Publications by authors named "Samuel L Barnett"

36 Publications

Surgical Site Infection After Autologous Cranioplasty for Decompressive Craniectomy in Traumatic Brain Injury: A Retrospective Review of Two Level 1 Trauma Centers.

J Craniofac Surg 2021 Jul 12. Epub 2021 Jul 12.

University of Texas Southwestern Department of Neurological Surgery, Dallas, TX St. Louis University Department of Neurological Surgery, St. Louis, MO Baylor University Medical Center, Division of Trauma, Department of Surgery, Dallas, TX.

Object: Surgical site infection (SSI) after cranioplasty can result in unnecessary morbidity. This analysis was designed to determine the risk factors of SSI after cranioplasty in patients who received a decompressive craniectomy with the autologous bone for traumatic brain injury (TBI).

Methods: A retrospective review was performed at two level 1 academic trauma centers for adult patients who underwent autologous cranioplasty after prior decompressive craniectomy for TBI. Demographic and procedural variables were collected and analyzed for associations with an increased incidence of surgical site infection with two-sample independent t tests and Mann Whitney U tests, and with a Bonferroni correction applied in cases of multiple comparisons. Statistical significance was reported with a P value of < 0.05.

Results: A total of 71 patients were identified. The mean interval from craniectomy to cranioplasty was 99 days (7-283), and 3 patients developed SSIs after cranioplasty (4.2%). Postoperative drain placement (P > 0.08) and administration of intrawound vancomycin powder (P = 0.99) were not predictive of infection risk. However, a trend was observed suggesting that administration of prophylactic preoperative IV vancomycin is associated with a reduced infection rate.

Conclusions: The SSI rate after autologous cranioplasty in TBI patients is lower than previously reported for heterogeneous groups and indications, and the infection risk is comparable to other elective neurosurgical procedures. As such, the authors recommend attempting to preserve native skull and perform autologous cranioplasty in this population whenever possible.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000007830DOI Listing
July 2021

Commentary: Hemifacial Spam: Endoscopic Assistance in Facial Nerve Decompression With Lateral Spread Response Corroboration: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 01;20(2):E129-E130

Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ons/opaa387DOI Listing
January 2021

The Association of Vestibular Schwannoma Volume With Facial Nerve Outcomes After Surgical Resection.

Laryngoscope 2021 04 2;131(4):E1328-E1334. Epub 2020 Oct 2.

Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.

Objective: To explore the relationship between tumor size and facial nerve outcomes following vestibular schwannoma (VS) resection.

Study Design: Single institutional retrospective chart review of all adult patients with untreated sporadic VS who underwent surgical resection from 2008 to 2018 with preoperative magnetic resonance imaging (MRI) and 1 year of follow-up. The primary outcome measure was facial nerve outcome as assessed by the House-Brackmann facial nerve grading system.

Results: One hundred sixty-seven patients, 54.5% female, with a median age of 49 years (20-76 years), were identified who underwent VS resection. Surgical resection was performed by translabyrinthine (76.7%), middle cranial fossa (14.4%), retrosigmoid (7.2%), and transpromontorial (1.8%) approaches. The median tumor diameter and volume were 25.3 mm (range: 4.1-47.1 mm) and 3.17 cm (range: 0.01-30.6 cm ), respectively. The median follow-up was 24.2 months (range: 12-114.2 months). Gross total resection was performed in 79% of cases, with residual tumor identified on MRI in 17% of cases. For patients with tumors <3 cm , 92.7% had grade 1 or 2 facial function after at least 1 year follow-up, compared to 81.2% for those with tumors >3 cm (univariate logistic regression OR = 2.9, P = .03). Tumor volume >3 cm was predictive of facial weakness on multivariate regression analysis (OR = 7.4, P = .02) when controlling for surgical approach, internal auditory canal extension, anterior extension, age, gender, and extent of resection.

Conclusions: Tumor volume >3 cm is associated with worse facial nerve outcomes 12 months following surgical resection.

Level Of Evidence: IV Laryngoscope, 131:E1328-E1334, 2021.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lary.29141DOI Listing
April 2021

Facial Nerve Outcomes After Vestibular Schwannoma Microsurgical Resection in Neurofibromatosis Type 2.

Otolaryngol Head Neck Surg 2021 04 22;164(4):850-858. Epub 2020 Sep 22.

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Objective: The aim of this study is to investigate facial nerve outcomes after microsurgical resection in neurofibromatosis type 2 (NF2) compared to sporadic tumors.

Study Design: Single institutional retrospective chart review.

Setting: Tertiary referral center.

Methods: All adult patients with NF2 vestibular schwannoma (VS) or sporadic VS who underwent microsurgical resection from 2008 to 2019 with preoperative magnetic resonance imaging (MRI) and 1 year of postsurgical follow-up were included. The primary outcome measure was postoperative House-Brackmann (HB) facial nerve score measured at first postoperative visit and after at least 10 months.

Results: In total, 161 sporadic VSs and 14 NF2 VSs met inclusion criteria. Both median tumor diameter (NF2, 33.5 mm vs sporadic, 24 mm, = .0011) and median tumor volume (NF2, 12.4 cm vs sporadic, 2.9 cm, = .0005) were significantly greater in patients with NF2. The median follow-up was 24.9 months (range, 12-130.1). Median facial nerve function after 1 year for patients with NF2 was HB 3 (range, 1-6) compared to HB 1 (range, 1-6) for sporadic VS ( = .001). With multivariate logistic regression, NF2 tumors (odds ratio [OR] = 13.9, = .001) and tumor volume ≥3 cm (OR = 3.6, = .025) were significantly associated with HB ≥3 when controlling for age, sex, extent of tumor resection, translabyrinthine approach, and prior radiation.

