Giant Skull Research Articles

Epilepsy in Association with Giant Skull Base Tumors: A Retrospective Case Series of Giant Skull Base Tumors in the Anterior and Middle Fossa

Abstract Objective This study aims to investigate the association between giant anterior and middle fossa skull base tumors and epilepsy, and implications for clinical management. Methods A retrospective analysis was conducted on a cohort of patients diagnosed with anterior skull base tumors between 2016 and 2023. Radiologic data were used to identify tumors with major diameter larger than 5 cm involving skull base with intracranial involvement. Relevant demographic information, tumor characteristics, seizure type, seizure frequency, and treatment outcomes were analyzed. Results Among the 236 patients diagnosed and operated with skull base tumors by senior author, 7.63% (n = 18) had giant skull base tumors of anterior and middle fossa, and 2.96% (n = 7) presented with concurrent epilepsy. Overall, in giant anterior and middle fossa skull base tumors, epilepsy was present in 38% of cases. The average age at operation was 47.56 ± 16.96, with 44.4% of cases being male and 55.6% of the cases being female. The majority of these cases exhibited focal epilepsy (71%), characterized by seizures originating from the proximity of the tumor location suggesting a potential correlation between tumor location and seizure generation. Of the remaining, 29% were generalized seizures. Tumors of the anterior fossa included 11 meningiomas, 3 pituitary adenomas, 1 chondrosarcoma, 1 hemangiopericytoma, 1 schwannoma, and 1 adenoid cyst carcinoma; half of which (n = 9) were of low grade. Conclusion Our findings provide evidence of low frequency of epilepsy in skull base tumors in general, with an association among giant anterior and middle fossa skull base tumor and epilepsy.

Giant skull base periosteal chondroma treated with endonasal endoscopic surgery: illustrative case.

Intracranial chondroma is an extremely rare type of tumor composed of mature hyaline cartilaginous tissues. No previous cases of skull base periosteal chondroma have been presented. A 31-year-old male had progressive memory loss and diminished motivation for the previous 1.5 years. Magnetic resonance imaging revealed a giant tumor with partial calcification arising from the upper clivus and extending to the prepontine cistern. Compression of the brainstem and hypothalamus was significant. Surgery was performed and intentionally limited to an intracapsular resection with endoscopic endonasal surgery (EES), and the brainstem and hypothalamus were successfully decompressed. Pathological examination findings showed a composition of hyaline cartilage with chondrocyte clusters. Genetic testing with next-generation sequencing indicated alternations in IDH1 R132C, KDR Q472H, IDH2 I142L, and TP53 P72R. On the basis of these findings, a diagnosis of periosteal chondroma was made. Postoperatively, complete relief from all symptoms was noted, and MRI one year later showed no evidence of tumor regrowth. This is the first known report of skull base periosteal chondroma. Genetic testing was useful for confirming the diagnosis, and EES was effective for treatment. Should such a tumor show adhesion to an important structure, an intracapsular excision can be beneficial for avoiding complications.

Surgical treatment of patients with skull defects and cerebrospinal fluid flow disorders after previous decompressive craniectomy

Decompressive craniectomy (DC) is performed for refractory intracranial hypertension following severe traumatic brain injury, vascular and oncological diseases. This fact increases the number of patients with extensive and giant skull defects. Cerebrospinal fluid (CSF) flow disorders after DC are often accompanied by ventriculomegaly. However, only some patients with ventriculomegaly have hydrocephalus and require CSF bypass procedures. Differentiation of post-traumatic hydrocephalus requiring surgical treatment and atrophic dilation of ventricular system «ex vacuo» caused by brain injury is still an important issue. Skull sealing as a way to normalize CSF circulation and eliminate hydrocephalus is also an open question. Currently, there is no unified approach to patients with extensive and giant cranial defects combined with post-traumatic hydrocephalus. There is no unified algorithm for sequence of reconstructive and CSF bypass operations in these patients. Literature data on risks of infectious complications for different surgical strategies are controversial.

Multiple Giant Skull Osteomas Associated with Gardner's Syndrome.

Multiple Giant Skull Osteomas Associated with Gardner's Syndrome.

Surgical management of giant skull osteomas.

