatine fossa and infratemporal fossa. The endoscopic endonasal surgery involved optic nerve decompression, internal carotid artery, treatment of middle skull base and clivus dura tumors, opening of pterygopalatine fossa and infratemporal fossa. The anti infection and anti inflammation treatment of the dura and the internal carotid artery and the treatment of the complications such as diplopia, vision decrease, and the adjustment of pituitary hormones were given to patients after operation. Results The visual of a patient with fungal sinusitis recovered from no light perception to "finger/1 m" at one week after surgery. One of the patients with pituitary tumor underwent unilateral eyeball abduction limitation. The symptoms disappeared after one week treatment. Insipidus occurred in 1 patient with invasive pituitary adenoma, after symptomatic treatment for half a month, urine volume and specific gravity tend to normal. Two patients with adenoid cystic carcinoma underwent enhanced MRI examination at 10 days, 3 months and 1 year after operation, both achieved total resection and no local recurrence. The patient with nasopharyngeal carcinoma reached total resection after operation, and showed no local recurrence after six-month follow-up. All the 8 patients achieved complete resection in one stage, without any serious complication after operation. Conclusion Endoscopic endonasal surgery is an important method for the treatment of tumour in anterior skull base, which needs extensive surgical experience and cooperation with other clinical departments.

A Case of Giant Skull Base Chondroma

Intracranial chondroma is a rare benign tumor. Here, we present the case of a 29-year-old female who was afflicted with left eye blindness and ptosis. Brain computerized tomography and magnetic resonance imaging revealed the presence of a giant calcified mass accompanied by a solid mass in the middle and posterior fossa. A differential diagnosis regarding chordoma, chondrosarcoma, and other chondroid tumors based on radiologic information was inconclusive. The lesion was resected completely under a microscope using a combined pterional and subtemporal approach. The pathologic report confirmed the diagnosis of chondroma. No evidence of neurological worsening was observed. The tumor had a calcified mass with mature hyaline cartilage surrounded by a thick fibrous capsule. We dissected the periphery of the tumor mass and removed it via aspiration. It was readily distinguished from normal brain parenchymal tissue. The large calcified mass at the center of the tumor had relatively high vascularity, and a high-speed drill and various rongeurs were used to remove the tumor.

Clival lesion incidentally discovered on cone-beam computed tomography: A case report and review of the literature

An osteolytic lesion with a small central area of mineralization and sclerotic borders was discovered incidentally in the clivus on the cone-beam computed tomography (CBCT) of a 27-year-old male patient. This benign appearance indicated a primary differential diagnosis of non-aggressive lesions such as fibro-osseous lesions and arrested pneumatization. Further, on magnetic resonance imaging (MRI), the lesion showed a homogenously low T1 signal intensity with mild internal enhancement after post-gadolinium and a heterogeneous T2 signal intensity. These signal characteristics might be attributed to the fibrous tissues, chondroid matrix, calcific material, or cystic component of the lesion; thus, chondroblastoma and chondromyxoid fibroma were added to the differential diagnosis. Although this report was limited by the lack of final diagnosis and the patient lost to follow-up, the incidental skull base finding would be important for interpreting the entire volume of CBCT by a qualified oral and maxillofacial radiologist.

Osteocondroma solitário intracraniano: relato de caso e revisão da literatura / Intracranial solitary ostheochondroma: case report and literature review

Osteocondromas são neoplasias relativamente raras que podem comprometer o espaço intracraniano. Geralmente estão localizadas na base do crânio em decorrência de sua origem proveniente das sincondroses da base do crânio. Deve-se suspeitar do diagnóstico em pacientes com sintomas de hipertensão intracraniana associados à lesão calcificada que apresente áreas de hipo e hiperdensidade à tomografia computadorizada de crânio.

Osteochondromas are relative rare tumors involving the intracranial space. When present, they are often localized at the skull base because their origin generally comes from the synchondrosis of the skull base. We must suspect the presence of an osteochondroma whenever a patient presents symptoms of high intracranial pressure associated with a calcified mass, which is seen as a high and low density image at the CT scan.

