Anatomical Basis of the Zygomatic-Transmandibular Approach: Operative Video

xlomafota13 shared this article with you from Inoreader Anatomical Basis of the Zygomatic-Transmandibular Approach: Operative Video Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727125 Tumor growth in infratemporal fossa (ITF) and parapharyngeal space (PPS) is generally slow and generates very few clinical manifestations, so it is not uncommon for tumors to reach large dimensions at the time of diagnosis, making necessary to perform ample approaches. In zygomatic-transmandibular approach (ZTMA), the access of the ITF and PPS is obtained by a combination of a pterional craniotomy plus a zygomatic-mandibular osteotomy. Tumor excision is achieved by its initial dissection from all of the neurovascular structures of the middle fossa by the neurosurgical team and the final resection by the head and neck team from below. In the first part of this video, w e present a brief anatomical–surgical description of the ITF and PPS and in the second part, we show case of a trigeminal schwannoma that could be successfully removed through a ZTMA. Using this approach, an ample and safe exposure of the ITF and PPS is achieved, without affecting the chewing or facial nerve function and with excellent cosmetic results, so it can be considered as a reliable surgical option, particularly in cases of giant tumors that affect these regions (Figs. 1 and 2).The link to the video can be found at: https://youtu.be/oxVFhzT8HsQ. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table o f contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma

xlomafota13 shared this article with you from Inoreader Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1726018 Objective We illustrate a cavernous sinus chondrosarcoma treated with an endoscopic endonasal transethmoidal-transsphenoidal approach. Design Case report of a 15-year-old girl with diplopia and esotropia due to complete abducens palsy. Preoperative images showed a right cavernous sinus lesion with multiple enhanced septa and intralesional calcified spots (Fig. 1). Considering tumor location and the lateral dislocation of the carotid artery, an endoscopic endonasal approach was performed to relieve symptoms and to optimize the target geometry for adjuvant conformal radiotherapy. Setting The study was conducted at University of Insubria, Department of Neurosurgery, Varese, Italy. Participants Skull base team was participated in the study. Main Outcome Measures A transethmoidal-transsphenoidal approach was performed by using a four-hand technique. We used a route lateral to medial turbinate to access ethmoid and the sphenoid sinus. During the sphenoid phase, we exposed the medial wall of the cavernous sinus (Fig. 2) and the lesion was then removed using curette. Skull base reconstruction was performed with fibrin glue and nasoseptal flap. Results No complications occurred after surgery, and the patient experienced a complete recovery of symptoms. A postoperative magnetic resonance imaging showed a small residual tumor inside the cavernous sinus (Fig. 1). After percutaneous proton-bean therapy, patient experienced only temporary low-grade toxicity with local control within 2 years after treatment completion. Conclusion Endoscopic endonasal extended approach is a safe and well-tolerated procedure that is indicated in selected cases (intracavernous tumors, soft tumors not infiltrating the vessels and/or the nerves). A tailored approach according to tumor extension is crucial for the best access to the compartments involved.The link to the video can be found at: https://youtu.be/TsqXjqpuOws. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Gross Total Resection of a Recurrent Cavernous Sinus Meningioma through a Combined Transzygomatic Transcavernous and Extended Middle Fossa Approach with Cavernous Carotid Denudation

xlomafota13 shared this article with you from Inoreader Gross Total Resection of a Recurrent Cavernous Sinus Meningioma through a Combined Transzygomatic Transcavernous and Extended Middle Fossa Approach with Cavernous Carotid Denudation Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727147 Objective The aim of this study is to describe surgical management of invasive cavernous sinus meningioma with a combination of skull base approaches. Design This study is an operative video. Results Resection of the recurrent skull base meningioma is still challenging, especially if the tumor involves or encases the carotid artery. In this video, we describe our experience with the successful treatment of a recurrent skull base meningioma, which involved the entire cavernous sinus and the internal carotid artery. A 53-year-old male presented with a 1-year history of progressing right-side complete oculomotor palsy and facial dysesthesia. The patient had previously undergone craniotomy for the right-side petroclival cavernous meningioma (Fig. 1A and B). Total 8 years after the first surgery, the remaining portion of the cavernous sinus grew up and extended into the posterior fossa (Fig. 1C). Then the second surgery was performed to resect only the posterior fossa component (Fig. 1D). However, the follow-up magnetic resonance imaging revealed an aggressive tumor regrowth in 2 years. The tumor occupied the right middle fossa with an extension to the posterior fo ssa and infratemporal fossa (Fig. 1E and F). We scheduled to perform gross total resection of the tumor through a combined transzygomatic transcavernous and extended middle fossa approach with preparation for vessel reconstruction. Mild adhesion between the tumor and the cavernous carotid artery facilitated complete resection of the intracavernous component of the tumor (Fig. 2A–C). Conclusion A combination of skull base approaches provides multidirectional operative corridors and wide exposure of the skull base lesions.The link to the video can be found at https://youtu.be/DB_WXFeyBvo. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Posterior Communicating Segment Aneurysm of the Supraclinoid Internal Carotid Artery Treated with an Extracranial to Intracranial Bypass and Trapping

