Impact of Salvage Surgery and Re-irradiation for Radiation Failed Recurrent Skull Base Meningiomas

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Chondromyxoid Fibroma of the Skull Base and Calvarium: Surgical Management and Literature Review

Chondromyxoid fibroma (CMF) is an exceedingly rare tumor that represents less than 1% of all primary bone neoplasms. Occurrence in the facial and cranial bones is extremely rare and frequently misdiagnosed. Case Reports We report two cases of CMF, one in the sphenoclival skull base and the other involving the parietal bone in two young female patients. Excision was performed in both cases. Presenting symptoms, treatment, and follow-up are reported. Methods A retrospective review of the literature on cranial CMF was performed. The location, demographics, presenting symptoms, and treatment of all calvarial and skull base CMF cases published since 1990 are summarized. Discussion In our literature review, we found 67 published cases of cranial CMF. Mean age of all calvarial and skull base CMFs at diagnosis was 38.2 years old. Of the cases affecting the cranium, the sinonasal structures were most commonly involved. To our knowledge we report only the second case of CMF involving the parietal bone published in an English-language journal. Total resection is the best treatment, and should be the goal of surgical intervention. Curettage results in high recurrence rates. Radiotherapy in the setting of subtotal resection or recurrence cannot be definitively recommended and needs further investigation

Functional Outcome in the Neurosurgical Patient and Its Impact on Quality of Life

Outcomes research has become an integral part of most clinical studies today. Extent of resection, increased median survival, and “time to progression” are no longer the only important end points in need of assessment. Identifying the long-term adverse effects of treatment has become increasingly important as patients try to resume previous activities and an independent lifestyle. The measurement of functional states and health-related quality of life issues are at the forefront of medicine and have become necessary measures of functional outcome following the treatment of a variety of medical and surgical disorders. In this article, we review the most recent studies on the functional outcome of patients undergoing neurological surgeries and its impact on quality of life

Resolution of Tonsillar Herniation and Cervical Syringomyelia Following Resection of a Large Petrous Meningioma: Case Report and Review of Literature

We describe a case of a large, petrous meningioma associated with tonsillar herniation and cervical syringomyelia. The patient, a 53-year-old woman, had a 6-month history of a dull, aching pain in the occipital region associated with numbness in the right C2 dermatome and left gaze evoked nystagmus. Magnetic resonance imaging (MRI) revealed a large tumor in the right posterior fossa associated with moderate supratentorial hydrocephalus. Secondary tonsillar herniation and cervical syringomyelia extending from C2 to C6 were also identified. The tumor, later confirmed to be a meningioma originating from the petrous region, was resected completely via a retrosigmoid approach. Postoperative MRI demonstrated total resolution of the tonsillar herniation and cervical syringomyelia. The radiological features, potential pathophysiological mechanisms, and treatment strategies are discussed in relation to the recent literature

Carcinoma of the Breast Metastatic to the Optic Nerve Mimicking an Optic Nerve Sheath Meningioma: Case Report and Review of the Literature

Isolated metastatic tumors to the optic nerve are extremely rare. We describe a rare and unusual case of metastatic breast carcinoma to the optic nerve that mimicked an optic nerve sheath meningioma in its presentation due to its indolent symptom progression, initial radiological appearance, and minimal growth on serial imaging. The patient, a 46-year-old woman with a history of stable metastatic breast carcinoma, presented with progressive visual loss in her right eye over a 6-month interval. Magnetic resonance imaging revealed an enhancing lesion in the optic canal with an extension to the right anterior clinoid process and planum sphenoidale and into the right orbital apex, consistent with the presumptive diagnosis of optic nerve sheath meningioma. The tumor was resected and pathologically confirmed to be metastatic carcinoma of the breast. The clinical course, radiological features, surgical approach, and treatment strategies are reviewed

Calvarial Reconstruction With Polyetheretherketone Implants

Despite the development of multiple cranial bone substitutes, calvarial reconstruction remains a significant challenge. Although autologous bone is preferred in many cases, its usefulness may be limited by difficulty with contouring, resorption, and donor site availability and morbidity. Alloplastic cranioplasties are also widely used with each material having its advantages and disadvantages. Computer-designed implants have the advantages of minimizing operative time for preparation, shaping, and insetting. We report our initial clinical experience in 6 patients with Computer-designed, prefabricated polyetheretherketone implants, which may have significant advantages over other alloplastic materials in terms of strength, stiffness, durability, thermal conductivity, and radiographic translucency

Skull Base Reconstruction in the Pediatric Patient

Tumors of the skull base are rare in children and adolescents and present a complicated management problem for oncologists and surgeons alike. Surgical resection is an integral component of the management of many pediatric neoplasms, especially those that are benign or, though not frankly malignant, are locally invasive. The general principles of skull base reconstruction following tumor ablation are applicable to nearly all patients; the reconstructive algorithm, however, is particularly complex in the pediatric population and the potential benefits of therapy must be balanced against the cumulative impact on craniofacial growth and maturity and the donor site morbidity. A retrospective analysis of all patients less than 19 years of age who underwent resection of a skull base tumor was performed. Particular emphasis was placed on the 12 patients who required complex reconstruction by the plastic surgical service. This represents approximately a third of the operated patients. Data were recorded on patient age, tumor pathology and location, prior therapies, surgical approach, extent of resection, margin status, defect components, details of reconstructive methods employed, complications, additional procedures or interventions, and the use and timing of adjuvant therapies. Patient outcome at most recent follow-up was recorded. All patients were followed clinically and by MRI and/or CT scan of the skull base. The reconstructive details recorded included flap choice, recipient vessels, and any concomitant procedures performed. The indications for and details of any staged surgical revisions or prosthetics were also noted. Complications recorded included partial or total flap loss, cerebrospinal fluid leakage, meningitis, infection, abscess, hematoma or seroma formation, delayed healing, and donor site dysfunction. The vertical rectus abdominis myocutaneous free flap was the most common means of reconstruction utilized in this series. Three of 12 patients had reconstruction related complications. Delayed reconstructive procedures or prosthetic interventions have been performed in 6 of the 12 patients who underwent complex reconstructions. On the basis of our experience and previous reports in the literature, we offer the following guidelines for the successful multidisciplinary care of children and adolescents undergoing skull base reconstruction after tumor resection: (1) skull base reconstruction may be safely performed in children and adolescents using free tissue transfer or local flaps; (2) larger defects and those involving more than one anatomic region of the skull base should be repaired with soft-tissue free flaps; and (3) because of the versatility and reliability of free flaps, pedicled flaps should be reserved for limited defects. Because of the potentially synergistic effects of multimodality treatment for skull base malignancies on craniofacial growth and development, we advocate soft-tissue reconstruction as the primary technique, reserving bony flaps for definitive procedures in survivors who have reached skeletal maturity

Feasibility of a Robotic Surgical Approach to Reconstruct the Skull Base

The role of robotic surgery in the skull base is evolving and represents the natural progression toward maximizing surgical resections in confined spaces without compromising oncological principles. In this study, we describe the novel application of robotic surgery to the repair of dural defects in the skull base. A transmaxillary-transantral approach to the nasal cavity was performed bilaterally in a cadaveric model. Repair of the skull base defect was undertaken robotically. In this technical report, we demonstrate the feasibility of a suture-based technique for surgical reconstruction of the skull base with robotic assistance in a cadaveric model. In all cases, suture repair of dural defects was successfully performed with robotic-assisted technique. Although preliminary in nature, this study suggests that traditional suture techniques can be implemented in a confined surgical site with the use of robotic technology