Conclusion: Tumor volume >3 cm and NF2 tumors are associated with poorer facial nerve outcomes 1 year following microsurgical resection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0194599820954144DOI Listing
April 2021

Biplane Fluoroscopic-Guided Balloon Rhizotomy for Trigeminal Neuralgia: A Technical Note.

Oper Neurosurg (Hagerstown) 2020 03;18(3):295-301

Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas.

Background: The classic percutaneous technique used to cannulate the foramen ovale for the treatment of trigeminal neuralgia can place important anatomic structures, such as the distal cervical internal carotid artery, at risk.

Objective: To use fixed anatomic landmarks to safely and reliably locate the foramen ovale on anteroposterior (AP) fluoroscopy.

Methods: Locating the foramen ovale was initially tested using AP fluoroscopy on cadaveric skulls in the neurosurgical simulation lab. Fluoroscopic landmarks were identified and utilized to assist in successfully locating the foramen ovale during percutaneous balloon rhizotomy procedures in patients with trigeminal neuralgia. This technique has been successfully used in multiple patients. In this report, we describe our technique in detail.

Results: The AP fluoroscopy is directed laterally in the coronal plane until a line drawn inferiorly from the lateral orbital rim bisects the inner concavity of the mandibular angle. Fluoroscopy is then directed inferiorly until the top of the petrous ridge bisects the mandibular ramus. The foramen ovale will come into view within the window between the mandibular ramus and hard palate. Two case illustrations are provided.

Conclusion: Balloon rhizotomy is a commonly used treatment option for trigeminal neuralgia. Direct visualization of the foramen ovale can reliably be achieved on AP fluoroscopy using specific anatomic landmarks. This technique can be utilized to increase the accuracy and safety of the procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ons/opz132DOI Listing
March 2020

Transcanal Microscopic Transpromontorial Approach for Vestibular Schwannoma.

J Neurol Surg B Skull Base 2019 Jun 28;80(Suppl 3):S279-S280. Epub 2019 Feb 28.

Department of Neurological Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States.

 This video demonstrates the transcanal transpromontorial approach for resection of vestibular schwannoma.  Present study is based on a video of a single patient undergoing the above approach at a tertiary care skull base surgery program.  This video demonstrates a transcanal microscopic transpromontorial approach for resection of an enlarging intracanalicular vestibular schwannoma in a young patient with nonserviceable hearing. The video highlights the pertinent surgical anatomy and outlines, in a step-by-step fashion, the approach to the internal auditory canal via this minimally invasive approach. The surgical indications and reconstructive techniques are also discussed ( Fig. 1 ).  A transcanal microscopic transpromontorial approach for vestibular schwannoma is feasible and offers a minimally invasive option for patients electing for microsurgical resection. The link to the video can be found at: https://youtu.be/-oKkRooytws .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-1677843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534664PMC
June 2019

Retrosigmoid Craniectomy for Vestibular Schwannoma with Hearing Preservation.

J Neurol Surg B Skull Base 2019 Jun 15;80(Suppl 3):S274-S275. Epub 2018 Oct 15.

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States.

 To describe a retrosigmoid craniectomy, hearing-preservation approach for resection of vestibular schwannoma.  A video of a single patient undergoing the above approach at a tertiary care skull base surgery program.  This video demonstrates a retrosigmoid craniectomy approach for resection of an enlarging intracanalicular vestibular schwannoma in a patient with normal hearing. The video highlights the pertinent surgical anatomy and outlines in a step-by-step fashion the surgical steps. The patient obtained a gross total resection with preservation of hearing.  A retrosigmoid craniectomy approach for vestibular schwannoma offers a potentially hearing preservation approach for selected tumors. The link to the video can be found at: https://youtu.be/VM663XztRZw .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0038-1675148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534507PMC
June 2019

Fractionated CyberKnife Stereotactic Radiotherapy for Perioptic Pituitary Adenomas.

World Neurosurg 2019 Jun 19;126:e1359-e1364. Epub 2019 Mar 19.

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Objective: Stereotactic radiosurgery (SRS) is the reference standard for radiotherapy for pituitary adenomas but has been limited to lesions with sufficient distance (i.e., >3 mm) from the optic apparatus. We used marginless, fractionated (i.e., 25-28 fractions) stereotactic radiotherapy and the CyberKnife to treat pituitary adenomas that were not eligible for SRS. We present the clinical outcomes, including local control, endocrine function, and toxicity from modern fractionated radiotherapy.

Methods: A total of 53 patients were treated for pituitary adenomas within 3 mm of the optic apparatus. The primary endpoint was tumor control with the secondary endpoints of vision and pituitary function preservation and endocrine control in hormone-secreting tumors.

Results: The tumor control rate as measured on magnetic resonance imaging as either stable or decreased in size was 98.1% (52 of 53) at a mean follow-up of 32.5 months (range, 3-77). All patients experienced preservation or improvement of their preexisting vision status. No change in pituitary function was noted in 52 of the 53 patients (98.1%). One patient experienced worsening of pituitary function secondary to pituitary apoplexy that occurred 4 months after treatment. The endocrine control rate in hormone-secreting tumors was 75% (6 of 8).

Conclusions: Marginless, fractionated CyberKnife radiotherapy demonstrated excellent local tumor control and endocrine control rates, comparable to those with SRS, with preservation of vision in patients with adenomas in close proximity to the optic pathway.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2019.03.102DOI Listing
June 2019

Combined Microsurgical, Endovascular, and Endoscopic Approach to the Treatment of a Giant Vertebrobasilar Aneurysm.

Oper Neurosurg (Hagerstown) 2019 08;17(2):149-156

Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas.

