Intracranial Invasion Research Articles

Advanced Endoscopic Endonasal Approach to the Pterygopalatine Fossa and Orbit: The Endoscopic Tri-port Approach.

Objective The pterygopalatine fossa (PPF) is a narrow space situated posterior to the maxillary sinus. While external approaches have been used to treat tumors of the PPF, recent endoscopic approaches have become favored as an alternative; we developed an endoscopic tri-port approach, which provides wide surgical corridor with minimal invasion, for PPF. This report aims to introduce and verify the new approach. Design Case series. Setting A tertiary referral hospital. Participants We reviewed 11 patients with PPF or orbital tumors who were treated with the endoscopic tri-port approach. Main Outcome Measures Accessing tri-port approach's effects and limitations. Results When the tumor was located in the PPF or orbit without intracranial invasion, en bloc resection was achieved in six patients. With the exception of one patient, the nasal septum was preserved if not used for skull base reconstruction. If not invaded by a tumor or necessary for reconstruction, the inferior and middle turbinates were preserved. Conclusion The endoscopic tri-port approach provides an excellent surgical view and wide corridor and not requires an external approach, including a gingival incision.

Infectivity of human coronavirus in the brain.

A new strain of human coronaviruses (hCoVs), Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), has been identified to be responsible for the current outbreak of the coronavirus disease 2019 (COVID-19). Though major symptoms are primarily generated from the respiratory system, neurological symptoms are being reported in some of the confirmed cases, raising concerns of its potential for intracranial invasion and neurological manifestations, both in the acute phase and in the long-term. At present, it remains unclear the extent to which SARS-CoV-2 is present in the brain, and if so, its pathogenic role in the central nervous system (CNS). Evidence for neuroinvasion and neurovirulence of hCoVs has been recognised in animal and human studies. Given that SARS-CoV-2 belongs to the same family and shares characteristics in terms of receptor binding properties, it is worthwhile exploring its potential CNS manifestations. This review summarises previous findings from hCoVs in relation to the CNS, and compares these with the new strain, aiming to provide a better understanding of the effects of SARS-CoV-2 on the CNS.

Juvenile nasopharyngeal angiofibroma with intracranial extension – diagnosis and treatment.

This retrospective study analyzes radiological findings, therapeutic management and outcomes of patients with intracranial extension of JNA. The routes of intracranial spread, incidence of intracranial disease and influence on therapeutic approach are discussed. An evaluation on the records of 62 patients with JNA was performed and 10 patients with intracranial tumors were included in the study. All patients were males aged 10 to 19 years. R esults: According to Andrews' classification 8 patients presented with stage IIIb, 1 patient stage IVa and another patient stage IVb tumor. Intracranial invasion was extradural in 8 cases and intradural in 2 patient. Surgery was performed in 9 cases and the most common was combined approach: infratemporal fossa and sublabial transantral. One patient was referred for radiotherapy. Follow-up ranged from 8 to 26 years. There was extracranial recurrence in 2 (22%) of 9 operated patients. C onclusions: The superior orbital fissure is the most frequent route of intracranial spread in patients with extensive involvement of the infratemporal fossa. Due to high risk of recurrence and potential serious complications advanced cases of JNA should be managed by experienced multidisciplinary team, preferably in tertiary referral centers, with an access to modern diagnostic and therapeutic modalities.

The usefulness of straight chemotherapy for dermal exposed anaplastic lymphoma kinase fusion-positive anaplastic large-cell lymphoma with intracranial invasion

Anaplastic large-cell lymphoma (ALCL) is characterized as extranodal lymphoma and usually chemosensitive disease with overall survival rate of 70%–90%. Prognosis is roughly distinguished by the existence of anaplastic lymphoma kinase (ALK) fusion in tumor cells with higher frequencies observed in the pediatric population, and the outcome of ALK fusion-positive ALCL is relatively good when appropriate treatment is completed. Here, we report a case of dermal-exposed ALK fusion-positive ALCL with intracranial invasion. The patient received straight chemotherapy (ALCL99 protocol) without any plastic or resection surgery. The dermal dehiscence was rapidly healed with controllable local infection, and the tumor was regressed without relapse. Therefore, straight chemotherapy has clinical relevance and is a useful treatment strategy for ALK fusion-positive ALCL with dermal dehiscence.

