An Unusual Case of Hybrid Peripheral Nerve Sheath Tumor (PNST) in the Nasal Cavity: a case report

Hybrid peripheral nerve sheath tumor (PNSTs), schwannoma/neurofibroma is a recently described benign nerve sheath tumor that is typically manifested as a dermal tumor on the extremities and trunk. However, occurrence in head and neck areas, especially in the nasal cavity, is extremely rare (there are only several cases reported so far). In this presentation, we report such a case. A 56-year-old woman was presented at our department with chronic nasal obstruction and anosmia. MRI and CT scan were performed. The imaging showed an intraseptal tumor in the middle and caudal part of the nasal septum. The tumor extended to ethmoids bilaterally, repressing the anterior wall of the sphenoid and medial wall of the maxillary sinus. In 2008 and 2009, the patient underwent endoscopic surgery for nasal polyps. The patohistological diagnosis was schwannoma. Considering the extent of the tumor and the diagnosis, we decided to perform an endoscopic removal of the tumor with a possible pericranial flap for the skull base defect. Histologically, the tumor consisted of two components including schwannoma and neurofibroma. Imunohistochemically all tumor cells were positive on S100 and SOX10, while p16 antigen was positive in 50% of the tumor cells, respectively. Mitosis and necrosis were not found. Based on these findings, the lesions were considered to be hybrid neurofibroma-schwannomas. In conclusion, although hybrid schwannoma/neurofibroma tumors are extremely rare in the nasopharyngeal area, they should be considered in differential diagnosis of tumors in the nasal cavity

Medical and Social Care in Rovinj from the Mid 15th to the Mid 19th Century

By using published and unpublished sources from various archival series kept in the Rovinj Heritage Museum, Chapter Archives of Rovinj and the Diocesan Archives of Pore~ the authors shed new light and present the health and social care system in the city of Rovinj covering the period which goes from the mid 15th to the mid 19th century. Altruistic mentality of individual citizens, lay and ecclesiastical institutions as well as the need to prevent diseases urged the foundation of medical-social-religious-charitable institutions. In the researched period Rovinj flourished demographically and economically, so that health and social institutions included offices in charge of prevention. When it came to various aspects of social activities, decisions were made by the foreign political authorities – Venetian, French and Austrian administration, although the first initiative would always come from the Rovinj Commune or individual citizens

An Unusual Case of Hybrid Peripheral Nerve Sheath Tumor (PNST) in the Nasal Cavity: a case report

Hybrid peripheral nerve sheath tumor (PNSTs), schwannoma/neurofibroma is a recently described benign nerve sheath tumor that is typically manifested as a dermal tumor on the extremities and trunk. However, occurrence in head and neck areas, especially in the nasal cavity, is extremely rare (there are only several cases reported so far). In this presentation, we report such a case. A 56-year-old woman was presented at our department with chronic nasal obstruction and anosmia. MRI and CT scan were performed. The imaging showed an intraseptal tumor in the middle and caudal part of the nasal septum. The tumor extended to ethmoids bilaterally, repressing the anterior wall of the sphenoid and medial wall of the maxillary sinus. In 2008 and 2009, the patient underwent endoscopic surgery for nasal polyps. The patohistological diagnosis was schwannoma. Considering the extent of the tumor and the diagnosis, we decided to perform an endoscopic removal of the tumor with a possible pericranial flap for the skull base defect. Histologically, the tumor consisted of two components including schwannoma and neurofibroma. Imunohistochemically all tumor cells were positive on S100 and SOX10, while p16 antigen was positive in 50% of the tumor cells, respectively. Mitosis and necrosis were not found. Based on these findings, the lesions were considered to be hybrid neurofibroma-schwannomas. In conclusion, although hybrid schwannoma/neurofibroma tumors are extremely rare in the nasopharyngeal area, they should be considered in differential diagnosis of tumors in the nasal cavity

CSF Leaks after Endoscopic Skull Base Surgery: A Single Institution Experience

Objective: To review our experience with endoscopic endonasal skull base reconstruction. Materials and Methods: A retrospective review of a single-institution endoscopic endonasal patient database from 2014-2019. The CSF leaks were graded based on defect size from 0 (no leak) to 2. The reconstruction method was documented for all patients. Results: There were in total 341 endoscopic endonasal operations for performed parasellar pathology. The pathology was: pituitary adenomas (85%), craniopharyngioma (1.1%), meningioma (2.9%), malignant tumors (0.5%) and other (9.9%). The total postoperative CSF leaks rates were 8.7%, and meningitis rates were 4.4%. The vast majority of CSF leaks were in the first 2 years of endoscopic endonasal skull base surgery. The flaps that were used: nasoseptal flap, middle turbinate flap (vascularized), free mucosal graft, fat graft and fat plug and the combination of these matherials. Conclusion: Reconstruction of skull base defects is of uttermost importance in the prevention of meningitis. There is a slow learning curve in achieving the surgical skills for endoscopic endonasal skull base surgery. The nasoseptal flap is the “work-horse” for anterior skull base reconstruction

CSF Leaks after Endoscopic Skull Base Surgery: A Single Institution Experience

Objective: To review our experience with endoscopic endonasal skull base reconstruction. Materials and Methods: A retrospective review of a single-institution endoscopic endonasal patient database from 2014-2019. The CSF leaks were graded based on defect size from 0 (no leak) to 2. The reconstruction method was documented for all patients. Results: There were in total 341 endoscopic endonasal operations for performed parasellar pathology. The pathology was: pituitary adenomas (85%), craniopharyngioma (1.1%), meningioma (2.9%), malignant tumors (0.5%) and other (9.9%). The total postoperative CSF leaks rates were 8.7%, and meningitis rates were 4.4%. The vast majority of CSF leaks were in the first 2 years of endoscopic endonasal skull base surgery. The flaps that were used: nasoseptal flap, middle turbinate flap (vascularized), free mucosal graft, fat graft and fat plug and the combination of these matherials. Conclusion: Reconstruction of skull base defects is of uttermost importance in the prevention of meningitis. There is a slow learning curve in achieving the surgical skills for endoscopic endonasal skull base surgery. The nasoseptal flap is the “work-horse” for anterior skull base reconstruction

Endoskopska endonazalna transsfenoidna kirurgija kraniofaringeoma: 12 godina iskustva u Kliničkom bolničkom centru Zagreb

Uvod: Kraniofaringeomi su rijetki benigni tumori supraselarne regije mozga. Njihova pojavnost slijedi bimodalnu distribuciju – drugim riječima, pojavljuju se, ili u dječjoj, ili u kasnoj odrasloj dobi. Uslijed učinka mase i lokalne destrukcije neuralnih struktura uzrokuju poremećaje vida, endokrinološke smetnje, poremećaje kognicije itd. Liječenje je kirurško, s ciljem potpunog uklanjanja, a tradicionalni pristup je transkranijski. Poslijeoperacijske rezidue liječe se radiokirurški. Endoskopska kirurgija u sve je široj primjeni, kroz čitav spektar neurokirurških indikacija, koji uključuje i operacijsko liječenje kraniofaringeoma kroz endonazalni transsfenoidalni prošireni pristup. Spomenuti pristup koristi prirodni koridor, omogućuje široki i sveobuhvatni prikaz supraselarne regije i pruža rezultate liječenja koji su superiorniji tradicionalnim transkranijskim alternativama. Cilj: S jedne strane, raspraviti indikacije, relevantnu anatomiju, prednosti i ograničenja proširenog endonazalnog endoskopskog pristupa u liječenju patologije selarne, supraselarne i paraselarne regije, a s druge prikazati naša iskustva kroz opis serije odraslih bolesnika s kraniofaringeomima liječenih na Klinici za neurokirurgiju Kliničkog bolničkog centra Zagreb. Metode: Sustavni pregled literature, kako bi identificirali sva objavljena izvješća o serijama slučajeva kraniofaringeoma operiranih endonazalnim endoskopskim putem. Institucionalni pregled slučajeva liječenih endonazalnom endoskopskom, kao i tradicionalnom metodom u Kliničkom bolničkom centru Zagreb i usporedba ishoda između obje metode. Rezultati: Kroz pregled literature identificirali smo desetak objavljenih izvješća (serije slučajeva), čiji rezultati govore o učinkovitosti endonazalnog endoskopskog pristupa u liječenju kraniofaringeoma, iako uz stopu komplikacija višu nego kod tradicionalnog transkranijskog pristupa. U razdoblju od interesa na Klinici za neurokirurgiju KBC-a Zagreb operirano je 50 odraslih bolesnika s kraniofaringeomima, od čega 20 endonazalnim endoskopskim pristupom. Kod potonjih je postignuta viša stopa uklanjanja tumora, usporedivi ishodi u smislu funkcije vida i endokrinološke funkcije, ali i viša stopa curenja cerebrospinalne tekućine i disrupcije postoperativne rane. Zaključak: Endoskopski endonazalna kirurgija sigurna je i učinkovita metoda liječenja kraniofaringeoma