Objective:Surgical management of giant skull osteomas Osteomas are benign, generally slow growing, bone forming tumors limited to the craniofacial and jaw bones.Materials and Methods:A retrospective review of all cases of osteoma diagnosed from 2009 to 2013 treated in our hospital. The data collected included age at diagnosis, gender, lesion location, size, presenting and duration of symptoms, treatment, complication and outcome.Results:During our study period there were 15 cases that were treated surgically. Their mean age was 42 years (range: 15–65 years) and all of our patients were female. The average duration of symptoms was 3 years and size varying from 4 cm to 12 cm. Eight patients complained of headache, whereas 6 patients complained about esthetics, and 1 patient presented with proptosis. The tumor was excised by cutting the base of the tumor and then residual tumor was grinded using a round head cutting bar. Osteoma was removed with esthetically acceptable appearance.Conclusion:There were no major complications during operative and postoperative period. Although osteomas are usually slow growing but surgery is usually performed due to esthetic reasons. It is important to plan an appropriate surgical approach that minimizes any damage to the adjacent structures.

The Role of Staging in Endoscopic Endonasal Approaches for Large and Giant Anterior Skull Base Meningiomas

The Role of Staging in Endoscopic Endonasal Approaches for Large and Giant Anterior Skull Base Meningiomas

Multimodality management of a giant skull base hemangioendothelioma of the sphenopetroclival region

A 20-year-old man presented with proptosis, nasal obstruction, vision loss and cavernous sinus syndrome, ongoing for 6years. Imaging and biopsy confirmed a middle skull base epithelioid hemangioendothelioma arising from the left sphenopetroclival region with infratemporal fossa and intracranial-intradural extension into the left temporal lobe. Preoperative embolization of the left internal maxillary artery followed by a combined neurosurgical (front-temporal orbito-zygomatic craniotomy) and otorhinolaryngology (maxillary swing) approach was performed for tumor debulking. Postoperative radiotherapy and maintenance interferon chemotherapy was given to achieve a favorable outcome at 6months follow-up. We describe the pertinent clinical, genetic, radiological and histopathological features, along with the available therapeutic modalities for a primary giant skull base hemangioendothelioma.

Large and giant skull base meningiomas: The role of radical surgical removal.

Background:The large and giant skull base meningiomas are challenging lesions, and the involvement of crucial neurovascular structures needs the surgical removal as the primordial treatment. The authors report on a series of patients with large and giant skull base meningiomas who were treated with the goal of radical removal.Methods:A retrospective study including 49 patients with large and giant skull base meningiomas was carried out. Tumors presenting 3 cm or larger were included.Results:The meningiomas in the sample included the following types: 10 olfactory groove, 8 sphenoorbital, 8 petroclival, 8 tentorial, 4 clinoidal, 4 cavernous sinus, 3 temporal floor, 2 tuberculum sellae and 2 foramen magnum. The average age was 53 years, the mean follow-up period was 52 months, Simpson Grades I and II were obtained in 75.5%. The overall mortality was 5%. Transient cranial nerve deficits occurred in 32% with definite cranial nerve lesion in 18%. Cerebrospinal fluid leak occurred in 14%.Conclusions:The surgical treatment is a mandatory option for large and giant skull base meningiomas. The radical removal is achievable and should be considered an alternative with a good outcome and an acceptable morbidity for such challenge lesions.

Ming the forgotten celebrity: a giant panda skull at the Royal College of Surgeons of England

Ming the forgotten celebrity: a giant panda skull at the Royal College of Surgeons of England

Endocranial Lesions

Numerous intracranial soft tissue and vascular structures are intimately related to the endocranial surface of the central skull base, including the pituitary gland, the pachymeninges, and multiple cranial nerves. These structures can give rise to pathologies that create imaging abnormalities along the bony surface of the skull base or result in gross changes of the underlying bone: hyperostosis, scalloping, permeation, erosion, or destruction. Large lesions with frank invasion may be difficult to differentiate from intrinsic bone lesions. This article reviews a variety of endocranial lesions affecting the central skull base, including the giant or invasive pituitary macroadenoma and skull base meningioma, and highlights the imaging features for a practical approach to their diagnosis.

Primary Skull Osteosarcoma: MDCT Evaluation and Histopathological Correlation in Two Cases

Osteosarcomas are typically long bone tumors and rarely affect the skull, with most articles reporting single cases. As elsewhere in the body, these lesions may be classified as primary or secondary, chiefly post-Paget and post-radiation therapy. We describe two cases of primary osteosarcoma of skull one presenting with cerebellar symptoms and another with giant skull swelling. Complete evaluation with 64 slice CT and histopathological correlation was carried out.