Background: Dolichoectasia is defined as elongation and dilatation of a blood vessel. In the intracranial circulation, the basilar artery is affected in 80% of cases. These are challenging lesions with an aggressive natural history, and treatment carries a relatively high rate of morbidity and mortality. We describe a case of multimodal treatment including endovascular, open microsurgical, and endoscopic endonasal approach (EEA) for management.

Objective: To describe the technical nuance of the addition of the EEA for management of posterior circulation dolichoectasia.

Methods: A 44-yr-old Hispanic woman with a 2-mo history of progressive headaches, gait disturbance, and lower cranial nerve dysfunction presented with acute neurologic decline. MRI demonstrated a dolichoectatic vertebrobasilar system with a giant 4.5-cm fusiform basilar aneurysm.

Results: She underwent concomitant endovascular bilateral vertebral artery sacrifice with suction decompression and trapping by clip ligation distal to the lesion. Postoperatively, she developed symptomatic pontine compression. She was then taken for a transclival EEA for intra-aneurysmal thrombectomy. Thereafter, she made a significant functional recovery.

Conclusion: The addition of endoscopic reconstruction to the treatment of a dolichoectatic basilar aneurysm is an operative nuance that can be employed in treating these highly morbid lesions. This case describing a multimodal treatment paradigm including EEA reconstruction can serve as an example for the future of treatment select cases of dolichoectasia of the vertebrobasilar complex.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ons/opy341DOI Listing
August 2019

Neoadjuvant Stereotactic Radiosurgery Before Surgical Resection of Cerebral Metastases.

World Neurosurg 2018 Dec 24;120:e480-e487. Epub 2018 Aug 24.

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address:

Objective: Stereotactic radiosurgery (SRS) has redefined the treatment paradigm for cerebral metastases. The benefits of SRS after surgical resection of a metastatic brain tumor have been well-defined. However, it is unclear whether preoperative SRS can improve the outcomes in select patients. The present study examined the safety and efficacy of preoperative neoadjuvant SRS (NaSRS) for the treatment of cerebral metastases.

Methods: We performed a retrospective review of 12 patients treated at The University of Texas Southwestern Medical Center. All patients underwent NaSRS, followed by surgical resection of a cerebral metastasis, from 2011 to 2015. Recurrence and overall survival were characterized using Kaplan-Meier and log-rank analyses.

Results: The mean age was 57.5 years (range, 39-69). The median follow-up period was 13 months (range, 1-22.6). The median maximum tumor diameter was 3.66 cm (range, 2.19-4.85). The 6- and 12-month local control rates were 81.8% and 49.1%, respectively. The distant disease control rates were 72.7% and 14.5% at 6 and 12 months, respectively. Overall survival was 83.3% and 74.1% at 6 and 12 months, respectively. Two patients developed leptomeningeal disease at a mean of 11.3 months. A trend toward increased local failure was seen with larger tumor volumes and diameters (P = 0.06).

Conclusions: NaSRS is a promising new approach for the treatment of select cerebral metastases that require surgical intervention. The approach is safe and effective at achieving local control. Further randomized studies with larger patient cohorts are necessary to determine whether the long-term outcomes are improved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2018.08.107DOI Listing
December 2018

Endoscopic Transcanal Transpromontorial Approach for Vestibular Schwannoma Resection: A Case Series.

Otol Neurotol 2017 12;38(10):e490-e494

*Department of Otolaryngology-Head and Neck Surgery †Department of Neurosurgery, University of Texas, Southwestern Medical Center, Dallas, Texas ‡Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee.

Objective: To demonstrate successful surgical management of vestibular schwannomas via an exclusively endoscopic transcanal transpromontorial approach (EETTA).

Patients: Four patients with vestibular schwannomas.

Interventions: Surgical excision via EETTA.

Main Outcomes: Technique refinements, tumor access, complete tumor removal, and patient morbidity.

Results: Three tumors were Koos grade I and one tumor was Koos grade II. All ears had non-serviceable hearing prior to surgery. The EETTA enabled access to the internal auditory canal and porus acousticus as well as limited access to the cerebellopontine angle. Gross total tumor resection was achieved in all cases. There were no intraoperative or postoperative complications and the mean hospital duration was 2.8 days. After a mean follow-up of 5.0 months, all cases had a good facial nerve outcome.

Conclusions: The EETTA can be successfully used for the management of small vestibular schwannomas in ears without serviceable hearing. Additional studies are needed to fully elucidate the risk-benefit profile of this minimally invasive approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAO.0000000000001588DOI Listing
December 2017

Intracranial Hemangiopericytomas: Recurrence, Metastasis, and Radiotherapy.

J Neurol Surg B Skull Base 2017 Aug 1;78(4):324-330. Epub 2017 Mar 1.

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States.

 Intracranial hemangiopericytomas (HPCs) are characterized by high recurrence rates and extracranial metastases. Radiotherapy provides an adjunct to surgery, but the timing of therapy and the patients most likely to benefit remain unclear.  A retrospective review of 20 patients with HPC treated at the University of Texas Southwestern Medical Center between 1985 and 2014 was conducted. Recurrence and metastasis rates along with overall survival (OS) were characterized based on therapeutic approach and tumor pathology using Kaplan-Meier and Cox regression analyses.  The mean age was 45.6 years (range: 19-77). Gross total resection (GTR) was achieved in 13 patients, whereas 5 patients underwent subtotal resection. Median follow-up was 91.5 months (range: 8-357). The 5-, 10-, and 15-year recurrence-free survival (RFS) rates were 61, 41, and 20%, respectively. Six patients developed metastases at an average of 113 months (range: 42-231). OS at last follow-up was 80%. Importantly, immediate postoperative adjuvant radiotherapy (IRT) did not influence RFS compared with surgery alone or OS compared with delayed radiotherapy at the time of recurrence.  HPCs have high recurrence rates necessitating close follow-up. Surgery remains an important first step, but the timing of radiotherapy for optimal control and OS remains uncertain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1599073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515655PMC
August 2017

Symptomatic Parietal Intradiploic Encephalocele-A Case Report and Literature Review.