SURG-02. STAGED SURGERY FOR SELECTED GIANT ADULT PITUITARY ADENOMA

Abstract PURPOSE Combined surgical strategy with both trans-cranial surgery and trans-sphenoid surgery is necessary for selected giant pituitary adenoma with both intra-cranial and intra-sphenoidal invasion. Cases of staged surgery were reviewed retrospectively to deeply investigate this treatment strategy. METHODS Adult cases received staged surgery were reviewed. Data regarding clinical presentation, laboratory tests, image examination, surgery details, and outcome were analyzed. The size and invasion was evaluated by pre-op MR and intra-op observation. Diagnosis was confirmed by histology examination. Literatures were reviewed. RESULTS 8 NFPAs were included. 4 received trans-cranial resection first while the other 4 received trans-sphenoidal resection first. Time interval between two operations was 1–2 months. After the first surgery, the rate of visual defects and of pituitary hypofunction improvement were higher in trans-cranial first group. 1 apoplexy and 1 CSF rhinorrhea were observed in trans-sphenoidal first group. After the second surgery, the extend of resection and the rate of complete visual symptoms improvement were higher in trans-cranial first group. All pituitary hypofunction resolved completely in long-term follow-up. 11 literatures were reviewed. CONCLUSIONS An appropriate surgical strategy is essential for selective pituitary adenoma requiring combined resection. For staged surgery cases, taking trans-cranial approach for first stage with trans-sphenoidal subsequently, comparing to the inverse resection order, would offer higher extent of resection with less recurrence, earlier and better symptom improvement, and less post-op complications after first stage. Further investigation is necessary.

Intraconal Metastasis Leading to the Diagnosis of Hepatocellular Carcinoma

Abstract Hepatocellular carcinoma (HCC) is the most common malignant cancer of the liver, with intrahepatic and extrahepatic metastasis accounting for 50% to 75% of HCC cases. Lung and regional lymph nodes are the most common sites of metastasis; however, bone, skin, and adrenal glands are rare sites. Orbital metastasis and intracranial invasion are extremely rare and believed to occur in 2% to 3% of patients with systemic cancer. Here, we present a case report of a 72-year-old man evaluated for progressive painful proptosis of the left eye with weight loss, loss of appetite, and generalized weakness of 3 months duration. Physical examination showed a 5.5 × 3.5-cm, firm, mildly tender mass in the upper and lateral part of the left eye with proptosis and hepatomegaly with no ascites. Laboratory investigations were within normal limits except for positive hepatitis B surface antigen and HBV-DNA. CT scan of the head and neck revealed a 5.7 × 4.7-cm heterogeneously enhancing irregular extraconal mass seen in superolateral aspect of the left orbit. Abdominal CT scan showed hepatomegaly with multiple heterogeneous enhancing lesions in the liver. Fine-needle aspiration from the orbital and liver lesions showed individually scattered clusters and sheets of round to polyhedral cells with enlarged, hyperchromatic nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. Immunohistochemistry showed tumor cells strongly positive for hepatocyte paraffin 1 (HepPar 1) and CD10 but negative for TTF-1, CEA, ALK-1, LCA, vimentin, S-100, and chromogranin, consistent with the diagnosis of HCC. Patient was started on chemotherapy and showed significant improvement with decrease in the size of the liver and orbital mass. Based on the present case and review of literature published since 2009, the current study recommends that metastasis must be considered when diagnosing retrobulbar head lesions in patients with HCC, regardless of contradictory imaging findings and other clinical indicators.

