Approach For Removal Of Tumors Research Articles

Combined craniofacial resection of nasopharyngeal malignancies

Nasopharyngeal carcinoma is endemic in south-eastern parts of Asia. Primary treatment modality is definitive radiotherapy ± chemotherapy depending on the stage of disease. Surgery serves as a means of salvage for persistent or recurrent diseases. Maxillary swing operation offers an anterolateral approach for removal of tumors in the nasopharynx ± parapharyngeal space extension including retropharyngeal lymph nodes. Maxillary swing operation may be combined with craniotomy for resection of locally advanced tumors involving the internal carotid artery, temporal bone and temporal dura. Encasement of internal carotid artery warrants prior extracranial intracranial bypass, so that the vessel can be removed en bloc with the tumor to ensure microscopic clearance. Exposed dura, skull base bone and internal carotid artery warrant coverage with well-vascularized muscle flap to facilitate wound healing. Attention to details peri-operation and meticulous tissue handling can help to prevent life threatening complications postoperation.

Endoscopic Modified Denker's Approach for the Treatment of Juvenile Nasopharyngeal Angiofibroma.

Juvenile nasopharyngeal angiofibroma is a benign vascular lesion with propensity of bony erosion leading to skull base involvement and intracranial extension. It involves multiple compartments which are difficult to access surgically. With surgical expertise endoscopic resection of angiofibroma has become the preferred choice of surgical management. This article presents our experience with endoscopic approach for angiofibroma and establishes the modified Denker's procedure as a effective approach for removal of tumor. A prospective case study was done on 25 cases of juvenile nasopharyngeal angiofibroma treated surgically by endonasal endoscopic modified Denker's approach in the department of ENT at BJ Medical College, Ahmedabad over a period of 4years from January 2015 to January 2019. This technique was used up to Fisch stage 3b with extension up to infratemporal fossa. Using this technique no major recurrence or major morbidity was observed and did not produce any late serious complications. The endoscopic technique allows the surgeon to achieve an extensive exposure of the sinuses and control of the sphenopalatine and internal maxillary arteries without the risk of palatal dysfunction, oronasal fistula, or facial scarring. In addition, the modified Denkers approach can be an effective and less mutilating technique in managing recurrences.

Clinical value of QST classification in the treatment of children with craniopharyngioma

Objective To explore the clinical manifestation of children with different QST classification of craniopharyngioma (CP) and its role in prognosis. Methods We retrospectively analyzed 149 children with CP who underwent surgery at Department of Neurosurgery, Nanfang Hospital of Southern Medical University from December 1998 to December 2015. Of those, 70 (47.0%) children underwent operation through frontal base approach, 46 (30.9%) through pterional approach and 33 (22.1%) through transsphenoidal approach for tumor removal. All patients underwent clinical follow-up after surgery, including MRI review of the sellar region to determine the tumor resection and recurrence, and measurement of relevant indicators to assess the prognosis. All 149 children were classified according to the QST classification criteria, and the differences in clinical characteristics of different types of children were analyzed. Furthermore, multivariate logistic regression analysis was used to determine the clinical factors affecting the prognosis of children. Results All children in this series underwent successful operation and 138 (92.6%) out of those had total resection and 11 (7.4%) had subtotal resection. The median follow-up duration of 149 patients was 87 months (range: 11-236 months). Good outcomes were reported in 134 patients and poor outcome in 15. In this study, 91 patients were type Q (Q-group), 14 were type S (S-group) and 44 were type T (T-group) according to the QST classification criteria. There were no significant differences in age, gender, maximum diameter, tumor calcification degree, degree of tumor resection and tumor recurrence between the 3 groups (all P>0.05), while the clinical symptoms, incidence of hydrocephalus, pre- and post-operative pituitary function, operation approach and pathological types were significantly different in patients with different QST classifications among 149 children with CP (all P<0.05). The T-type was more often associated with hydrocephalus, the Q-type was more prone to have abnormal pituitary function, and the S-type was more likely to have vision and visual field damage. Multivariate logistic regression analysis showed that QST classification(OR=5.984, 95%CI: 1.529-23.417, P=0.037) and degree of tumor resection(OR=8.220, 95%CI: 2.158-31.318, P=0.002) were independent prognostic factor in children with CP. Conclusions The clinical characteristics of children with different QST classification of craniopharyngioma are different, and QST classification is one of the independent risk factors affecting the prognosis of children with craniopharyngioma. Key words: Craniopharyngioma; Child; Prognosis; Disease attributes; QST typing

Central Hepatectomy Using the Hilar Approach for Removal of Tumors in the Paracaval Portion of the Caudate Lobe

Central Hepatectomy Using the Hilar Approach for Removal of Tumors in the Paracaval Portion of the Caudate Lobe

Glomus tympanicum: Clinical presentation, management and outcomes

Objective: The objective of the study is to describe the clinical presentation, management, and outcomes of glomus tympanicum (GT) Grade 1–3 (based on Glasscock Jackson staging). Materials and Methods: This is a retrospective chart review of five patients who presented with GT (Grade 1–3) over a period of 4 years to a tertiary hospital. All of them had undergone tumor excision without preoperative embolization. Details of clinical features, diagnostic protocol, surgical approach based on grade of tumor, tumor control, treatment complications, and follow-up results were noted and analyzed. Results: All five patients presented with unilateral hearing loss and tinnitus. Imaging done was magnetic resonance imaging with gadolinium of the brain and high-resolution temporal bone computed tomography. Three patients had transmastoid facial recess approach and one had transcanal approach for tumor removal. One patient had canal wall down mastoidectomy. The average follow-up was 34.8 months. Symptomatic improvement in pulsatile tinnitus was observed in all patients. Hearing remained the same in 1 patient and improved in 4 patients. One patient presented with cholesteatoma 1 year postsurgery. None of the patients had recurrence/residual tumor. Conclusions: GT Grades 1–3 can be managed successfully without preoperative embolization. This gives satisfactory results with respect to hearing improvement and recurrence rates.