J Neurol Surg Rep 2017 Jan;78(1):e43-e48

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States.

Encephalocele is a rare condition that consists of herniation of cerebral matter through openings of dura and skull. A majority of encephaloceles are congenital and manifest in childhood. We present a case of a 45-year-old man presenting with contralateral hemiparesis and found to have an extremely rare phenomenon of a symptomatic posttraumatic parietal intradiploic encephalocele (IE) manifesting 36 years following pediatric traumatic head injury. Computed tomography and magnetic resonance imaging confirmed herniation of brain tissue into the intradiploic space. Surgical treatment with reduction of the encephalocele achieved near resolution of preoperative hemiparesis on follow-up. The pathogenesis and a literature review of IE are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1599799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5355005PMC
January 2017

Calcified Middle Cranial Fossa Mass.

J Neurol Surg Rep 2017 Jan;78(1):e37-e39

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States.

A 21-year-old male presented for evaluation of transient loss of consciousness and was found to have a hyperdense mass in the left middle fossa. He underwent craniotomy for tumor resection. Intra- and extradural invasion was noted. Gross total resection was achieved. Pathology demonstrated a densely cellular neoplasm with predominately spindle cell morphology in a collagen-containing stroma, areas of vascular proliferation, focal mineralization, and regions of cartilage formation. High mitotic index and regions of necrosis were seen. Based on the final diagnosis of osteosarcoma, the patient was referred for chemotherapy and radiation. Intracranial osteosarcoma is a nonmeningiomatous mesenchymal tumor. Most osteosarcomas are meningeal-based and supratentorial. Presentation depends on tumor location and may include focal neurologic deficits, cranial neuropathy, seizures, or symptoms of increased intracranial pressure. Given the relative rarity of intracranial osteosarcoma, there are no established guidelines for treatment, and therapy is guided by experience with systemic osteosarcoma. Gross total resection is recommended whenever feasible. Both chemotherapy and radiation therapy are used as adjuvant therapy. Regardless of treatment, osteosarcoma remains a highly aggressive malignancy with a poor prognosis. Morbidity and mortality may be the result of local recurrence or development of pulmonary or skeletal metastasis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1598112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332251PMC
January 2017

Unusual skull tumors with psammomatoid bodies: a diagnostic challenge.

Clin Neuropathol 2017 May/Jun;36 (2017)(3):114-120

Aim: We describe a series of three diagnostically challenging, histologically similar fibro-osseous skull masses.

Methods: The cases were identified in our archives among 50,000 neuropathology specimens. A comprehensive review of the histological, immunohistochemical, ultrastructural, and imaging features as well as the clinical outcome was performed.

Results: The routine histology was similar in all 3 cases and showed spindle cell proliferations with frequent calcospheres or psammomatoid bodies. There was no evidence of an underlying subdural component. Immunohistochemistry for the meningioma markers EMA and SSTR2A raised the possibility of intraosseous meningioma, as all 3 lesions were convincingly positive for epithelial membrane antigen (EMA) and 1 lesion was convincingly positive for the somatostatin receptor subtype 2A (SSTR2A); weak, questionable positivity for SSTR2 was present in the remaining 2 cases. In addition, electron microscopy was available in 1 case and showed features consistent with meningioma.

Conclusions: Overall, the findings were most consistent with intraosseous meningioma. Primary intraosseous meningiomas are rare lesions that may present a diagnostic challenge. It is important to consider meningiomas in the differential diagnosis, as extradural meningiomas are associated with an increased risk of recurrence and may occasionally undergo malignant transformation.
.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5414/NP300997DOI Listing
January 2018

Petroclival Chondrosarcoma: A Multicenter Review of 55 Cases and New Staging System.

Otol Neurotol 2016 08;37(7):940-50

*Department of Otolaryngology †Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota ‡The Otology Group, Department of Otolaryngology-Head and Neck Surgery §Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee ||Department of Head and Neck Surgery ¶Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas #Department of Otolaryngology-Head and Neck Surgery **Department of Neurosurgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.

Objective: To analyze clinical outcomes after treatment of petroclival chondrosarcoma and to propose a novel staging system.

Study Design: Retrospective case review, 1995 to 2015.

Setting: Multicenter study.

Patients: Consecutive patients with histopathologically proven petroclival chondrosarcoma.

Intervention(s): Microsurgery, endoscopic endonasal surgery, radiation therapy, observation.

Main Outcome Measures: Disease- and treatment-associated morbidity, recurrence, mortality.

Results: Fifty-five patients (mean age 42 years; 56% women) presenting with primary or recurrent petroclival chondrosarcoma were analyzed. The mean duration of follow-up was 74 months. Among 47 primary cases, the most common presenting symptoms were headache (55%) and diplopia (49%) and the mean tumor size at diagnosis was 3.3 cm. Subtotal resection was performed in 33 (73%) patients and gross total resection in 12 (27%). Adjuvant postoperative radiation was administered in 30 (64%) cases. Preoperative cranial neuropathy improved in 13 (29%), worsened in 11 (24%), and remained stable in 21 (47%) patients; notably, 11 preoperative sixth nerve palsies resolved after treatment. Nine recurrences occurred at a mean of 42 months. The 1-, 3-, 5- and 10-year recurrence-free survival rate for all 45 patients who underwent primary microsurgery with or without adjuvant radiation therapy was 97%, 89%, 70%, and 56%, respectively. Higher tumor stage, larger categorical size (<4 versus ≥4 cm), lack of adjuvant radiation, and longer duration of follow-up were associated with greater risk of recurrence. The overall mortality rate was 2% for patients presenting with primary disease.Analyzing the cohort of 17 cases with 20 recurrences, 3 received salvage surgery alone, 5 radiation therapy alone, 11 multimodality treatment, and one patient has been observed. Tumor control was ultimately achieved in 15 of 17 patients with recurrent disease. One patient (6%) with grade 3 petroclival chondrosarcoma died as a result of rapidly progressive disease within 6 months of salvage treatment. The overall mortality rate was 6% for patients with recurrent disease.