Facial mucocele and brain complications: diagnostic priorities

We present the case of a male with a history of nasal polyposis underwent bilateral nasosinusal endoscopic surgery. He went to the emergency department because of having behavioral changes and left frontal headache. An emergency CT showed nasal-sinus polyposis and several nodular lesions with a characteristic “ring” enhancement and perilesional edema. These findings were compatible facial mucocele complicated with rupture of the bone wall of the left frontal sinus and frontal abscess. Urgent surgery was performed, with left frontal craniectomy and drainage of the abscesses. Mucoceles are benign slowly growing lesions which can associate important complications. The most frequent are abscesses and the invasion of neighboring structures. It is very important to remember that frontal mucoceles can cause intracranial invasion when there is an erosion of the internal osseous table.

Endothelial cells promote 3D invasion of GBM by IL-8-dependent induction of cancer stem cell properties

Rapid growth and perivascular invasion are hallmarks of glioblastoma (GBM) that have been attributed to the presence of cancer stem-like cells (CSCs) and their association with the perivascular niche. However, the mechanisms by which the perivascular niche regulates GBM invasion and CSCs remain poorly understood due in part to a lack of relevant model systems. To simulate perivascular niche conditions and analyze consequential changes of GBM growth and invasion, patient-derived GBM spheroids were co-cultured with brain endothelial cells (ECs) in microfabricated collagen gels. Integrating these systems with 3D imaging and biochemical assays revealed that ECs increase GBM invasiveness and growth through interleukin-8 (IL-8)-mediated enrichment of CSCs. Blockade of IL-8 inhibited these effects in GBM-EC co-cultures, while IL-8 supplementation increased CSC-mediated growth and invasion in GBM-monocultures. Experiments in mice confirmed that ECs and IL-8 stimulate intracranial tumor growth and invasion in vivo. Collectively, perivascular niche conditions promote GBM growth and invasion by increasing CSC frequency, and IL-8 may be explored clinically to inhibit these interactions.

Isolated leptomeningeal progression from sinonasal carcinomas: Implications for staging workup and treatment.

To evaluate the rate and risk factors of isolated leptomeningeal progression in sinonasal carcinomas. We retrospectively reviewed imaging and clinical records to determine progression patterns, and estimated rates using the Kaplan-Meier method. We evaluated risk factors using proportional hazard regression. We analyzed 120 patients who received adjuvant or primary radiotherapy for sinonasal carcinomas. Most patients had T4 disease (68%) and underwent surgery (84%) and chemotherapy (72%). Twenty-seven (23%) patients developed distant metastases (DM), including 20 (17%) with isolated DMs. Leptomeningeal progression was the most common site of isolated DMs (n = 9; 45%) with an average disease-free interval of 1.2 years (0.1-4.3 years). High-grade histology (P = 0.0003), intracranial invasion (P < 0.0001), and neuroendocrine histology (P = 0.06) were associated with increased risk. Isolated leptomeningeal progression is a common pattern of DM in advanced sinonasal carcinomas. We recommend adding cerebrospinal fluid cytology and contrast-enhanced spine MRI to routine staging evaluations for high-risk patients.

Results of surgical treatment of skull-base primary malignant tumors with intracranial invasion

