558 results match your criteria Skull Base Petrous Apex Tumors


Recurrent Chordoma Resection in the Advanced Multimodality Image Guided Operating Suite: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Apr;20(5):E344-E345

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Recurrent skull base chordomas are challenging lesions. They already had maximum radiation, and in the absence of any effective medical treatment, surgical resection is the only treatment.1,2 Surgery on recurrent previously radiated chordomas, however, carries much higher risk and the likelihood of subtotal resection. Read More

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Petrosal Approach With Preservation of the Superior Petrosal Sinus (the Graceful Petrosal) for Resection of Giant Trigeminal Schwannoma: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Apr;20(5):E342-E343

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Trigeminal schwannomas are benign tumors amendable to curative surgical resection.1 Excellent outcomes, with preservation and improvement of cranial nerve function, including trigeminal nerve function, have been reported with microsurgical resection through skull base approaches.2 Dumbell shaped tumors, involving the middle and posterior fossa, are more challenging. Read More

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Analysis of Approaches in the Microsurgical Treatment of 102 Cases of Petroclival Meningioma in a Single Center.

Front Neurol 2021 19;12:627736. Epub 2021 Mar 19.

Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

We identified the optimal approaches for treating the diverse tumor subtypes of petroclival meningioma (PM) by analyzing the clinical benefits of various surgical approaches adopted for each subtype. Tumors in 102 PM patients from a single center who underwent surgical treatment were classified as upper clivus (UC), cavernous sinus (CS), tentorium (TE), or petrous apex (PA) types based on the attachment site of the tumor base and the displacement of the trigeminal nerve. The therapeutic effects of different surgical approaches among the subtypes were evaluated according to the patient outcomes. Read More

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Contralateral Transmaxillary Approach for Resection of Chondrosarcoma of the Petrous Apex: A Case Report.

Ear Nose Throat J 2021 Feb 9:145561320982161. Epub 2021 Feb 9.

Department of Otolaryngology-Head and Neck Surgery, 5631West Virginia University, Morgantown, WV, USA.

Background: Deep location and neurovascular structures make access to lesions of the petrous apex a significant challenge. A novel approach for these tumors is the contralateral transmaxillary approach.

Clinical Presentation: A 31-year-old male was evaluated for left abducens nerve palsy. Read More

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February 2021

Anatomical variation of the internal carotid artery and its implication to the endoscopic endonasal translacerum approach.

Head Neck 2021 May 27;43(5):1535-1544. Epub 2021 Jan 27.

Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.

Background: The endoscopic endonasal trans-lacerum approach (EETLA) is useful in handling skull base tumors around inferior petrous apex (IPA); however, its surgical corridor is exclusively a triangular space (supra-eustachian triangle [SET]), between the internal carotid artery (ICA) and eustachian tube.

Methods: We investigated correlation between SET size and extent of resection around the IPA (lateral extent of resection [EOR]) through a retrospective analysis of 15 surgeries using EETLA.

Results: Of 15 cases (9 chordomas, 4 chondrosarcomas, and 2 meningiomas), 20 sides of IPA were affected by the tumor. Read More

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Navigated, endoscopically controlled, transtympanic resection of an infracochlear cholesteastoma recurrence.

HNO 2021 Jan 26;69(Suppl 1):31-33. Epub 2021 Jan 26.

Department of Otorhinolaryngology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany.

An infracochlear cholesteatoma of the petrous apex with direct contact to the internal carotid artery (ICA) is rare. Due to the risk of cochlear injury with consecutive deafness or injury of the ICA, precise preoperative planning of the approach and strategy is recommended, as well as thorough preoperative counseling of the patient for their informed consent. This case report presents navigated endoscopically controlled transtympanic resection of such a cholesteatoma recurrence. Read More

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January 2021

[Analysis on endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach under the microscope for skull base tumor with intra and extra-cranial involvement].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021 Jan;56(1):33-40

Department of Otorhinolaryngology Head and Neck Surgery, Tianjin Huanhu Hospital, Tianjin 300350, China.

To evaluate the application of combination use of endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically in skull base tumor with intra and extra-cranial involvement. A total of 7 patients (4 males and 3 females, aging from 27 to 65 years old, with a medium age of 48) undergone complicated skull base surgeries via endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically from May 2016 to January 2018 were reviewed respectively. The patients included 2 cases of recurrent invasive pituitary adenoma, 3 cases of basal skull meningiomas, 1 case of clivus chondrosarcoma, and 1 case of recurrent nasopharyngeal carcinoma. Read More

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January 2021

Combined Petrosal Approach for Resection of a Large Trigeminal Schwannoma With Meckel's Cave Involvement-Part I: Anatomic Rationale and Analysis: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Feb;20(3):E225

Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.

Resection of large trigeminal schwannomas involving both posterior and middle cranial fossae is challenging. The depth of the surgical target in the superomedial corner of the cerebellopontine angle and the petrous apex makes for a difficult lesion to favorably access, expose, and safely resect. Judicious planning of a skull base approach is therefore the most crucial step in successful management of these formidable tumors. Read More

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February 2021

Aberrant AICA Injury During Translabyrinthine Approach.

Otol Neurotol 2020 12;41(10):1423-1426

Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.

Objective: To define a complication of the translabyrinthine surgical approach to the posterior fossa related to a rare variant of the anterior inferior cerebellar artery (AICA) that penetrated into the petrous temporal bone.

Patient: A healthy 59-year-old male with a unilateral sporadic vestibular schwannoma.

Intervention: The patient elected to undergo a translabyrinthine approach for resection of a vestibular schwannoma. Read More

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December 2020

How I do it: retrosigmoid intradural inframeatal petrosectomy.

Acta Neurochir (Wien) 2021 03 28;163(3):649-653. Epub 2020 Sep 28.

Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.

Background: Lesions infiltrating the petrous temporal bone are some of the most complex to treat surgically. Many approaches have been developed in order to address these lesions, including endoscopic endonasal, anterior petrosectomy, posterior petrosectomy, and retrosigmoid.

Method: We describe in a stepwise fashion the surgical steps of the retrosigmoid intradural inframeatal petrosectomy. Read More

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Anatomical location of the abducens nerves (VI) in the ventral approach of clival tumors.

Surg Radiol Anat 2020 Nov 30;42(11):1371-1375. Epub 2020 Jun 30.

Department of Anatomy, University of Bordeaux, 33076, Bordeaux, France.

The aim of this work was to determine reliable anatomical landmarks for locating and preserving the abducens nerves (6th cranial nerves) during trans-facial or trans-nasal endoscopic approaches of skull base tumors involving the clivus and the petrous apex. In order to describe this specific anatomy, we carefully dissected 10 cadaveric heads under optic magnification. Several measurements were taken between the two petro-sphénoidal foramina, from the bottom of the sella and the dorsum sellae. Read More

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November 2020

Middle fossa meningiomas.

Handb Clin Neurol 2020 ;170:65-67

Miami Neuroscience Institute, Baptist Health of South Florida, Miami, FL, United States; Division of Neuroscience, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States. Electronic address:

The middle cranial fossa is bounded anteriorly by the sphenoid ridge, medially by the lateral wall of the cavernous sinus and Meckel's cave, posteriorly by the sphenoid wing and petrous bone, and laterally by the greater wing of sphenoid and squamous temporal bone. In normal individuals, unnamed venous channels within the dura and arachnoid granulations can be seen on the floor of this fossa by the operating surgeon. Meningiomas arising mainly from the dura of the floor are uncommon, and middle fossa meningiomas have been arbitrarily named so based on an attachment of more than 75% to this location. Read More

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Petrous face meningiomas.

Handb Clin Neurol 2020 ;170:157-165

Miami Neuroscience Institute, Baptist Health of South Florida, Miami, FL, United States; Division of Neuroscience, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States.

Cerebellopontine angle (CPA) meningiomas arise from the petrous face of the temporal bone, which forms the lateral boundary of the CPA. They can be categorized into anterior, middle, and posterior, based on their attachment in relation to the internal acoustic meatus. Each of them presents with their own characteristic clinical syndromes. Read More

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Anatomy of petrous face.

Handb Clin Neurol 2020 ;170:143-156

Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States. Electronic address:

The anatomy of the petrous face of the temporal bone, also known as the petrous pyramid, should be carefully examined to understand the location of, blood supply to, and venous drainage of meningiomas in this area (42%-59% of posterior fossa meningiomas). The petrous face is located in the skull base between the sphenoid and occipital bones. It consists of a base that joins the mastoid laterally and an apex that extends anteromedially to form the foramen lacerum. Read More

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Tentorial Peeling: Surgical Extradural Navigation to Protect the Temporal Lobe in the Focused Combined Transpetrosal Approach.

Oper Neurosurg (Hagerstown) 2020 Oct;19(5):589-598

Skull Base Surgery Center, Baylor University Medical Center, Dallas, Texas.

Background: Transpetrosal approaches have been used for treatment of tumors in the petroclival region for many years. Injury to the temporal lobe, however, has been a potential drawback of the techniques described to date.

Objective: To describe modifications of the transpetrosal surgical technique, which allows extradural manipulation of the temporal lobe during the focused combined transpetrosal approach. Read More

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October 2020

Experience With the Endoscopic Contralateral Transmaxillary Approach to the Petroclival Skull Base.