Conclusion: Gross total or subtotal resection with adjuvant radiation provides durable tumor control with minimal morbidity in most patients. Surgery may improve preoperative cranial nerve dysfunction, particularly in the case of cranial nerve 6 paralysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAO.0000000000001037DOI Listing
August 2016

Pre-treatment factors associated with detecting additional brain metastases at stereotactic radiosurgery.

J Neurooncol 2016 06 10;128(2):251-7. Epub 2016 Mar 10.

Department of Radiation Oncology, Inova Dwight and Martha Schar Cancer Institute, 3300 Gallows Road, Falls Church, VA, 22042, USA.

The number of brain metastases identified on diagnostic magnetic resonance imaging (MRI) is a key factor in consideration of stereotactic radiosurgery (SRS). However, additional lesions are often detected on high-resolution SRS-planning MRI. We investigated pre-treatment clinical characteristics that are associated with finding additional metastases at SRS. Patients treated with SRS for brain metastases between the years of 2009-2014 comprised the study cohort. All patients underwent frame-fixed, 1 mm thick MRI on the day of SRS. Patient, tumor, and treatment characteristics were analyzed for an association with increase in number of metastases identified on SRS-planning MRI. 289 consecutive SRS cases were analyzed. 725 metastases were identified on pre-treatment MRI and 1062 metastases were identified on SRS-planning MRI. An increase in the number of metastases occurred in 34 % of the cases. On univariate analysis, more than four metastases and the diameter of the largest lesion were significantly associated with an increase in number of metastases on SRS-planning MRI. When stratified by the diameter of the largest lesion into <2, 2-3, or ≥3 cm, additional metastases were identified in 37, 29, and 18 %, respectively. While this increase in the number of metastases is largely due to the difference in imaging technique, the number and size of the metastases were also associated with finding additional lesions. These clinical factors may be considered when determining treatment options for brain metastases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11060-016-2103-3DOI Listing
June 2016

Endoscopic Endonasal Management of Olfactory Neuroblastoma: A Retrospective Analysis of 10 Patients with Quality-of-Life Measures.

World Neurosurg 2016 06 16;90:1-5. Epub 2016 Feb 16.

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address:

Objective: Anterior craniofacial resection has served as the traditional surgical treatment of olfactory neuroblastoma (ON). With the development of extended endonasal approaches, the opportunity exists for using minimal access techniques for management of select tumors. This study assesses the impact of endoscopic resection on ON and patient outcomes and quality of life.

Methods: A retrospective review identified 10 patients with ON (3 women, 7 men; mean age 49.1 years) who underwent endoscopic resection during the period 2010-2013. Modified Kadish staging divided the cohort into 3 stage B patients (30%), 5 stage C patients (50%), and 2 stage D patients (20%). Outcome measures included extent of resection, complications, recurrence, and preoperative and postoperative Sino-Nasal Outcome Test-20 scores.

Results: Gross total resection was achieved in all patients, with negative margins in 9 patients. One patient had negative frozen section pathology but was noted to have a positive posterior dural margin on final pathology. There was a 20% complication rate (pneumocephalus, ethmoid meningoencephalocele). Neoadjuvant chemotherapy and radiation were performed in 2 patients (Kadish stage C and D). Adjuvant chemotherapy and radiation were performed in 5 patients (4 Kadish stage C and 1 stage D). Postoperative radiation alone was administered in 3 patients (Kadish stage B). Analysis of postoperative Sino-Nasal Outcome Test-20 scores demonstrated no significant change relative to preoperative Sino-Nasal Outcome Test-20 scores. At the most recent follow-up examination, there was no evidence of recurrent disease in patients who underwent endoscopic resection. One patient (Kadish stage D) died during the follow-up period. Mean follow-up duration was 21.1 months.

Conclusions: This series adds to the growing body of literature that suggests equivalent or improved outcomes of purely endonasal resection for select patients. Given the advanced Kadish stage of most of our patients, longer follow-up is required to determine the full applicability of purely endoscopic approaches to the treatment of ON.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2016.02.035DOI Listing
June 2016

Intracranial Facial Nerve Grafting in the Setting of Skull Base Tumors: Global and Regional Facial Function Analysis and Possible Implications for Facial Reanimation Surgery.

Plast Reconstr Surg 2016 Jan;137(1):267-278

Dallas, Texas From the Departments of Plastic Surgery, Otolaryngology, Physical Therapy, and Neurosurgery, University of Texas Southwestern.

Background: Reconstructive surgeons may encounter patients presenting after intracranial facial nerve resection and grafting in the setting of skull base tumors, who inquire regarding progression, final facial function, and need for future operations. Study goals were to analyze global and regional facial function using established grading systems and videography, while examine variables possibly affecting outcomes.

Methods: Between 1997 and 2012, 28 patients underwent intracranial nerve grafting. Fifteen were prospectively evaluated by three facial nerve physical therapists with the Facial Nerve Grading System 2.0 and the Sunnybrook Facial Grading Score for function and the Facial Disability Index for quality of life. Still photographs and videography were used to assess quality of motion and tone, while demographic and medical variables were analyzed regarding their effect on end results.