Giant Skull Base Atypical Meningioma Presenting With Rapidly Progressive Impaired Consciousness Caused by Severe Venous Congestion -Case Report-

A 43-year-old female presented with a giant skull base atypical meningioma manifesting as rapid progression of impaired consciousness. The meningioma was located in the ethmoid sinus, sphenoid sinus, nasal cavity, and left middle temporal fossa, and the intracranial portion of the tumor involved the left temporal region with massive surrounding brain edema in the left temporal lobe and basal ganglia. She underwent emergent fronto-temporo-parietal decompressive craniectomy, and the intracranial portion of the tumor was resected to control intracranial pressure. She recovered consciousness and neurological function dramatically, and subsequently underwent radical tumor resection via combined extended transbasal and left lateral transzygomatic infratemporal fossa approaches one month after the initial surgery. The extensive brain edema completely disappeared after tumor resection, and the patient fully recovered without neurological deficits except anosmia and small visual field defect. Rapid neurological deterioration and disturbance of consciousness caused by extensive peritumoral brain swelling are unusual in meningioma. In this case, the extemporaneous decompressive craniectomy was highly useful in the management of increased intracranial pressure.

Multidisciplinary management of giant functional petrous bone paraganglioma

Giant and functional paragangliomas of the skull base are rare. Their endocrinological and surgical management is challenging. We report the case of an aggressive giant noradrenalin-secreting paraganglioma of the right temporal bone. Three procedures of embolisation were performed. The second one was complicated by a hypertensive crisis due to catecholamine release. The tumour was resected via a widened transcochlear approach. Tumour residue was treated by gamma knife radiosurgery, without additional growth at the last follow-up. This case illustrates the interest of multidisciplinary management of giant skull base paragangliomas.

Giant Skull and Brain Metastasis from a Neglected Thyroid Papillary Carcinoma

Giant Skull and Brain Metastasis from a Neglected Thyroid Papillary Carcinoma

Giant skull metastasis of Hürthle cell variant of thyroid’s papillary carcinoma

We report the MRI and pathological findings of a 53-year-old woman with a giant skull metastasis from a Hürthle cell variant of thyroid's papillary carcinoma. To our knowledge, this is the first case of a skull metastasis from a Hürthle cell variant of thyroid's papillary carcinoma.

Facial translocation procedure for giant multicompartmental lateral and central skull base tumours

Facial translocation procedure for giant multicompartmental lateral and central skull base tumours

Victor Hugo on the Universe Within the Poet

Montrez-moi le ciel charge de nuages Repetant le monde enfoui sous mes paupieres Eluard The soul, the mind, moral entities, mental functions, have always, in literature as well as in the arts and folklore, been personified in human or animal form. Whether it be the souls of the dead symbolized by winged figures, or Jupiter's wisdom symbolized by Minerva springing from his brow, or the thoughts of comic strip characters symbolized by pictures enclosed in little clouds rising from the tops of their-heads--they have a durability that testifies to their archetypal nature. Likewise archetypal in the human imagination is that portion of the body chosen as theatre for the play of thoughts and passions. Shape influenced the choice; sort and inert, the brain was not very inspiring; the heart made an easy metaphor because of its obvious reaction to emotion so poetry let it burn, bleed, suffer in the clutches of Jealousy and other monsters--but its plastic possibilities are limited. Not so with the natural architecture of the head, especially of the skull, with the eyes that are windows, and the hollow within made familiar by centuries of Christian art as the soul's abode. Thus the poets have called it man's sanctuary, temple ou son ame habite, in the words of Lamartine, (1) or they have called it an inner universe where, says Baudelaire, revolutions et les evenements les plus curieux se passent sous le ciel du crane. (2) At times we find the metaphor sustained by other images, such as the camera obscura, which was a minor literary fashion around the rime the daguerreotype was invented. This kind of image usually throws into relief a mental obsession, as when Proust locks in his head the memory of the girl his jealousy had long held captive: l'Albertine d'autrefois, invisible a moi-meme, etait pourant enfermee au fond de moi comme aux plombs d'une Venise interieure, dont parfois un incident faisait glisser le couvercle durci jusqu'a me donner une ouverture sur ce passe, (3) or else the image emphasizes an acute distress, like Mallarme's migraine, mixed with nostalgia, Des crepuscules blancs tiedissent sous mon crane Qu'un cercle de fer serre ainsi qu'un vieux tombeau. (4) But no writer exploits this theme more thoroughly than Hugo or in such a visionary manner. His obsession has two sources. First, death is ever present to his mind, hence a veritable fixation on the obvious symbol of the death's head: even objects only remotely similar, like a ruined tower or a submarine cave, (5) will remind him of a skull--an inhabited one, so to say. Some poets see the inside of the head as a diminutive sky; Hugo sees the sky as a giant skull. (6) Second, Hugo, like Nerval, his protege, like the Illuminists (above all Swedenborg), believes in symbolism and in correspondences that weave between similar things the web of universal harmony, relating the flower and the star, the beast and the criminal, the depths of ocean and the depths of heart, the vault of the skull and the celestial vault. In one text, their common roundness was sufficient for him to assert an affinity between heaven, earth and skeleton's head, and to declare it their common function to serve as mansions of the spirit. (7) No wonder he so often chose this theme when he would oppose and relate the human microcosm to the universal macrocosm. In a first and relatively simple application of this theme, the skull is but the prison of the soul. Hugo uses and graphically develops the traditional opposition between a purer essence never really at home in us, and the body, its temporary dwelling place. But he pushes this opposition to its extreme and draws from it effects of pathos by substituting for lien, chaines or enveloppe, the usual metaphors of the flesh, a new metaphor, semantically similar but stylistically hyperbolic--the metaphor of the prison cell: Ne sens-tu pas en toi comme une aile captive? …

Successful Removal of a Giant Skull Base Metastasis from Hepatocellular Carcinoma after Direct Ethanol Injection: Case Report

Skull metastases from hepatocellular carcinoma (HCC) are extremely rich in vascularity, which sometimes makes surgery dangerous. For minimally invasive surgery, it is very important to diminish the intratumoral vascular flow preoperatively. We report the case of a 69-year-old man with a giant skull base metastasis from HCC that was successfully removed after two sessions of direct ethanol injection into the tumor as a preoperative treatment to diminish the intratumoral vascular flow. Direct ethanol injection is a modification of percutaneous ethanol injection therapy, which is widely used in the treatment of primary HCC. In this article, we describe in detail the practical procedures and the usefulness of this treatment for a giant skull base metastasis from HCC.

Combined transpetrosal and fronto-orbito-zygomatic approach to a giant skull based meningioma: a case report

BACKGROUND Recently, various surgical approaches to skull base lesions have been developed. Skillful use of the combination of two standard approaches make possible the removal of large brain lesions, which conventionally had been considered inoperative. In this study, we present a case of a giant meningioma located in the cerebellopontine angle and middle cranial fossa. A near total resection was achieved using a combined transpetrosal and fronto-orbito-zygomatic approach. CASE REPORT A 15-year-old boy presented with a meningioma that caused a left hearing loss, dysarthria, and cerebellar ataxia. Preoperative magnetic resonance imaging revealed a giant meningioma located in the right cerebellopontine angle, middle fossa, and cavernous sinus. The patient underwent a near total resection of the tumor through a combined transpetrosal and fronto-orbito-zygomatic approach. He experienced a marked improvement postoperatively and entered high school the following year. CONCLUSIONS An approach from several angles was necessary for the giant skull based tumor presented here. A combination approach was selected for obtaining a wide operative field with minimal brain compression during resection of neoplasm. According to the individual features of each case, selection of the operative approach, decisions regarding the extent of excision, and postoperative treatment regimens should be adequately planned in the preoperative period.

Solitary giant skull base schwannomas—Report of four, cases

Solitary intracranial schwannomas not related to major nerves or neurofibromatosis as well as paranasal schwannomas are rare. Schwannomas simultaneously involving the paranasal sinuses and intracranial cavity are even rarer. We report four cases of schwannomas simultaneously involving the intracranial cavity and paranasal sinuses. They were successfully managed by surgery. The literature on such tumors is reviewed. All patients were young adults; the male to female ratio was 1:3. In two patients, the tumor was predominantly intracranial with extension into the sphenoid and ethmoid sinuses, whereas in the other patients, the tumor was located predominantly in the paranasal sinuses and nasopharynx with intracranial extension. Radiologically, bone destruction was seen in three cases. The tumors were totally removed piecemeal with repair of the basal dura. Histopathologic examination confirmed the diagnosis of schwannoma in all four cases. Three patients are alive and well; one of them was reoperated for a recurrence. These tumors should be excised completely if possible. Radiologically, bone erosion or destruction are suggestive of malignancy but histopathology clinches the diagnosis. Therefore, drastic surgery should be avoided in these cases. Surgery is generally curative in these massive schwannomas.