xlomafota13 shared this article with you from Inoreader A Posterior Communicating Segment Aneurysm of the Supraclinoid Internal Carotid Artery Treated with an Extracranial to Intracranial Bypass and Trapping Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1725940 Surgical treatment of giant aneurysms often poses significant challenges. Endovascular techniques have evolved exponentially over the last decades, and most of these complex aneurysms can be treated with flow-diverting techniques; however, successful obliteration of all giant aneurysms is not always possible with endovascular flow-diverting techniques. Although the need for microsurgical intervention has undoubtedly diminished, a versatile-thinking surgeon should keep in mind that obliteration of these aneurysms combined with revascularizing the distal circulation via extracranial–intracranial bypass techniques can provide a potentially life-long durable solution. T he key to curing these pathologies is to utilize interdisciplinary decision making with a robust knowledge of the pros and cons of different treatment approaches. Herein, we present a case of a giant posterior communicating segment aneurysm of the left supraclinoid internal carotid artery (ICA), which was treated by obliteration (Fig. 1). Extradural anterior clinoidectomy was used to provide exposure of the supraclinoidal ICA proximal to the aneurysm, and revascularization of the distal circulation was achieved with a common carotid artery to M2-superior trunk bypass using a radial artery interposition graft (Fig. 2). The patient was a 62-year-old female who presented with vision loss in her left eye but was otherwise neurologically intact. She had a history of two unsuccessful flow-diverting stent placement attempts 2 months prior to this surgery. Postoperatively, the patient woke up without any deficits, with her left eye vision partially recovered and ultimately returning to norm al at 1-year follow-up. Computed tomography (CT) angiography at a 1-year follow-up showed complete obliteration of the aneurysm and successful revascularization of the distal circulation.The link to the video can be found at: https://youtu.be/3Zz-ecvlDIc . [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cavernous Sinus Epidermoid Cyst Removal through a No-Keyhole Pterional Craniotomy: Operative Video and Technical Nuances

xlomafota13 shared this article with you from Inoreader Cavernous Sinus Epidermoid Cyst Removal through a No-Keyhole Pterional Craniotomy: Operative Video and Technical Nuances Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727118 Intracranial epidermoid cysts are considered benign tumors with good general prognosis. However, their radical removal may be associated with certain morbidity, especially when the capsule is attached to neurovascular structures. Epidermoid cysts located in the cavernous sinus are very rare. We present an operative video of a 22-year-old female patient, who suffered a right-sided headache for 5 years. The video demonstrates main steps and surgical nuances of resection of a right interdural cavernous sinus epidermoid cyst, measuring 22 × 19 × 21 mm (4.3 cc) (Fig. 1A). On initial physical examination, the patient had a right partial third nerve palsy (mild p tosis with minimal diplopia), without any other cranial nerve deficit. A right no-keyhole pterional craniotomy was performed, followed by extradural anterior clinoidectomy and peeling of the outer dural layer of the lateral wall of the cavernous sinus. The dura matter was also detached from the distal carotid dural ring, which was exposed by the clinoidectomy (Fig. 2A). This maneuver provided excellent exposure of the interdural epidermoid cyst, which severely compressed the oculomotor nerve against the posterior petroclinoid dural fold (Fig. 2B). Gross total resection of the epidermoid cyst was achieved (Fig. 1B and C). The patient developed a transient worsening of the third nerve palsy, which recovered completely 3 months after the surgery. Postoperative magnetic resonance imaging revealed no signs of residual tumor.The link to the video can be found at: https://youtu.be/pobhYb5ZNig. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic Transnasal Resection of Trigeminal Schwannoma