Results: Average patient age was 41.9 years (range, 22 to 66 years), and there were 10 women and five men. Average time interval between nerve grafting and evaluations was 42.9 months (range, 12 to 146 months). Both grading scores demonstrated best outcomes in the periorbita and worst outcomes in the brow. Buccinator muscle tone also improved. The average total Facial Disability Index was 67.5 percent. Although not statistically significant, the data suggest that nerve gap length affected total resting symmetry and voluntary movement, whereas preoperative palsy and age may affect total resting symmetry. Perioperative radiation therapy, tumor type, donor nerve, and coaptation technique were not found to affect outcomes.

Conclusions: Intracranial facial nerve grafting largely provides better resting tone and facial symmetry, potentially improving end results of future intervention; however, overall voluntary facial motion is poor.

Clinical Question/level Of Evidence: Therapeutic, IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PRS.0000000000001881DOI Listing
January 2016

From Patchell to Brown: An Evidence-Based Evolution of the Role of Radiotherapy on the Management of Brain Metastases.

World Neurosurg 2016 Jan 8;85:10-4. Epub 2015 Dec 8.

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2015.12.003DOI Listing
January 2016

Comparative analysis of quality-of-life metrics after endoscopic surgery for sinonasal neoplasms.

Am J Rhinol Allergy 2015 Mar-Apr;29(2):151-5

Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA.

Background: The objective of this study was to evaluate the postoperative quality of life (QOL) after endoscopic resection of sinus and skull base neoplasms using validated outcomes measures and to perform correlation of the various metrics to better discern their efficacy. Prospective QOL data collection and retrospective chart review were performed.

Methods: QOL data were collected using the 20-item Sino-Nasal Outcome Test (SNOT-20), Anterior Skull Base Questionnaire (ASBQ), European Quality-of-Life-5 Dimension (EQ-5D) questionnaire, and Lund-Kennedy endoscopic (LKE) score in 71 patients with sinonasal and skull base tumors.

Results: The mean age was 53 years and mean follow-up was 14.5 months at the time QOL data were collected. Benign and malignant tumors represented 39 (54.9%) and 32 (45.1%) cases, respectively. Twenty malignancies (62.5%) were stage T3 or T4, and 23 required postoperative chemotherapy and radiation (CRT). Factors indicating worsened postoperative QOL included malignant histopathology, T3 or T4 tumors, and the use of postoperative CRT (p < 0.05). There was a strong correlation of ASBQ with EQ-5D and SNOT-20 scores (r < -0.5) and a moderate correlation between the SNOT-20 and EQ-5D (r > 0.3), and the LKE had moderate correlation with SNOT-20 (r > 0.3) and weak correlation to the ASBQ (r > -0.3) and EQ-5D (r < 0.3).

Conclusion: Patients who have undergone endoscopic resection of sinonasal tumors have quantifiable QOL changes as measured by various validated metrics. This study shows that concurrent use of these instruments may better discern QOL outcomes after endoscopic tumor surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2500/ajra.2015.29.4137DOI Listing
January 2016

The utility of preoperative diffusion tensor imaging in the surgical management of brainstem cavernous malformations.

J Neurosurg 2015 Mar 9;122(3):653-62. Epub 2015 Jan 9.

Departments of 1 Neurological Surgery and.

Object: Resection of brainstem cavernous malformations (BSCMs) may reduce the risk of stepwise neurological deterioration secondary to hemorrhage, but the morbidity of surgery remains high. Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) are neuroimaging techniques that may assist in the complex surgical planning necessary for these lesions. The authors evaluate the utility of preoperative DTI and DTT in the surgical management of BSCMs and their correlation with functional outcome.

Methods: A retrospective review was conducted to identify patients who underwent resection of a BSCM between 2007 and 2012. All patients had preoperative DTI/DTT studies and a minimum of 6 months of clinical and radiographic follow-up. Five major fiber tracts were evaluated preoperatively using the DTI/DTT protocol: 1) corticospinal tract, 2) medial lemniscus and medial longitudinal fasciculus, 3) inferior cerebellar peduncle, 4) middle cerebellar peduncle, and 5) superior cerebellar peduncle. Scores were applied according to the degree of distortion seen, and the sum of scores was used for analysis. Functional outcomes were measured at hospital admission, discharge, and last clinic visit using modified Rankin Scale (mRS) scores.

Results: Eleven patients who underwent resection of a BSCM and preoperative DTI were identified. The mean age at presentation was 49 years, with a male-to-female ratio of 1.75:1. Cranial nerve deficit was the most common presenting symptom (81.8%), followed by cerebellar signs or gait/balance difficulties (54.5%) and hemibody anesthesia (27.2%). The majority of the lesions were located within the pons (54.5%). The mean diameter and estimated volume of lesions were 1.21 cm and 1.93 cm(3), respectively. Using DTI and DTT, 9 patients (82%) were found to have involvement of 2 or more major fiber tracts; the corticospinal tract and medial lemniscus/medial longitudinal fasciculus were the most commonly affected. In 2 patients with BSCMs without pial presentation, DTI/DTT findings were important in the selection of the surgical approach. In 2 other patients, the results from preoperative DTI/DTT were important for selection of brainstem entry zones. All 11 patients underwent gross-total resection of their BSCMs. After a mean postoperative follow-up duration of 32.04 months, all 11 patients had excellent or good outcome (mRS Score 0-3) at the time of last outpatient clinic evaluation. DTI score did not correlate with long-term outcome.

Conclusions: Preoperative DTI and DTT should be considered in the resection of symptomatic BSCMs. These imaging studies may influence the selection of surgical approach or brainstem entry zones, especially in deep-seated lesions without pial or ependymal presentation. DTI/DTT findings may allow for more aggressive management of lesions previously considered surgically inaccessible. Preoperative DTI/DTT changes do not appear to correlate with functional postoperative outcome in long-term follow-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2014.11.JNS13680DOI Listing
March 2015

Management of intracranial aneurysms associated with arteriovenous malformations.

