Pediatric Skull Base Tumors

Management of pediatric skull base tumors requires a multi-disciplinary team that integrates advances in neuro-imaging, radiation, medical and surgical treatments, and allied therapies. Tumors of the skull base harbor complex genetic and molecular signatures that have major implications on prognosis and quality of life. Individualized management requires a strong inter-disciplinary alliance amongst practitioners, as well as a strong therapeutic alliance with the patient and family to navigate the complex decision-making process of treatments. In this chapter, we present our experience managing surgical lesions of the pediatric skull base. General considerations to tumor pathology genetics and radiobiology, diagnostic imaging, rehabilitation of cranial neuropathies and cognitive function, surgical anatomy and reconstructive options, and quality of life should be applied to each case. We also present location- and tumor-specific considerations in the anterior, middle, and posterior fossa skull base with a focus on surgical approaches and complication avoidance. Special consideration is given to syndromic tumors, particularly those from neurofibromatosis type 2 (NF-2). Tumors can exist in multiple cranial compartments and as such some redundancy in concepts is unavoidable. Nevertheless, each patient presents with a unique clinical picture and tumor behavior. Knowledge and proficiency in skull base approaches is a necessary tool in every pediatric neurosurgeon’s armamentarium

Endoscopic assisted surgery of posterior skull base. Analysis of the advantages

Zusammenfassung (Schlussfolgerungen) Objektiv: Zur Durchführung einer Risikobewertung der endoskopgestützten Mikrochirurgie mittels transkranieller Ansätze für posteriore Fossa-Läsionen Methoden: Wir haben 85 Patienten untersucht, die eine endoskopassistierte Chirurgie für verschiedene Pathologien der hinteren Fossa durch transkranielle Ansätze von Februar 2010 bis März 2015 in unserer Abteilung durchgeführt haben. Retrospektiv analysierten wir die Patientendiagramme, Betriebsberichte, prä- und postoperative Bildgebung, intraoperative Videoaufnahmen, ICU-Charts und Follow-up-Daten.Wir konzentrierten uns insbesondere auf Morbidität und Mortalität durch das endoskopische Verfahren. Alle Operationen wurden mit dem Mikroskop (Pentero OPMI, Karl Zeiss, Oberkochen) und dem starren Endoskop (0 °, 30 °, 45 ° Optik, Karl Storz, Tuttlingen) durchgeführt. Die Winkeloptik wurde immer unter direkter mikroskopischer Kontrolle eingeführt. Kontinuierliche intraoperative Neuromonitoring ist Standard in unserer Abteilung für Verfahren in der hinteren Fossa. Ergebnisse: Das mittlere Alter der Patienten betrug 47,24 ± 13,99 Jahre; 48 Frauen, 37 Männer. Die behandelten Pathologien waren: Vestibuläres Schwannom (40), Epidermoidzyste (17), Aneurysma der hinteren Zirkulation (6), Chordom (1), Chondrosarkom (1), Meningiom (3), Trigeminusneuralgie (6), Trigeminusganglionentzündung (1), Hirnstammgliom (1), Liqur-Fistel (1), Foramen magnum Läsion (2), Hemifacialer Spasmus (1), Trigeminusneurinom (1), Ventrikels Ependymom (3), Hirnstammkavernom (1), Vagusneurinom (1). Wir operierten durch die folgenden Ansätze: laterales suboccipital (72 Fälle), medianes suboccipital (8 Fälle), pterional (3cases), weit lateral (1 Fall), subtemporal (1 Fall). Komplikationen: 22 Fälle von Hirnnervenverletzung: 1 Fall von Dysphagie, 1 Fall von Abducens-Lähmung, 1 Fall von Trochlear-Lähmung, 19 Fälle von Gesichts-Lähmung. Alle Defizite waren vorübergehend und in der Follow-up neben der Trochlea-Verletzung und einem Fall von Gesichtslähmung, die ein Suralis-Transplantat benötigt. Darüber hinaus haben wir 2 Fälle von postoperativen Infektionen, 4 Fälle von CSF Fistel, 1 Fall von Gefäßbeleidigung (PICA Beleidigung). Die Sterblichkeit war Null. Hinsichtlich der Verwendung des Endoskops trat keine thermische KN-Verletzung auf. In einem Fall wurde der Trochlearisnerv mechanisch durch das Endoskop verletzt. Schlussfolgerung: Das Endoskop hilft, versteckte Bereiche der hinteren Schädel-Grube zu erforschen, die das Bohren und das Zurückziehen der neurovaskulären und Gehirnstrukturen minimieren. Die Verwendung des Endoskops zusätzlich zum Mikroskop ermöglicht eine sicherere Operation in der hinteren Fossa auch bei Läsionen nicht sichtbar in einer geraden Linie mit der mikroskopischen Ansicht. Die Risiken durch Einführen des Endoskops unter mikroskopische Führung sind minimal. Wir erwarten, dass neue Fortschritte bei den endoskopischen Instrumenten eine Verbesserung der endoskopisch-assistierten Chirurgie ermöglichen werden