xlomafota13 shared this article with you from Inoreader Endoscopic Transnasal Resection of Trigeminal Schwannoma Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727122 Trigeminal schwannoma is a rare skull base tumor that can be managed in a variety of treatments including image observation, surgery, stereotactic radiosurgery, such as gamma knife radiosurgery (GKS), and combination of these. Endoscopic transnasal resection is very effective when the tumor is not invading far laterally, or the risk of cerebrospinal fluid (CSF) leak is estimated to be low. A 74-year-old man with a history of prostate cancer and diabetes presented with left oculomotor nerve palsy over a month. Magnetic resonance images (MRI) demonstrated a 25-mm mass in the left cavernous sinus protruding to the left orbit via the superior orbital fissure (Fig. 1). The patient underwent endoscopic transnasal surgery to decompress the mass. The surgery was uneventful, and postoperative MRI demonstrated satisfactory subtotal resection of the mass (Fig. 2). The final pathology returned as schwannoma. At 1-year follow-up, the tumor slowly enlarged, and the patient underwent GKS with a marginal dose of 14 Gy. At the last follow-up, 4 months after GKS, the tumor was stable. Unfortunately the patient deceased from the known prostate cancer. Endoscopic transnasal surgery was especially useful in this case, considering the preoperative known cancer state that management of this benign tumor did not ruin the quality of life of this patient while minimizing hospitalization, as achieving satisfactory tumor control with aid from postoperative GKS, minimizing complications.The link to the video can be found at: https://youtu.be/Q0Ugc2VFV4w. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic factors in patients with advanced differentiated thyroid cancer treated with multikinase inhibitors - a single Brazilian center experience

xlomafota13 shared this article with you from Inoreader Prognostic factors in patients with advanced differentiated thyroid cancer treated with multikinase inhibitors - a single Brazilian center experience Via radioactive iodine Arch Endocrinol Metab. 2021 Apr 29:2359-3997000000364. doi: 10.20945/2359-3997000000364. Online ahead of print. ABSTRACT OBJECTIVE: The aim of this study was to describe the real-world experience multikinase inhibitors (MKI) in the treatment advanced differentiated thyroid carcinoma (DTC) refractory to radioactive iodine (RAIR) therapy. METHODS: We reviewed the records of all patients with MKI-treated DTC from 2010 to 2018. Progression free survival (PFS), response rates (RR) and adverse events (AE) profiles were assessed. Clinical parameters were compared between groups with different outcomes (disease progression and death) to identify possible prognostic factors and benefit from treatment. RESULTS: Forty-four patients received MKI for progressive RAIR DTC. Median PFS was 24 months (10.2-37.7) and median overall survival (OS) was 31 months. Best overall response was complete response in one patient (4.5%), partial response in nine (20.4%), stable disease in twenty-two (50%), and progressive disease (PD) in twelve (27.3%). Seventy-two point 7 percent patients had clinical benefit and AE were mild in most cases (82.7%). Progressive patients were more likely to have FDG positive target lesion than those who did not progress (p = 0.033) and higher maximum SUV on target lesions (p = 0.042). Presence of lung-only metastasis and lower thyroglobulin (Tg) during treatment was associated with stable disease (p = 0.015 and 0,049, respectively). Patients wi th shorter survival had larger primary tumor size (p = 0.015) and higher maximum SUV on target lesions (p = 0.023). CONCLUSION: Our findings demonstrate safety and effectiveness of MKI in patients with advanced RAIR DTC. We were able to identify as possible prognostic markers of better outcomes: absence of FDG uptake on target lesions, lower maximum SUV on PET-CT, presence of lung-only metastasis and lower Tg during treatment. PMID:33939907 | DOI:10.20945/2359-3997000000364 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

ὁ δὲ ἡγεμὼν ἔφη· τί γὰρ κακὸν ἐποίησεν; οἱ δὲ περισσῶς ἔκραζον λέγοντες· σταυρωθήτω