Neurosurg Focus 2014 Sep;37(3):E11

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

Intracranial or brain arteriovenous malformations (BAVMs) are some of the most interesting and challenging lesions treated by the cerebrovascular neurosurgeon. It is generally believed that the combination of BAVMs and intracranial aneurysms (IAs) is associated with higher hemorrhage rates at presentation and higher rehemorrhage rates and thus with a more aggressive course and natural history. There is wide variation in the literature on the prevalence of BAVM-associated aneurysms (range 2.7%-58%), with 10%-20% being most often cited in the largest case series. The risk of intracranial hemorrhage in patients with unruptured BAVMs and coexisting IAs has been reported to be 7% annually, compared with 2%-4% annually for those with BAVM alone. Several different classification systems have been applied in an attempt to better understand the natural history of this combination of lesions and implications for treatment. Independent of the classification used, it is clear that a few subtypes of aneurysms have a direct hemodynamic correlation with the BAVM itself. This is exemplified by the fact that the presence of a distal flow-related or an intranidal aneurysm appears to be associated with an increased hemorrhage risk, when compared with an aneurysm located on a vessel with no direct supply to the BAVM nidus. Debate still exists regarding the etiology of the association between those two vascular lesions, the subsequent implications for patients' risk of hemorrhagic stroke, and finally the determination of which patients warrant treatment and when. The ultimate goals of the treatment of a BAVM associated with an IA are to prevent hemorrhage, avoid stepwise neurological deterioration, and eliminate the mortality risk associated with recurrent hemorrhagic events. The treatment is only justifiable if the risks associated with an intervention are lower than or equivalent to the long-term risks of disability or mortality caused by the lesion itself. When faced with this difficult decision, a few questions need to be answered by the treating neu-rosurgeon: What is the mode of presentation? What is the symptomatic lesion? Which one of the lesions bled? What is the relationship between the BAVM and IA? Is it possible to safely treat both BAVM and IA? The objective of this review is to discuss the demographics, natural history, classification, and strategies for management of BAVMs associated with IAs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2014.6.FOCUS14165DOI Listing
September 2014

Dermoid cyst of the infratemporal fossa: case report and review of the literature.

J Neurol Surg Rep 2014 Aug 12;75(1):e33-7. Epub 2013 Dec 12.

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States.

Background Intracranial dermoid cysts are rare tumors of congenital origin. We report a case of a large dermoid tumor arising in the infratemporal fossa (ITF) with erosion into the middle cranial fossa. After reviewing the literature, we believe this represents the first reported dermoid tumor of the ITF with extension into the middle cranial fossa. Results A 21-year-old women presented with a large cystic mass involving the left infratemporal fossa and middle cranial fossa that was discovered following a motor vehicle collision. Neurologic examination was normal. The mass was resected through a frontotemporal extradural approach with endoscopic assistance. Imaging studies, gross findings, and histopathology were consistent with a dermoid tumor. Conclusion This is the first report of a dermoid cyst arising in the ITF with extension into the middle cranial fossa. We suggest including dermoid tumor in the differential diagnosis of cystic abnormalities in this region. Complete resection of the cyst remains the preferred treatment with surgical approach guided by preoperative imaging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0033-1358795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110133PMC
August 2014

The treatment of cavernous sinus meningiomas: evolution of a modern approach.

Neurosurg Focus 2013 Dec;35(6):E8

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

Cavernous sinus meningiomas (CSMs) are challenging lesions for the skull base neurosurgeon to manage given their close association with cranial nerves II-VI and the internal carotid artery. In the 1980s and early 1990s, with advancements in microsurgical techniques, increasing knowledge of the relevant microsurgical neuroanatomy, and the advent of advanced skull base surgical approaches, the treatment of CSMs involved attempts at gross-total resection (GTR). Initial fervor for a surgical cure waned, however, as skull base neurosurgeons demonstrated the limits of complete resection in this region, the ongoing issue of potential tumor recurrences, and the unacceptably high cranial nerve and vascular morbidity associated with this strategy. The advent of radiosurgery and its documented success for tumor growth control and limited morbidity in cavernous lesions has helped to shift the treatment goals for CSMs from GTR to tumor control and symptom relief while minimizing treatment- and lesion-associated morbidity. The authors review the relevant microanatomy of the cavernous sinus with anatomical and radiographic correlates, as well as the various treatment options. A modernized, multimodality treatment algorithm to guide management of these lesions is proposed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2013.9.FOCUS13345DOI Listing
December 2013

The far-lateral approach for foramen magnum meningiomas.

Neurosurg Focus 2013 Dec;35(6):E12

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

Foramen magnum meningiomas (FMMs) are slow growing, most often intradural and extramedullary tumors that pose significant challenges to the skull base neurosurgeon. The indolent clinical course of FMMs and their insidious onset of symptoms are important factors that contribute to delayed diagnosis and relative large size at the time of presentation. Symptoms are often produced by compression of surrounding structures (such as the medulla oblongata, upper cervical spinal cord, lower cranial nerves, and vertebral artery) within a critically confined space. Since the initial pathological description of a FMM in 1872, various surgical approaches have been described with the aim of achieving radical tumor resection. The surgical treatment of FMMs has evolved considerably over the last 4 decades due to the progress in microsurgical techniques and development of a multitude of skull base approaches. Posterior and posterolateral FMMs can be safely resected via a standard midline suboccipital approach. However, controversy still exits regarding the optimal management of anterior or anterolateral lesions. Independently of technical variations and the degree of bone removal, all modern surgical approaches to the lower clivus and anterior foramen magnum derive from the posterolateral (or far-lateral) craniotomy originally described by Roberto Heros and Bernard George. This paper is a review of the surgical management of FMMs, with emphasis on the far-lateral approach and its variations. Clinical presentation, imaging findings, important neuroanatomical correlations, recurrence rates, and outcomes are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2013.10.FOCUS13332DOI Listing
December 2013

Endoscopic skull base surgery practice patterns: survey of the North American Skull Base Society.