Endoscopy

Endoscopy is a fast moving field, and new techniques are continuously emerging. In recent decades, endoscopy has evolved and branched out from a diagnostic modality to enhanced video and computer assisting imaging with impressive interventional capabilities. The modern endoscopy has seen advances not only in types of endoscopes available, but also in types of interventions amenable to the endoscopic approach. To date, there are a lot more developments that are being trialed. Modern endoscopic equipment provides physicians with the benefit of many technical advances. Endoscopy is an effective and safe procedure even in special populations including pediatric patients and renal transplant patients. It serves as the tool for diagnosis and therapeutic interventions of many organs including gastrointestinal tract, head and neck, urinary tract and others

ICAR: endoscopic skull‐base surgery

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Visor Osteotomy of the Anterior Mandible

Current techniques for three-dimensional correction of the chin in patients with mandibular retrusion may increase mentolabial fold depth, but have limited effect on the lips. The authors present a single surgical technique to support the mentolabial fold and improve labial competence. The visor osteotomy is performed from canine to canine. The bone fragment pedicled to the lingual periosteum is coronally mobilized and fixed in the new position. Preserved vascularization is supposed to minimize the amount of bone resorbed. Visor osteotomy of the anterior mandible may improve the existing treatments for micrognathia by creating an aesthetic mentolabial fold and a competent lip seal

Pituitary Adenomas

Pituitary Adenomas is a comprehensive book about the most common pathology of the pituitary gland in the sellar region. The book chapters include epidemiology, symptoms and signs, clinical, imaging, immunohistochemical and ultrastructural pathological diagnosis, therapeutic approaches and outcome of the functional and non-functional pituitary tumors. Therapies include medications, endoscopic transphenoidal and open surgeries; radiotherapy includes gamma knife radiosurgery. Visual symptoms has important and characteristic patterns which has discussed in one specific chapter. Endocrine secretion is another characteristic in 40% of pituitary adenomas. Therefore, another chapter presents it. Stereotactic radiosurgery and endoscopic surgery both have special role in recent decades. Thus, they have considered specifically, too. Authors expect to give excellent insight in pituitary adenoma to the book readers

A Textbook of Advanced Oral and Maxillofacial Surgery

The scope of OMF surgery has expanded; encompassing treatment of diseases, disorders, defects and injuries of the head, face, jaws and oral cavity. This internationally-recognized specialty is evolving with advancements in technology and instrumentation. Specialists of this discipline treat patients with impacted teeth, facial pain, misaligned jaws, facial trauma, oral cancer, cysts and tumors; they also perform facial cosmetic surgery and place dental implants. The contents of this volume essentially complements the volume 1; with chapters that cover both basic and advanced concepts on complex topics in oral and maxillofacial surgery

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery