Journal of Neurological Surgery Part B: Skull Base最新文献

Introduction Giant meningiomas invading the cavernous sinus (GMICSs) are a subgroup of challenging tumors due to their volume and the extent of neurological impairment. Preserving quality of life is one of the most relevant aspects of treating patients with GMICS.

Methods A retrospective study was conducted for surgeries performed between 2012 and 2022, including 33 patients presenting meningiomas with the largest diameter of at least 5 cm invading the cavernous sinus. The data from surgical intervention, Simpson grade of resection, tumor location, and morbimortality related to the surgeries were reviewed.

Results The group comprised 25 women and 8 men with a median age of 56 years. The mean follow-up period was 52 months. The tumors were in the sphenoid wing, anterior clinoid, spheno-orbital, spheno-petroclival, petroclival, and Meckel's cave. Simpson grade I, II, and III were obtained in 70% of cases. The meningiomas were classified as WHO grade 1 in 94%, grade 2 in 3%, and grade 3 in 3%. The overall mortality was 3%. Permanent cranial nerve deficits occurred in 21%, transient cranial nerve deficits in 42%, cerebrospinal fistula in 15%, and hemiparesis in 18%. The recurrence/regrowth rate was 6%. The Karnofsky Performance Status score of 100 and 90 was 82%.

Conclusions The surgical treatment of GMICS is an effective treatment modality with acceptable morbimortality and good long-term control. Involvement of the internal carotid artery is essential to determine the extent of resection inside the cavernous sinus, and training in the microsurgical laboratory is mandatory for safe surgical treatment.

[This corrects the article DOI: 10.1055/s-0044-1779888.].

Background SDHx variant carriers have an increased risk of developing head and neck paraganglioma. The Dutch guidelines state that these patients require lifelong follow-up, but no clear recommendation is made about the frequency of screening.

Objective To determine the annual risk of developing head and neck paraganglioma in SDHx variant carriers after a negative initial screening.

Methods We conducted a retrospective single-center cohort study in the Netherlands that included 49 SDHA, SDHB, and SDHD variant carriers with a negative first screening and at least one follow-up. The main outcome measure was the annual risk of developing a paraganglioma for the SDHx variants separately.

Results Between 2000 and 2022, nine patients developed a paraganglioma all of whom were carriers of a SDHD variant (n = 23). Neither the 24 SDHB-related cases nor the 2 SDHA variant carriers developed a paraganglioma after a median of 4.83 and 5.92 years of follow-up, respectively.

Conclusion The 5-year risk for head and neck paragangliomas in pathological SDHx variant carriers is less than 20%. A 5-year interval for screening SDHx carriers seems sufficient to prevent the unnoticed development of head and neck paragangliomas that warrant treatment.

Introduction Endonasal odontoidectomy (EO) is a procedure for addressing compressive pathology of the craniovertebral junction. While EO has been well established in adults, its complications and cervical fusion practices are less understood in pediatric patients, despite differences in sinonasal and craniocervical anatomy. This study summarizes and compares EO complications and need for cervical fusion in pediatric and adult patients.

Methods This was a systematic review and meta-analysis. Literature review was conducted using PubMed, Web of Science, and Embase to identify studies reporting complications post-EO in adult and pediatric patients. Complications were categorized as neurologic, swallowing, or respiratory. Complication and posterior fusion rates were compared using a random-effects model.

Results A total of 738 articles were identified, of which 28 studies including 307 adult cases and 22 pediatric cases met inclusion criteria for systematic qualitative and quantitative review. The rates for adult and pediatric cases, respectively, were: respiratory complications 13.4 versus 9.1%, swallowing complications 12.1 versus 4.5%, neurologic complications 8.5 versus 9.1%, and cervical fusion rates 73.3 versus 86.4%. Across eight studies qualifying for meta-analysis, there were no differences in cervical fusion (odds ratio [OR]: 0.5, 95% confidence interval [CI]: [0.1, 2.1]), respiratory complications (OR: 3.5, 95% CI: [0.8, 14.5]), or swallowing complications (OR: 3.5, 95% CI: [0.5, 26.0]); however, pediatric patients had a higher rate of neurologic complications (OR: 5.2, 95% CI: [1.1, 25.0]).

Conclusion In EO, rates of aerodigestive complications and cervical fusion are similar in both populations. There may be an increased risk of neurologic complications in pediatric patients, although more high-quality studies are needed.

Purpose To assess the feasibility and safety of cone-beam computed tomography (CBCT) advanced navigation for optimizing intra-arterial chemotherapy infusion (IACI) in patients with skull base tumors.

Materials and Methods Retrospective review on 10 consecutive IACI procedures performed in five patients (four women, 1 man) over a 1-year period. The median age of the patients was 71 years (interquartile range: 34–74). During the procedures, a CBCT-based navigation software was employed to evaluate tumor perfusion and guide the infusion methods. Catheterization of the primary tumor feeding vessel was performed in seven cases when it originated from the external carotid artery, whereas a temporary balloon-assisted occlusion technique was utilized in the remaining three cases where the tumor was primarily fed by the internal carotid artery. Carboplatin, topotecan, and melphalan were injected over a 10-minute period. Fluoroscopy time, reference dose, and Kerma area product, which estimates effective dose, were analyzed.

Results The technical success rate was 100%, with a median procedure length of 82 minutes (79–90). The median fluoroscopy time was 11.3 minutes (9.4–16.9), reference dose was 93.5 mGy (62–256.5), and Kerma area product was 11.6 Gy.cm² (9.5–25.4). The median effective dose was 3.8 mSv (1.5–5.1). The median follow-up duration was 233.5 days (186.3–432). One severe adverse event was reported, involving a right brachial hematoma and brachiocephalic artery dissection related to catheterization through a type III aortic arch. Three patients exhibited disease progression, but two patients showed stable disease.

Conclusion IACI for skull base tumors guided by CBCT navigation is both feasible and safe.

Objective The purpose of this study is to report the technical procedure and our experience using a polydioxanone suture (PDS) plate with dural substitute as part of a fully resorbable gasket seal technique to repair anterior skull base defects.

Methods A series of patients undergoing anterior skull base reconstruction utilizing our resorbable gasket seal technique from January 2014 to July 2022 was reviewed.

Results A total of 155 patients were included. Nine (5.8%) of the included patients developed postoperative cerebrospinal fluid (CSF) leaks requiring reoperation. There were no cases of intraoperative cranial nerve injury or internal carotid artery injury. A total of 103 (66.5%) patients were observed to have an intraoperative CSF leak, including 57 low-flow leaks and 46 high-flow leaks; 1 of 57 (1.8%) patients with low-flow leaks and 8 of 46 (17.4%) patients with high-flow leaks developed a postoperative CSF leak. During the first 3 years that this technique was utilized at our center for the management of high-flow intraoperative CSF leaks, postoperative CSF leaks were documented in 4 of 12 (33.3%) patients, in comparison to 4 of 34 (11.8%) in the following years.

Conclusion PDS plate reconstruction confers several advantages and can be used in a diverse set of operative scenarios in conjunction with other reconstruction options. There appeared to be an associated learning curve as surgeons at our center gained experience with this new technique. Our findings show that the PDS plate reconstruction is safe and effective in repairing the skull base.

Objectives In the present study, we investigated the round window (RW) and neighboring anatomical structures using temporal computed tomography (CT) which are important for cochlear implant (CI) electrodes.

Methods In this retrospective study, the temporal CT images of 112 adult patients (45 males and 67 females) were evaluated. We classified mastoid pneumatization, and measured RW diameter, RW–carotid canal (CC) distance, RW–facial nerve mastoid segment (FNMS) distance, RW–pyramidal eminence distance, RW–jugular bulb (JB) distance, and RW–internal acoustic canal (IAC) distance. Additionally, RW–cochlea angle and RW–facial nerve angle were also measured.

Results RW diameters in males were significantly higher than those in females bilaterally (p < 0.05). RW–CC distance and RW–JB distance were both smaller than 10 mm. RW–IAC distance was 2.54 to 2.68 mm, and RW–FNMS distance was 4.20 to 4.40 mm. RW–cochlea angle ranged from 39.62 to 41.91 degrees and RW–FN angle ranged from 17.28 to 18.40 degrees. Males showed better mastoid pneumatization values (p < 0.05). In higher RW diameters, RW–JB distance decreased, and in pneumatized mastoids, RW–JB distance increased. RW–JB distance and RW–CC distance were detected to increase together (p < 0.05).

Conclusion RW is crucial anatomic structure for CI surgeries. RW diameters are between 1.21 and 1.35 mm and lower in the females. Males exhibited better mastoid pneumatization values than the females, and CC and JB distances from RW were farther in well-pneumatized mastoids. Future studies should include comprehensive clinical and surgical findings.

Objectives This retrospective study aimed to explore the prognostic effect of cumulative score based on neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and fibrinogen in older adults diagnosed with glioblastoma (GBM).

Design Retrospective study.

Setting Huashan Hospital.

Participants Patients aged over 60 years and diagnosed with GBM between 2010 and 2017.

Main Outcome Measures Results of preoperative routine biochemistry and coagulation blood examinations were reviewed from medical records. Overall survival (OS) was considered a period from first resection surgery until death. Progression-free survival (PFS) was considered a period from initial operation until the date of tumor progression demonstrated in brain magnetic resonance imaging or death from any cause. If no event occurred, the last follow-up appointment was the end of the observation for OS or PFS. The Kaplan–Meier method was used to evaluate survival curves, and prognostic factors were analyzed by the Cox proportional hazards model.

Results A total of 289 patients were included. Patients with higher levels of fibrinogen, NLR, and PLR had significantly shorter median OS (p = 0.001, p = 0.016, and p = 0.002, respectively) and PFS (p = 0.004, p = 0.022, and p = 0.009, respectively) compared with those with lower levels. Multivariate analyses showed a significant association between higher F-NLR-PLR score and reduced OS (adjusted hazard ratios [aHRs]: 1.356, 95% confidence interval [CI] 1.009–1.822 for scores 1–2 compared with 0; 5.974, 95% CI 2.811–12.698 for score 3 compared with 0). Similarly, a significant association between higher F-NLR-PLR score and reduced PFS was observed (aHR: 1.428, 95% CI 1.066–1.912 for scores 1–2 compared with 0; aHR: 2.860, 95% CI 1.315–6.223 for score 3 compared with 0).

Conclusion Higher F-NLR-PLR score is associated with reduced OS and PFS in older adults with GBM, which helps identify patients at high risk and guide the individualized treatment in clinical practice.