Laryngoscope 2021 02 15;131(2):294-298. Epub 2020 May 15.

Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.

Objectives/hypothesis: The contralateral transmaxillary (CTM) approach is a new surgical approach that improves the surgical trajectory relative to the petrous segment of the internal carotid artery (ICA). Here, we present our clinical experience with the CTM approach to the petroclival region of the skull base.

Study Design: Retrospective review. Read More

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February 2021

Dissection of the Petrosal Presigmoid-Retrolabyrinthine Approach for the Petroclival Region on a Cadaver: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2020 Sep;19(4):E398-E399

The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.

Skull base epidermoid tumors, meningiomas, and schwannomas can be accessed by different techniques depending on the location and size of the lesion. Small lesions located anterior to the internal acoustic meatus (IAM) can be accessed via the subtemporal approach, and lesions located posterior to the IAM can be approached via retrosigmoid craniotomy. However, expansive lesions that are located anterior to the IAM and extend posteriorly toward the lower clivus can be accessed via the petrosal approach. Read More

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September 2020

Giant Cephalocele Case Mimicking Cystic Neoplasia in Skull Base.

J Craniofac Surg 2020 Sep;31(6):e530-e532

Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey.

Petrous apex cephalocel, also called arachnoid cyst or meningocele, is a rare cephalocele caused by protrusion of the posterolateral wall of the Meckel cave to the petrous apex. Increased intracranial pressure is thought to play a role in etiopathogenesis and is generally asymptomatic. Radiologically, they are expansile lesions with the same density or intensity as cerebrospinal fluid and may mimic cystic masses. Read More

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September 2020

Hybrid antero-lateral transcondylar approach to the clivus: a laboratory investigation and case illustration.

Acta Neurochir (Wien) 2020 06 25;162(6):1259-1268. Epub 2020 Apr 25.

Department of Neurosurgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, 2 rue Ambroise Pare, 75010, Paris, France.

Background: Surgical treatment of lesions involving the ventral craniovertebral junction (CVJ) and the lower clivus, traditionally involved complex lateral or transoral approaches to the skull base. However, mid or upper clivus involvement requires more extensive lateral approaches. Recently, the endoscopic endonasal approach (EEA) has become the standard for upper CVJ lesions and medial clival, and a valuable alternative for those tumors extending in its upper third as well as laterally. Read More

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Extended Anterior Petrosectomy Through the Transcranial Middle Fossa Approach and Extended Endoscopic Transsphenoidal-Transclival Approach: Qualitative and Quantitative Anatomic Analysis.

World Neurosurg 2020 06 4;138:e405-e412. Epub 2020 Mar 4.

Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA.

Background: Petroclival tumors and ventrolateral lesions of the pons present unique surgical challenges. This cadaveric study provides qualitative and quantitative anatomic comparison for an anterior petrous apicectomy through the transcranial middle fossa (TMF) and expanded endoscopic transsphenoidal-transclival approaches.

Methods: In 10 silicone-injected heads, the petrous apex and clivus were drilled extradurally using middle fossa and endonasal approaches. Read More

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Anterior Transpetrosal Approach for Petroclival Meningioma: Operative Nuances.

Neurol India 2020 Jan-Feb;68(1):20-25

Department of Neurosurgery, All India Institute for Medical Sciences, Bhopal, Madhya Pradesh, India.

Petroclival meningiomas are unique neurosurgical challenges that require planning an approach to the retrosellar and upper and mid retroclival locations. The classical subtemporal-transtentorial approach went into disrepute due to excessive brain retraction. To resolve this challenge Buchenek and Kukwa introduced extradural approach with drilling of the petrous bone and called it the extended middle fossa approach. Read More

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December 2020

Surgical outcomes of anterior cerebellopontine angle meningiomas using the anterior transpetrosal approach compared with the lateral suboccipital approach.

Acta Neurochir (Wien) 2020 06 14;162(6):1243-1248. Epub 2020 Feb 14.

Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.

Background: Anterior transpetrosal approach (ATPA) and lateral suboccipital approach (LSO) are the major surgical approaches for cerebellopontine angle (CPA) meningiomas. Particularly, anterior CPA meningiomas are challenging lesions to be treated surgically. To date, only a few studies have directly compared the outcomes of both approaches focusing on the anterior CPA meningiomas. Read More

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Tumors of the temporal bone.

Cas Lek Cesk 2019 ;158(6):248-252

Temporal bone tumors are rare entities. Histologically these pathologies represent heterogeneous group of diseases. The most common tumors of the temporal bone are vestibular schwannoma, tympanojugular paragangliomas and temporal bone carcinomas. Read More

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January 2020

Endoscopic Nasopharyngectomy Combined with a Nerve-sparing Transpterygoid Approach.