Analysis of factors affecting life expectancy at patients with primary malignant tumors of anterior and middle parts of the skull base with intracranial invasion. 139 patients (47 women and 92 men) with primary malignant tumors of the anterior and middle parts of the skull base with intracranial invasion (stage T4 according to TNM classification or stage C according to Kadish classification for estesioneuroblast ) were treated at the NMRCN Burdenko for the period from 2004 till 2018. The study was conducted by the method of total sampling. The observations are divided into 2 groups: primarily operated (group I) and repeatedly operated (group II). The average age in both groups was 50 years. In most (64.7%) cases, the tumor affected the medial sections of the base of anterior and middle cranial fossae, and in 35.3% of cases it was localized laterally. All tumors were classified to T4 stage according to TNM classification or (9 olfactory neuroblastomas) to stage C according to Kadish classification. The impact on life expectancy was largely provided by postoperative radiation therapy, the repeated nature of operation, and the presence of brain infiltration. In the total cohort of patients 5-year OS, 5-year RVS, 5-year-old IDF and 5-year LC were 50.7, 35, 54.2 and 36.4%, respectively. In group I, the medians OS and IDF were equal and amounted to 138.3 months. The median RVS was 43.8 months. 5-year OS equal to 63.6%, 5-year RVS - 40.8%, 5-year-IDF - 64.8%, 5-year LC was up to 65.7%. The survival rate in the analyzed cohort for 1, 2, 3 years was 81.4, 71.8 and 67.8%, respectively. In group II, the treatment results for the group of repeatedly treated patients were significantly worse. There were no cases of 5-year survival. The 1-, 2-, and 3-year survival rates were 59.3, 50.8 and 31.8%, respectively. The median OS was 27.1 months, IDF was 27.1 months, RVS was 18.2 months, and LC was 9.1 months. The results and analysis of literature justify the feasibility of surgical treatment of patients with malignant tumors of craniofacial localization at T4 stage. The purpose of surgical intervention should be: elimination of the immediate threat to the patient's life due to edema and dislocation of the brain; the maximum possible removal of tumor tissue (cytoreduction); if possible, the elimination of the most significant symptoms for the patient (pain, nasal breathing disorders, cosmetic defect). If there are special reserves, it is obligatory to include radiation and chemotherapy in the treatment process.

Predictive Value of EGFR-PI3K-pAKT-mTOR-pS6 Pathway in Sinonasal Squamous Cell Carcinomas

Background and objectivesWe have previously indicated that EGFR has a role in carcinogenesis in a subgroup of sinonasal squamous cell carcinomas (SNSCC). In addition, EGFR activates 2 of the most important intracellular signalling pathways: PI3K/pAKT/mTOR/pS6 and MAP pathway kinases. The objective of this study was to evaluate the involvement of the EGFR/PI3K/pAKT/mTOR/pS6 pathway and its relationship with clinical–pathological parameters and follow-up of sinonasal squamous cell carcinoma. Material and methodsThe immunohistochemical expression of different components of the PI3K/AKT/mTOR/pS6 pathway and its relationship with various clinical-pathological parameters was studied in a series of 54 patients with SNSCC. ResultsLoss of PTEN expression was observed in 33/54 cases (61%) and pAKT, mTOR and pS6 pre-expression was observed in 19/54 cases (35%), 8/54 cases (15%), and 47/54 cases (87%), respectively. Loss of PTEN expression was related to intracranial invasion and development of regional metastases (P=.005). Overexpression of pS6 was associated with a decrease in survival (P=.008), presence of local recurrences (P=.055), and worsening of overall prognosis (P=.007). No significant relationships were observed between pAKT and mTOR expression and the clinicopathological parameters studied. ConclusionsAlterations in the expression of EGFR/PI3K/pAKT/mTOR/pS6 pathway components are common in a subgroup of SNSCC. This study reveals that the absence of pS6 overexpression is associated with better clinical outcomes. Therefore, pS6 expression could be considered as an unfavourable prognostic marker.

Diffuse large B-cell non-hodgkin lymphoma of the ear with intracranial invasion

&lt;p class="abstract"&gt;We report a 62-year-old woman with primary diffuse large B-cell lymphoma (DLBCL) of the ear. The patient presented with facial palsy, left ear hearing loss and a mass in the left external auditory canal. CT and MRI showed an occupied external auditory canal, middle ear and temporal bone with extensive intracranial invasion, R-CHOP therapy was started, but she died after one course. Primary lymphoma of the ear is extremely rare and to the best of our knowledge this is the first case reported in a Mexican medical center, and also the first overall with such an extensive invasion.&lt;/p&gt;

The Tumor-Infiltrating T-Cell Receptor-b Repertoire Is Linked to Risk of Radiation-Induced Temporal Lobe Necrosis in Locally Advanced Nasopharyngeal Carcinoma