Endonasal Endoscopic Hydatid Cyst Removal Located in the Pterygopalatine Fossa

Introduction: Hydatid cyst (Echinococcosis) is a zoonosis, most commonly caused by the larval stage of Echinococcus granulosus. The disease has a worldwide geographic distribution and the Mediterranean region is an important endemic area. Definitive hosts are carnivores (e.g. dogs, foxes, cats), and humans are accidental hosts. The infection occurs by ingesting food contaminated with Echinoccocus eggs. Hydatid cysts are most commonly seen in the liver and lungs. Head and neck involvment is rare. To our knowledge, this is the sixth reported case of pterygopalatine fossa involvement in literature. Case report: A 45-years old female patient presented with a hydatid cyst in the right pterygopalatine fossa, which was accidentally discovered on MRI of the head performed for follow up due to previous hydatid cyst management in the parietooccipital brain lobe. We managed the cyst with endoscopic endonasal approach. Discussion: In this report, we present a case of hydatid cyst of the right pterygopalatine fossa and right middle nose meatus which was treated with endoscopic endonasal approach. Conclusion: The hydatid cyst of pterygopalatine fossa is extremely rare. A multidisciplinary approach is mandatory in the management of hydatid cysts. Endoscopic endonasal management has low morbidity and the technique may vary due to surgeon skills, localization of the cyst and available instruments

Intracranial epidural haematoma following surgical removal of a giant lumbosacral schwannoma: a case report and literature review.

Postoperative intracranial epidural haematoma (EDH) is an extremely rare complication following spinal surgery, with only a handful of cases described in the literature. We report the case of a 16-year-old girl who underwent a successful subtotal resection of a giant lumbosacral schwannoma (L2-S2 level). Recovery from general anaesthesia was uneventful; however, her neurological status deteriorated rapidly within 24 h after surgery. A head computed tomography scan revealed a large right frontoparietal EDH with midline shift. An immediate frontotemporoparietal osteoplastic craniotomy and evacuation of the EDH were performed. At 1 year postoperatively, the patient regained full neurological recovery with no radiological signs of growth of the residual tumour

Endoskopska endonazalna transsfenoidna kirurgija kraniofaringeoma: 12 godina iskustva u Kliničkom bolničkom centru Zagreb

Uvod: Kraniofaringeomi su rijetki benigni tumori supraselarne regije mozga. Njihova pojavnost slijedi bimodalnu distribuciju – drugim riječima, pojavljuju se, ili u dječjoj, ili u kasnoj odrasloj dobi. Uslijed učinka mase i lokalne destrukcije neuralnih struktura uzrokuju poremećaje vida, endokrinološke smetnje, poremećaje kognicije itd. Liječenje je kirurško, s ciljem potpunog uklanjanja, a tradicionalni pristup je transkranijski. Poslijeoperacijske rezidue liječe se radiokirurški. Endoskopska kirurgija u sve je široj primjeni, kroz čitav spektar neurokirurških indikacija, koji uključuje i operacijsko liječenje kraniofaringeoma kroz endonazalni transsfenoidalni prošireni pristup. Spomenuti pristup koristi prirodni koridor, omogućuje široki i sveobuhvatni prikaz supraselarne regije i pruža rezultate liječenja koji su superiorniji tradicionalnim transkranijskim alternativama. Cilj: S jedne strane, raspraviti indikacije, relevantnu anatomiju, prednosti i ograničenja proširenog endonazalnog endoskopskog pristupa u liječenju patologije selarne, supraselarne i paraselarne regije, a s druge prikazati naša iskustva kroz opis serije odraslih bolesnika s kraniofaringeomima liječenih na Klinici za neurokirurgiju Kliničkog bolničkog centra Zagreb. Metode: Sustavni pregled literature, kako bi identificirali sva objavljena izvješća o serijama slučajeva kraniofaringeoma operiranih endonazalnim endoskopskim putem. Institucionalni pregled slučajeva liječenih endonazalnom endoskopskom, kao i tradicionalnom metodom u Kliničkom bolničkom centru Zagreb i usporedba ishoda između obje metode. Rezultati: Kroz pregled literature identificirali smo desetak objavljenih izvješća (serije slučajeva), čiji rezultati govore o učinkovitosti endonazalnog endoskopskog pristupa u liječenju kraniofaringeoma, iako uz stopu komplikacija višu nego kod tradicionalnog transkranijskog pristupa. U razdoblju od interesa na Klinici za neurokirurgiju KBC-a Zagreb operirano je 50 odraslih bolesnika s kraniofaringeomima, od čega 20 endonazalnim endoskopskim pristupom. Kod potonjih je postignuta viša stopa uklanjanja tumora, usporedivi ishodi u smislu funkcije vida i endokrinološke funkcije, ali i viša stopa curenja cerebrospinalne tekućine i disrupcije postoperativne rane. Zaključak: Endoskopski endonazalna kirurgija sigurna je i učinkovita metoda liječenja kraniofaringeoma

Rekonstrukcije turskog sedla – retrospektivni pregled 273 bolesnika

Cilj: U ovom radu prikazujemo naše rezultate selarne rekonstrukcije nakon endoskopskog endonazalnog pristupa na područje turskog sedla. Analiziramo naše stope postoperativnih likvoreja i stvaranja krusti. Materijali i metode: Retrospektivna analiza 273 bolesnika koji su bili podvrgnuti operaciji endonazalnom endoskopom tehnikom, radi patologije turskog sedla u razdoblju 2018. – 2023. godine. Bolesnici su podijeljeni u tri grupe s obzirom na veličinu defekta. U grupi 1 nije bilo jasne likvoreje, te je učinjena potpora defekta sele oksidiranom celulozom i/ili prekrivanje sluznicom sfenoidnog sinusa. U grupi 2 evidentirana je likvoreja niskog protoka, rekonstrukcija je učinjena sintetičkim materijalima, sluznicom srednje nosne školjke, dna nosnog kavuma ili slobodnom sluznicom septuma. U grupi 3 evidentirana je likvoreja visokog protoka s jasnim znakovima defekta dijafragme, a defekt je rekonstruiran u više slojeva: kolagenska spužva, fascija temporalnog mišića ili fascija lata, te vaskularizirani režanj – najčešće nazoseptalni režanj. Rezultati: Patologija je uključivala adenome hipofize, meningeome, kraniofaringeome, metastaze zloćudnih tumora, epidermoidne ciste. Među ispitanicima je bilo 56% muškaraca (152/273) i 44% žena (121/273). Sveukupna stopa postoperativne likvoreje iznosila je 2,93% (8/273), u grupi 1 iznosila je 2,1% (2/93), u grupi 2 3,22% (1/31), te u grupi 3 – 3,35% (5/149). U grupama je na tromjesečnoj kontroli rađena evaluacija stvaranja krusti u nosu: u grupi 1 je 16% ispitanika imalo kruste, u grupi 2 25,8%, a u grupi 3 – 39,5%. Zaključci: Naši rezultati pokazuju da tehnike kojima se koristimo pokazuju visoku učinkovitost uz minimalni morbiditet. Budući da ovaj tip kirurgije ima sporu krivulju učenja, a u svrhu smanjenja postoperativnih komplikacija, smatramo da se ovi zahvati trebaju obavljati u centrima s formiranim multidisciplinarnim timovima i operativnim timom, koji čini više članova kirurških struka