The neuroendoscope-assisted surgical treatment of communicating tumors on anterior skull base:report of 19 cases / 中国医师进修杂志

Objective To investigate the clinical effects of communicating tumors on anterior skull base with neuroendoscope-assisted surgery. Methods Nineteen eases of crani-nosel and crani-orbital nosel communicating tumors underwent the combined craniofacial approach. The defect of anterior skull base was repaired with the compound flap with pedicel frontal galea muscle and temporalis myofascial flap.Results All 19 patients were successfully treated without CSF leak and cranial infection. The tumor total re-section rate was 78.9%, subtotal resection rate was 15.8% ,partial resection rate was 5.3%. Four patients of benign tumor were survival,15 patients of malignant tumor 2- year survival was 11, 3-year survival was 8,above 5- year survival was 6. Conclusion The neuroendoscope-assisted combined craniofacial approach can provide a relatively safe and effective resection for communicating tumors on anterior skull base,and has better clinicall value.

Comparison between SPECT and MRI in detecting skull-base invasion in nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective To investigate the ability of single photon emission computed tomography (SPECT) and MRI in detecting skull-base invasion in nasopharyngeal carcinoma. Methods Sixty-one patients with nasopharyngeal carcinoma received whole body and skull-base tomography SPECT, and nasopharynx and skull-base MRI before radiotherapy. The results were double-blind compared and evaluated. Results The overall positive rates of skull-base invasion detected by SPECT and MRI were 51% and 46% (P=0.508). In paitents with headache, cranial nerve palsy or both, the rates were 83% and 86% (P=1.000) ,80% and 80% (P=1.000), 88% and 94% (P=1.000), respectively. In patients with T1+T2 and T3+T4lesions,the rates were 22% and 0(P=0.031) ,74% and 82% (P=0.250) ,repectively. In patients with N0+N1and N2+N3lesions,they were 50% and 48% (P=1.000) ,53% and 40% (P=0.500) ,respectively. The conformation rate between SPECT and MRI was 85%. Binary Logistic regression analysis showed that T stage was a risk factor for positive SPECT(χ2=4.23,P=0.040, OR=3.04). Headache tended to be a risk factor for both positive SPECT and positive MRI (χ2=3.13, P=0.077, OR=4.54;χ2=3.64,P=0.056,OR=12.00). Conclusions The detection sensitivity of SPECT in skull-base invasion in nasopharyngeal carcinoma is equivalent to that of MRI. The consistency between SPECT and MRI is good. Moreover, there is a good correlation between SPECT and symptoms, signs and stage. SPECT of skullbase tomography is necessary for patients with severe headache, negative CT and those who can not receive MRI. When SPECT result is positive,skull-base should be considered to be invaded and should be defined as gross tumor volume in radiotherapy planning.

Endoscopic surgery in nasal-skull base tumor / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the efficacy and feasibility of endoscopic surgery to manage the tumors involving naso-ethmoidal complex and anterior skull base.METHODS 19 cases of tumors involving nasal cavity,ethmoid sinus and anterior skull base were summarized retrospectively, including 3 cases of ethmoidal squamous carcinoma, 3 cases of esthesioneuroblastoma,3 cases of melanoma,1 case of plasmocytoma,2 cases of ethmoidal adenocarcinoma,4 cases of adenoid cystic carcinoma,2 cases of meningioma.RESULTS Tumors were totally removed in 18 cases and subtotally removed in 1 case,all the cases were followed up for 1 to 3 years.Of the 3 cases of melanoma,1 case died of brain metastases 1 year after surgery,1 case recurred 8 months after surgery,1 case of adenoid cystic carcinoma recurred 17 months after surgery.No recurrence were found in the rest 16 cases during 1-3 years of following-up.CONCLUSION Endoscopic surgery is a effective method for malignant tumors localized in nasal cavity and ethmoid sinus and benign anterior skull base tumors involving nasal cavity and sinuses.Indication must be carefully selected for malignant tumors and postoperative radiotherapy should be advised.

Initiation of Endolymphatic Hydrops after Resection of the Endolymphatic Duct / 대한이비인후과학회지

While data from animal models have shown endolymphatic hydrops to be developed following the obstruction of the endolymphatic duct, such connection has not yet been established in humans. This study reports on a case of hearing loss at low frequencies, tinnitus and aural fullness after removal of a clival oculomotor schwannoma via retrolabyrinthine approach that included resection of the endolymphatic duct. Commencement of a low salt diet and diuretic medication resulted in almost complete recovery of hearing, although some subtle tinnitus and aural fullness persisted. The clinical outcome supports the appearance of this case to be an evidence of initiation of endolymphatic hydrops due to resection of the endolymphatic duct.