Temporal lobe necrosis (TLN), a late complication of nasopharyngeal carcinoma (NPC) patients after concurrent chemoradiotherapy (CCRT), causes permanent neurological deficits. We aimed to investigate the risk factors for the development of CCRT-induced TLN in locally advanced NPC with intracranial invasion. The impact of CCRT-induced TLN on clinical outcomes was assessed in 73 consecutive patients initially staged T4N0-3M0 NPCs receiving curative intensity-modulated radiotherapy (IMRT) and cisplatin-based chemotherapy with long-term follow-up. The TLN risk was evaluated with the dose-volume histograms (a dosimetric impact of organ injury) and the dynamics of blood-circulating neutrophil-to-lymphocyte ratios (a clinical indicator of systemic inflammation) by linear and logistic regression models. High-throughput unbiased T-cell receptor-beta (TCRbeta) sequencing was performed to correlate the different TCRbeta repertoires of NPC-infiltrating lymphocytes (a biological factor of immune microenvironment) with the TLN incidence. We found that in the era of modern IMRT-based CCRT, radiation dose up to 74 Gy achieved more than 90% of the 5-year local control rate but still induced 30% of TLN incidence in the T4 NPC patients. TLN occurrence did not affect the local recurrence-free survival rate. Univariate and multivariate analyses showed the radiation tolerance dose-volume effect was not an absolutely independent factor for TLN occurrence. However, increased TLN risk was seen in association with higher pre-CCRT baseline and increased post-CCRT levels of neutrophil-to-lymphocyte ratios. There was also a link of intratumoral TCRbeta repertoire subgroups to higher TLN incidence. Combining the inherent TCRbeta genomic susceptibility with clinical variable neutrophil-to-lymphocyte ratios better predicted the risk of TLN for T4 NPC following CCRT. These findings suggest that the immune system should play a role in CCRT-induced TLN. The reciprocal interactions of neutrophils and lymphocytes in the immune microenvironment around NPC, whether modulated or provoked by CCRT, could be a key player or driver in TLN development.

Valor pronóstico de la ruta de EGFR-PI3K-pAKT-mTOR-pS6 en los carcinomas epidermoides nasosinusales

Background and objectivesWe have previously indicated that EGFR has a role in carcinogenesis in a subgroup of sinonasal squamous cell carcinomas (SNSCC). In addition, EGFR activates 2 of the most important intracellular signalling pathways: PI3K/pAKT/mTOR/pS6 and MAP pathway kinases. The objective of this study was to evaluate the involvement of the EGFR/PI3K/pAKT/mTOR/pS6 pathway and its relationship with clinical-pathological parameters and follow-up of sinonasal squamous cell carcinoma. Material and methodsThe immunohistochemical expression of different components of the PI3K/AKT/mTOR/pS6 pathway and its relationship with various clinical-pathological parameters was studied in a series of 54 patients with SNSCC. ResultsLoss of PTEN expression was observed in 33/54 cases (61%) and pAKT, mTOR and pS6 pre-expression was observed in 19/54 cases (35%), 8/54 cases (15%), and 47/54 cases (87%), respectively. Loss of PTEN expression was related to intracranial invasion and development of regional metastases (p=0.005). Overexpression of pS6 was associated with a decrease in survival (p=0.008), presence of local recurrences (p=0.055), and worsening of overall prognosis (p=0.007). No significant relationships were observed between pAKT and mTOR expression and the clinicopathological parameters studied. ConclusionsAlterations in the expression of EGFR/PI3K/pAKT/mTOR/pS6 pathway components are common in a subgroup of SNSCC. This study reveals that the absence of pS6 overexpression is associated with better clinical outcomes. Therefore, pS6 expression could be considered as an unfavourable prognostic marker.

Isolated Leptomeningeal Progression from Sinonasal Carcinomas: Implications for Staging Workup and Treatment

To determine the rate of isolated leptomeningeal progression among patients treated for locally advanced sinonasal carcinomas and to evaluate associated risk factors. The records of 120 patients who completed treatment with either adjuvant or primary radiation therapy for sinonasal carcinomas were retrospectively reviewed. The majority of patients had T4 disease (68%), underwent surgery (84%), and also received chemotherapy (72%). Median follow-up was 3.2 years among living patients. Patterns of recurrence were detailed, including first site of progression. Leptomeningeal progression was coded based on a review of imaging and clinical records and the rate progression was estimated using the Kaplan-Meier method. Risk factors were evaluated using proportional hazard regression. A total of 27 (23%) patients developed distant metastases (DMs), including 20 (17%) with isolated DMs. The 3-year rate of freedom from DM was 73% (81% for freedom from isolated DMs). Leptomeningeal progression was the single most common site of isolated DM progression and occurred in 9 of the 20 (45%) patients with an average disease-free interval of 1.2 years (range, 0.1-4.3 years) after initiation of radiation therapy. High-grade histology (P=.0003), intracranial invasion (P<.0001), and neuroendocrine differentiation (P=.061) were associated with isolated leptomeningeal progression while surgery (P=.872) and the presence of gross disease at the time of radiation therapy (P=.339) were not associated with leptomeningeal progression. Isolated leptomeningeal progression is a common pattern of DMs among patients with advanced sinonasal carcinomas. Intracranial invasion, neuroendocrine differentiation, and high-grade histology were associated with an increased risk for this unique pattern of recurrence. We suggest cerebrospinal fluid (CSF) cytology and contrast-enhanced spine MRI in addition to established staging evaluations for this patient subset. To date there are no data regarding the role of CSF-directed therapy, such as craniospinal irradiation or intrathecal chemotherapy, but these are areas of potential investigation to reduce the risk of leptomeningeal progression in patients with positive findings on CSF cytology or spine MRI.

Clinical utility of simultaneous whole-body 18F-FDG PET/MRI as a single-step imaging modality in the staging of primary nasopharyngeal carcinoma.

Both head and neck magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) play a crucial role in the staging of primary nasopharyngeal carcinoma (NPC). In this study, we sought to prospectively investigate the clinical utility of simultaneous whole-body 18F-FDG PET/MRI for primary staging of NPC patients. We examined 113 patients with histologically confirmed NPC who underwent pretreatment, simultaneous whole-body PET/MRI and PET/CT for primary tumor staging. The images obtained with the different imaging modalities were interpreted independently and compared with each other. PET/MRI increased the accuracy of head and neck MRI for assessment of primary tumor extent in four patients via addition of FDG uptake information to increase the conspicuity of morphologically subtle lesions. PET/MR images were more discernible than PET/CT images for mapping tumor extension, especially intracranial invasion. Regarding the N staging assessment, the sensitivity of PET/MRI (99.5%) was higher than that of head and neck MRI (94.2%) and PET/CT (90.9%). PET/MRI was particularly useful for distinguishing retropharyngeal nodal metastasis from adjacent nasopharyngeal tumors. For distant metastasis evaluation, PET/MRI exhibited a similar sensitivity (90% vs. 86.7% vs. 83.3%), but higher positive predictive value (93.1% vs. 78.8% vs. 83.3%) than whole-body MRI and PET/CT, respectively. For tumor staging of NPC, simultaneous whole-body PET/MRI was more accurate than head and neck MRI and PET/CT, and may serve as a single-step staging modality.

Mucocele of the Paranasal Sinuses - Retrospective Analysis of a Series of Seven Cases.

The present study aimed at identifying the risk factors, typical clinical symptoms and applied treatment in seven cases with mucocele of the paranasal sinuses. Seven patients suffering from mucocele of the paranasal sinuses were admitted to the Clinic of Neurosurgery and the Clinic of Ear, Nose and Throat Diseases between 2014 and 2016. There were 4 females and 3 males aged between 22 and 78 (95% CI [31.44, 70.23]). Initial symptoms, their duration, clinical presentation upon admission, localization of the mucocele, type of surgical intervention and outcome have all been studied. The localization of the mucocele was frontal (2 cases), fronto-ethmoidal (2 cases), ethmoidal (1 case) and spheno-ethmoidal (2 cases). Risk factors were identified in 4 cases. Endoscopic marsupialization of the mucocele was performed in 5 cases. One patient with intracranial extension of frontal mucocele was treated via right frontobasal craniotomy. One of the patients refused surgery. Endoscopic marsupialization should be considered as a method of choice in cases with mucoceles without extensive intracranial invasion. This approach offers adequate drainage, balloon dilatation of the natural sinus openings that prevents future recurrence.

Clinical and radiological findings of temporomandibular joint synovial chondromatosis perforating the glenoid fossa: A rare case report

Synovial chondromatosis (SC) of temporomandibular joint (TMJ) is a rare benign disorder in which mesenchymal remnants of synovial tissue undergo cartilaginous metaplasia. It is usually confined to the superior joint space; however, it can occasionally extend beyond the joint capsule into the cranium, parotid gland, infratemporal fossa, or external auditory meatus. SC of TMJ with intracranial invasion is very rare. Few cases with such large extent of the disease have been reported in the literature. In this report, we present the clinical features and imaging findings of a rare case of TMJ SC perforating the glenoid fossa leading to communication with the base of the skull. This case report attempts to identify clinical characteristics of intracranial extension and highlighting the various imaging modalities which aid in the diagnosis of SC.

Orbital Solitary Fibrous Tumour: A Report of Two Cases and Review of the Literature

We present two clinical cases of patients aged 36 and 74 with an orbital solitary fibrous tumour (SFT). The diagnosis was confirmed by immunohistochemistry being positive for CD34, BCL-2, CD99 and STAT6. The first case was satisfactorily removed during the biopsy and in the second case partial resection was achieved. The patient was referred to neurosurgery after confirming the diagnosis and because of intracranial invasion of the tumour. Discussion Orbital SFT is a generally benign neoplasm originating from the mesenchyme, uncommon in the orbit. It is diagnosed using immunohistochemical technique and the treatment of choice is surgical resection of the tumour in order to prevent recurrences. Usually, local resection of the tumour is sufficient. However, in some situations, infiltration of the tumour requires more extensive resection of adjacent tissues. Radiation therapy does not appear to be beneficial and the efficacy of chemotherapy has not been demonstrated in this type of tumour.

Basal cell carcinoma of the scalp with destruction and invasion into the calvarium and dura mater: Report of 7 cases and review of literature

Basal cell carcinoma (BCC) is the most common skin malignancy in humans. Giant BCC is a rarer entity that is characterised by aggressive biological behaviour. Intracranial invasion by a BCC on the scalp is extremely rare. The gold standard treatment of BCCs is represented by surgical excision with a wide variety of reconstructive techniques. In this paper, we describe the largest series to date of recurrent BCCs with intracranial extension involving the dura mater. We report recurrent giant BCC of the scalp with dura mater invasion in 7 patients. All patients in this series previously had more than 2 operations. Gadolinium-enhanced MRI revealed neoplastic invasion of the meninges and brain tissues. All patients had a multi-disciplinary team approach with the surgical margins ranging between 1 and 2 cm depending on the location and the size of the tumour. 5 of the patients underwent reconstruction of the skin defect by antero-lateral thigh flap, 1 patient underwent reconstruction with pedicled myocutaneous (trapezius) flap, and 1 with a pedicled myocutaneous latissimus dorsi flap. There was a mean follow-up of 5.3 years. 2 patients died due to cardio-pulmonary complications in the neuro-intensive care unit. A multi-disciplinary team approach and early aggressive tumour resection followed by sophisticated reconstructive and aesthetic procedures appears to be a reliable and realistic treatment modality for invasive BCC.