Int Forum Allergy Rhinol 2013 Aug 6;3(8):659-63. Epub 2013 Feb 6.

Department of Otolaryngology-Head and Neck Surgery, Comprehensive Skull Base Program, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.

Background: The objective of this study was to evaluate the potential impact of advanced endoscopic techniques on the current practice patterns in skull base surgery.

Methods: A 20-item written survey approved by the American Rhinologic Society (ARS) and North American Skull Base Society (NASBS) was conducted at the 22nd Annual NASBS meeting in Las Vegas, NV, from February 17 to 19, 2012. The target group included 212 practicing skull base surgeons.

Results: Seventy-nine physicians (37.3%) completed the survey. The subspecialty composition was 42 (53%) otolaryngologists and 35 (44%) neurosurgeons. The respondents represented all regions of the country, with most common being the North Central (24%) and Mid-Atlantic (23%) states. Open and endoscopic skull base techniques were used by 91% and 80%, respectively. During a typical year, the number of endoscopic skull base cases ranged between 20 and 50 in 32%, 50 to 100 in 13%, and >100 in 8%. Endoscopic pituitary surgery was performed by 95%, while transcribriform, transplanum, and transclival approaches were performed by 70.5%, 66%, and 66%, respectively. Wide variation in coding philosophy was noted, including use of unlisted neurosurgical (28%), open skull base (28%), unlisted endoscopic (24%), and sinus surgery (20%) codes. Only 30% of physicians reported adequate reimbursement in ≥50% of the performed cases. Overall, 87% were supportive of the creation of dedicated endoscopic skull base codes.

Conclusion: The present survey attests to the widespread adaptation of endoscopic techniques in the management schema of skull base surgery. The wide variation in coding techniques and inadequate reimbursement suggests that future dialogue should also focus on developing consensus with respect to the coding and billing process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/alr.21151DOI Listing
August 2013

Sinonasal teratocarcinosarcoma with intracranial extension: case report and literature review.

Ear Nose Throat J 2012 Dec;91(12):536-9

Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.

Sinonasal teratocarcinosarcoma (SNTCS) is an extremely rare malignancy of the paranasal sinuses that possesses the histopathologic features of both teratomas and carcinosarcomas. We report the case of a 58-year-old white man who presented with a 1-year history of a gradually enlarging left-sided nasal mass. The patient had previously undergone endoscopic sinus surgery at another facility, and the final pathologic specimen was reported as an SNTCS with positive margins. He was then referred to our institution, where he underwent a craniofacial resection combined with endoscopic intranasal resection. Postoperatively, he received combined chemotherapy and irradiation. At 48 months of follow-up, he was alive without evidence of disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/014556131209101210DOI Listing
December 2012

Hearing preservation using the middle fossa approach for the treatment of vestibular schwannoma.

Neurosurgery 2012 Feb;70(2):334-40; discussion 340-1

Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Background: The incidence of small vestibular schwannomas in patients with serviceable hearing is increasing because of the widespread use of MRI. The middle fossa approach provides the patient with an opportunity for tumor removal with hearing preservation.

Objective: To determine the rate of hearing preservation and facial nerve outcomes after removal of a vestibular schwannoma with the use of the middle fossa approach.

Methods: A retrospective case review at a tertiary, academic medical center was performed identifying patients from 1998 through 2008 that underwent removal of a vestibular schwannoma by the middle fossa approach. Preoperative and postoperative audiograms were compared to determine hearing preservation rates. In addition, facial nerve outcomes at last follow-up were recorded.

Results: Forty-six patients underwent a middle fossa craniotomy for the removal of a vestibular schwannoma. Of the 38 patients that had class A or class B hearing preoperatively, 24 (63.2%) retained class A or B hearing and 29 (76.3%) retained class A, B, or C hearing. When tumors were 10 mm or less in patients with class A or B preoperative hearing, 22 of 30 patients (73.3%) retained class A or B hearing. When the tumor size was greater than 10 mm in patients with class A or B preoperative hearing, 2 of 8 patients (25%) retained class A or B hearing. At most recent follow-up, 76.1% of patients had House-Brackmann grade I facial function, 13.0% had House-Brackmann grade II facial function, and 10.9% had House-Brackmann grade III facial function.

Conclusion: Hearing preservation rates are excellent using the middle fossa approach, especially for smaller tumors. No patient experienced long-term facial nerve function worse than House-Brackmann grade III.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1227/NEU.0b013e31823110f1DOI Listing
February 2012

Perineural extension of cutaneous desmoplastic melanoma mimicking an intracranial malignant peripheral nerve sheath tumor. Case report.

J Neurosurg 2011 Aug 6;115(2):273-7. Epub 2011 May 6.

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA.

The authors present a case illustrating the importance of obtaining a biopsy of any facial skin lesions in a patient presenting with an intracranial tumor involving the facial or trigeminal nerve. Conventional malignant melanoma metastasizes to the brain frequently and does not usually pose diagnostic difficulties. Direct intracranial spread of cutaneous melanoma is rare. In our patient, desmoplastic melanoma with perineural spread to the Meckel cave mimicked a malignant peripheral nerve sheath tumor clinically, radiographically, and histologically.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2011.4.JNS10913DOI Listing
August 2011
-->