What are the surveillance recommendations following resection of sinonasal inverted papilloma?

What are the surveillance recommendations following resection of sinonasal inverted papilloma?

Extended endoscopic endonasal approach for selected pituitary adenomas: early experience

Whereas most pituitary adenomas are removable via the transsphenoidal approach, certain cases, such as dumbbell-shaped or suprasellar adenomas and recurrent and/or fibrous tumors, remain difficult to treat. The authors present their experience with the extended endoscopic endonasal approach to the suprasellar area in managing this subset of tumors, which are classically treated through a transcranial route. From June 1997 to December 2008, 615 patients underwent endoscopic endonasal transsphenoidal surgery for pituitary adenomas in the Department of Neurosurgery of the Università degli Studi di Napoli Federico II. Of this group, 20 patients with pituitary adenomas needed an extended endoscopic endonasal transtuberculum/transplanum approach for tumor removal. Two surgical corridors were used during the transsphenoidal approach: 1) the conventional endosellar extraarachnoidal corridor and 2) a suprasellar transarachnoidal corridor. The extent of resection was gross total in 12 (60%) of the 20 patients, near total in 4 (20%), subtotal in 3 (15%), and partial in 1 (5%). Postoperative CSF leakage occurred in 1 patient. One patient experienced worsening of temporal hemianopsia. The authors' initial results with the extended endoscopic approach to the suprasellar area for selected pituitary adenomas are promising and may justify a widening of the current classical indications for transsphenoidal surgery.

The presigmoid approach for removal of tumours causing ventral compression of the brainstem. Surgical results and postoperative quality of life

Objective. To assess surgical results and quality of life after removal of tumours causing ventral compression of the brainstem using the presigmoid or combined presigmoid/retrosigmoid approaches.Methods. A review of all our patients operated on with removal of tumours causing ventral compression of the brainstem in whom either the presigmoid or combined presigmoid/retrosigmoid approaches were used. Post-operative quality of life was assessed using the SF-36 questionnaire.Results. A total of 12 consecutive patients were included. A favourable complication profile was found. Cerebrospinal fluid leakage and secondary hydrocephalus were the most frequent complications. Post-operative scores from Karnofsky Performance Scale and ECOG after median 24 months were median 85 and 1, respectively, representing ability to carry on daily activities. Nevertheless, quality of life as assessed subjectively by SF-36 showed significantly reduced values as compared with normative values from Norwegian population.Conclusions. We found favourable surgical results when using the presigmoid approach alone or combined with the retrosigmoid route for large-sized extrinsic tumours causing ventral compression of the brainstem, both regarding complication profile, degree of tumour removal and functional outcome. However, impact of disease and surgery on quality of life appears to be more significant when assessed subjectively by the patients.

Endoscopic Transsphenoidal Approach for Removal of Tumors of the Pituitary: Indications and Complications

Endoscopic Transsphenoidal Approach for Removal of Tumors of the Pituitary: Indications and Complications

The Le Fort I osteotomy as a surgical approach for removal of tumours of the midface

Tumours of the midface and maxillary sinuses have been removed via multiple approaches. The most common approaches are those using incisions in the facial skin, especially in the case of malignant tumours. The Le Fort I procedure via an intraoral incision as described by Sailer in 1986 is a versatile alternative. Combined with a coronal approach and various osteotomies of the upper face it also allows removal of tumours extending into the orbits, the nasoethmoidal complex and the skull base. The versatility of the Le Fort I osteotomy as a surgical approach was analysed in 17 cases. This method is reliable and gives excellent access. Further advantages are the wide surgical exposure and the clear visibility of the resection margins, the absence of visible scars, the feasibility of combining this approach with reconstruction using the buccal fat pad and the possibility of simultaneous placement of bone grafts, insertion of endosseous implants or other preprosthetic procedures via the same incision.

Evaluation of the patient with otoneurologic disease.

THE OTORHINOLARYNGOLOGIST is embarking upon a new adventure, for certain new surgical procedures have come into his hands. Among these are the translabyrinthine approach for removal of tumors of the internal auditory meatus and middle cranial fossa exploration. The adventure promises to be a challenging one, but the ability to perform the operative maneuvers per se does not equip him for the full responsibility which is his. The neurologists and neurosurgeons as well as the internists have come to rely upon the otolaryngologist's audiologic and labyrinthine tests in the overall localization and diagnosis of many central nervous system lesions. With these thoughts in mind the following material was prepared with the realization that the known facts are so numerous and the specialty of otoneurology so young and rapidly changing that it is completely impossible to include everything that is known about the subject. It is hoped, however, that the work