Clinical value of the video head impulse test in patients with vestibular neuritis: a systematic review

xlomafota13 shared this article with you from Inoreader Clinical value of the video head impulse test in patients with vestibular neuritis: a systematic review Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Apr 24. doi: 10.1007/s00405-021-06803-8. Online ahead of print. ABSTRACT PURPOSE: The aim of this systematic review was to evaluate the clinical application potential of the video head impulse test (vHIT) in diagnosing vestibular neuritis (VN). METHODS: An electronic search was conducted in the following databases: Embase, MEDLINE, ScienceDirect, Google scholar, and the Cochrane Database of Systematic Reviews. Clinical studies were included in which an evaluation was made using vHIT either alone or in combination with other tests or bedside algorithms. Evaluations that were carried out using unvalidated tools were excluded. Only studies of patients with VN (superior, inferior, or in toto) were included. Screening of titles, abstracts, full texts, and data extraction were undertaken independently by pairs of reviewers. Included studies were quality appraised using a modified version of the Newcastle -Ottawa scale. RESULTS: Results were reported according to the preferred reporting items for systematic reviews and meta-analyses. Our search yielded 1309 unique records, 21 of which remained after screening titles and abstracts. Sixteen studies were included, i.e., for a total of 933 patients including 474 patients with a diagnosis of VN. CONCLUSIONS: The diagnostic value of vHIT is high for VN, as it is a high-frequency measurement tool. vHIT is a useful complement or alternative to caloric and rotational tests as an indicator of lesions of vestibular canal functioning, especially at the time of onset. This tool can provide useful clues about the clinical progress of recovery from the lesion through the value of the vestibulo ocular reflex gain and the consequent evolution of the saccade pattern, which allows the patient to stabilize vision on the retina. PMID:33893851 | DOI:10.1007/s00405-021-06803-8 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Computed tomographic angiography (CTA) diagnosis of a rare meandering right pulmonary vein (MRPV)

xlomafota13 shared this article with you from Inoreader Computed tomographic angiography (CTA) diagnosis of a rare meandering right pulmonary vein (MRPV) Via radiol anat Surg Radiol Anat. 2021 Apr 24. doi: 10.1007/s00276-021-02751-4. Online ahead of print. ABSTRACT Meandering right pulmonary vein (MRPV) is an exceedingly rare congenital pulmonary vascular variant with less than 20 reported cases. MPVR is a tortuous aberrant venous drainage of the right pulmonary upper lobe anastomosing with the right lower pulmonary vein instead of directly joining the left atrium. The variant is benign with an orthotopic venous drainage without any kind of shunting. The differential diagnosis mostly comprises the scimitar syndrome but also primary varix, arteriovenous malformations, and pulmonary sequestration. We report a case of MRPV fortuitously diagnosed in a 70-year-old patient. Multi-detector computed tomographic angiography (CTA) with MPR, MIP, and 3D reconstructions allowed the diagnosis obviating the need for invasive procedures. PMID:33893860 | DOI:10.1007/s00276-021-02751-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Diagnostic discrepancy in second opinion reviews of primary epithelial neoplasms involving salivary gland: An 11‐year experience from a tertiary referral center focusing on useful pathologic approaches and potential clinical impacts

xlomafota13 shared this article with you from Inoreader Diagnostic discrepancy in second opinion reviews of primary epithelial neoplasms involving salivary gland: An 11‐year experience from a tertiary referral center focusing on useful pathologic approaches and potential clinical impacts Via Head & Neck Abstract Aims In the era of precision medicine, accurate pathologic diagnoses are crucial for appropriate management. Methods We herein described the histologic features and clinical impacts of 66 salivary gland epithelial neoplasms in which the diagnosis was altered after expert review. Results The most common revised diagnosis was that of salivary duct carcinoma (SDC, n = 12), adenoid cystic carcinoma (n = 12), and myoepithelial carcinoma (n = 10). The most common initial diagnosis was mucoepidermoid carcinoma (n = 19) with SDC being the most common revised diagnosis (7/19). Thirteen salivary gland carcinomas were initially diagnosed as benign entities, whereas five benign tumors were initially interpreted as carcinoma. The change in diagnosis was considered to be clinically significant in 65 (97%) cases. Conclusions Given their rarity, salivary gland neoplasms are prone to diagnostic inaccuracy and discrepancy. A constellation of histologic features and ancillary studies are useful in reaching the correct diagnosis, which can have significant clinical impacts. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.