Laryngoscope 2020 10 16;130(10):2343-2348. Epub 2019 Dec 16.

the Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.

Objectives/hypothesis: Surgical management of nasopharyngeal tumors has evolved in the endoscopic era. Lateral exposure remains difficult especially near the petrous internal carotid artery and bony Eustachian tube (ET). Our study examines the need to sacrifice the vidian and greater palatine nerves in order to successfully perform en bloc endoscopic nasopharyngectomy. Read More

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October 2020

Petroclival intravascular papillary endothelial hyperplasia with psammoma body-like structures.

Neuropathology 2020 Jun 4;40(3):268-274. Epub 2019 Dec 4.

Laboratory of Orthopaedic Pathology, Buenos Aires, Argentina.

Masson's tumor or intravascular papillary endothelial hyperplasia (IPEH) is considered a non-neoplastic lesion. It is probably an unusual exaggerated reorganization of a thrombus. IPEH may be present as a secondary lesion in hemangiomas. Read More

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From the Occipital Condyle to the Sphenoid Sinus: Extradural Extension of the Far Lateral Transcondylar Approach with Endoscopic Assistance.

World Neurosurg 2020 Feb 14;134:e771-e782. Epub 2019 Nov 14.

Department of Neurosurgery, Lariboisière Hospital, Paris VII-Diderot University, Paris, France.

Background: Surgical management of extensive skull base tumors, such as chordoma and chondrosarcoma, remains very challenging. The need for gross total removal to improve survival must be weighed against the risk of injury to neurovascular structures and the loss of stability at the craniovertebral junction. In cases of tumors that are already compromising craniovertebral junction stability, the occipital condyle can be exploited as a deep keyhole to reach the clivus, petrous apex, and sphenoid sinus. Read More

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February 2020

Application of 3D-Printed Craniocerebral Model in Simulated Surgery for Complex Intracranial Lesions.

World Neurosurg 2020 Feb 8;134:e761-e770. Epub 2019 Nov 8.

Biomanufacturing Center, Department of Mechanical Engineering, Tsinghua University, Beijing, P. R. China.

Objective: To demonstrate the use of 3-dimensional (3D)-printed intracranial lesion models for complex neurosurgery to increase the success rate of clinical surgeries via practice in simulated surgeries.

Methods: We collected computed tomographic, magnetic resonance (MR), and computed tomographic images from patients with intracranial tumor or aneurysm, conducted multimodal image reconstruction, and then constructed a 3D-printed model with the skull base, cerebral arteries, and brain tumor or aneurysm. Forty-nine simulated surgeries were carried out on the model under a microscope, and actual surgery was carried out after validation and accumulation of experience. Read More

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February 2020

Combined Endoscopic and Microscopic Surgery for Perilabyrinthine Lesions: Feasibility and Technique.

Otol Neurotol 2019 12;40(10):1306-1312

Department of Otorhinolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China.

Objectives: To determine the feasibility of endoscopic-assisted surgery for lesions involving the perilabyrinthine recesses, and develop and validate a technique for this kind of lesions that increases the possibility of preserving the labyrinth and cochlea.

Study Design: Observational study.

Setting: Referral center. Read More

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December 2019

Endoscopic transmastoid posterior petrosal approach for locally aggressive tumors in the petrous part of the temporal bone involving the internal auditory canal, jugular foramen, and hypoglossal canal.

J Neurosurg 2019 Sep 27:1-13. Epub 2019 Sep 27.

Departments of1Neurosurgery and.

Objective: The posterior petrosal approach is an established surgical method offering wide access to skull base lesions through mastoid air cells. The authors describe their experience with the endoscopic transmastoid "posterior petrosal" approach (EPPAP) for skull base tumors involving the internal auditory canal (IAC), jugular foramen, and hypoglossal canal.

Methods: The EPPAP was performed for 7 tumors (3 chordomas, 2 chondrosarcomas, 1 schwannoma, and 1 solitary fibrous tumor). Read More

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September 2019

Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection.

Eur Arch Otorhinolaryngol 2019 Dec 12;276(12):3487-3494. Epub 2019 Sep 12.

Department of Otolaryngology and Laryngological Oncology, Medical University of Lublin, Jaczewskiego 8, 20 954, Lublin, Poland.

Purpose: Evaluation of the utility of the free anterolateral thigh flap reconstruction of the defects resulting from radical temporal bone resection in the management of lateral skull base malignancies in a single institution.

Methods: An analysis of 17 en bloc subtotal petrosectomies for removal of malignant tumours was performed. There were 12 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenoid cystic carcinoma. Read More

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December 2019