Prognostic value of the nodal yield in elective neck dissections in patients with head and neck carcinomas

xlomafota13 shared this article with you from Inoreader Prognostic value of the nodal yield in elective neck dissections in patients with head and neck carcinomas Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 May 3. doi: 10.1007/s00405-021-06819-0. Online ahead of print. ABSTRACT PURPOSE: The objective of this study is to assess the prognostic capacity of the nodal yield in elective neck dissections performed in patients with head and neck squamous cell carcinomas (HNSCC) without clinical or radiological evidence of regional involvement (cN0) at the time of diagnosis. METHODS: Retrospective study including 647 patients with HNSCC treated with an elective neck dissection. RESULTS: Patients with < 15 dissected nodes (n = 172, 26.6%) had a 5-year disease-specific survival of 64.9% (95% CI: 57.3-72.5%), while for patients with ≥ 15 dissected nodes (n = 475, 73.4%), it was of 81.9% (95% CI: 78.4-85.4%) (P = 0.0001). The nodal yield category had prognostic capacity on the disease-specific survival in patients with tumors located in the oral cavity (P = 0.001), the oropharynx (P = 0.023) and the hyp opharynx (P = 0.034), while for patients with tumors located in the larynx, no significant differences appeared (P = 0.779). Differences in regional recurrence-free survival were also observed based on the nodal yield category in patients with extra-laryngeal tumors (5-year regional recurrence-free survival of 81.0% in patients with < 15 dissected nodes vs 89.0% in patients with ≥ 15 dissected nodes; P = 0.046). CONCLUSION: The nodal yield in elective neck dissections in patients without evidence of lymph node disease (cN0) had prognostic capacity depending on the location of the primary tumor. For tumors located in the larynx, the number of dissected nodes did not significantly influence the prognosis. For tumors located in the oral cavity, oropharynx or hypopharynx, patients with < 15 dissected nodes had a disease-specific mortality 2.9 times higher than patients with ≥ 15 dissected nodes. PMID:33938992 | DOI:10.1007/s00405-021-06819-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lasers in endoscopic middle ear surgery: where do we stand today?

xlomafota13 shared this article with you from Inoreader Lasers in endoscopic middle ear surgery: where do we stand today? Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 May 3. doi: 10.1007/s00405-021-06807-4. Online ahead of print. ABSTRACT OBJECTIVE: To provide an overview of the current status regarding the parallel use of the endoscope and the laser in middle ear surgery. METHODS: Comprehensive Pubmed search from 1975 to 2020 including clinical articles, of any type, reporting the combined use of a laser and an endoscope. Purely experimental and non-human studies were excluded. RESULTS: Reports on the application of the laser in pediatric and adult endoscopic middle ear surgery (EES) are increasing since 2013. Laser-assisted EES is performed for cholesteatoma, non-squamous chronic otitis media, ossicular fixation, otosclerosis and tympanic paraganglioma. The improved haemostasis and the non-contact ablation of tissue around the ossicles and inaccessible areas, represent unique advantages. In stapes surgery, the resection of stapes superstructure with mini mal force and the non-contact footplate fenestration are potential advantages. Proper use of the laser, i.e. direction away from the facial nerve and the open labyrinth and safe energy settings have resulted in minimal complications. CONCLUSION: Based on the increasing number of publications, endoscopic ear surgeons show an interest in using a laser for specific operative tasks. The configuration of a hand-held laser probe does not differ significantly from other otological instruments and therefore is easy to use alongside the endoscope, even in children. The 'handicap' of single-handed surgery can be partially offset by the bloodless and non-contact laser ablation of tissue. PMID:33938993 | DOI:10.1007/s00405-021-06807-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Microsurgical Resection of Tuberculum Sellae Meningioma through Pterional Approach with Extradural Optic Canal Unroofing

xlomafota13 shared this article with you from Inoreader Microsurgical Resection of Tuberculum Sellae Meningioma through Pterional Approach with Extradural Optic Canal Unroofing Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727148 Tuberculum sellae meningiomas pose significant challenges because they are surrounded by crucial neurovascular structures, such as the optic and oculomotor nerves, pituitary stalk, internal carotid artery and its branches, and the anterior cerebral arteries. Even if small, such meningiomas frequently extend to the optic canal that is considered a poor prognostic factor for vision. In this video clip, we illustrate the case of a 60-year-old female who had an approximately 3-cm tuberculum sellae meningioma with optic canal involvement. She underwent surgical resection of the tumor through a pterional approach. After extradural optic canal unroofing, detaching, devascula rizing, and debulking the tumor, careful dissection of the meningioma from the surrounding tissues was performed. Next, the tumor extensions into both of the optic canals were removed. Finally, coagulation and resection of the tumor origin on the dura of the tuberculum sellae following Simpson's grade-I resection were performed. Histopathology revealed that the tumor was a World Health Organization (WHO) grade-I meningioma. The patient had an uneventful postoperative course and her visual acuity was preserved, with no visual field defect on postoperative visual examination. In this video, the basic surgical techniques in performing extradural optic canal unroofing, preserving the arachnoid plane, and stay in collect layer, which is the essential technique for dissecting meningiomas and for preserving neurovascular structures, are demonstrated.The link to the video can be found at: https://youtu.be/vD54Iji0C4Q. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extended Endoscopic Endonasal Approach for a Giant Parasellar Epidermoid Cyst

xlomafota13 shared this article with you from Inoreader Extended Endoscopic Endonasal Approach for a Giant Parasellar Epidermoid Cyst Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727127 Epidermoid cysts are rare lesions which typically grow slowly. For this reason, these lesions are usually discovered when they are already very large. The parasellar location is no exception to this rule and may involve the cavernous sinus or the Meckel cave.We present a 34-year-old female patient without past medical history who was admitted in our tertiary referral center for episodes of diplopia in the right lateral gaze and right trigeminal dysesthesias. Brain magnetic resonance imaging (MRI) showed a large right parasellar mass with mixed intensity signal on the T1 and T2 sequences, without contrast enhancement and a typical hypersignal intensity on diffusion-wei ghted sequences evoking an epidermoid cyst. We discuss the radiologic criteria which differentiate the lesions originating in the cavernous sinus from those of the Meckel cave (Figs. 1 and 2).Parasellar tumors may be approached through classical transcranial approaches such the epidural temporopolar or the subtemporal approach which involve a significant degree of brain retraction. The last decade witnessed the advent of extended endonasal approaches which offer an interesting alternative and avoid the manipulation of the brain. We used the endoscopic transpterygoid approach in our patient and we were able to achieve an excellent clinical and radiological result. We discuss the nuances of the technique and present the surgical steps of the procedure (Figs. 3 and 4).The endoscopic endonasal approach represents an excellent therapeutic option for parasellar lesions. A thorough knowledge of the anatomy and experience with endoscopic techniques are obvious prerequisite.The link to the v ideo can be found at: https://youtu.be/QonSvHrCwOU. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anatomical Basis of the Zygomatic-Transmandibular Approach: Operative Video

xlomafota13 shared this article with you from Inoreader Anatomical Basis of the Zygomatic-Transmandibular Approach: Operative Video Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727125 Tumor growth in infratemporal fossa (ITF) and parapharyngeal space (PPS) is generally slow and generates very few clinical manifestations, so it is not uncommon for tumors to reach large dimensions at the time of diagnosis, making necessary to perform ample approaches. In zygomatic-transmandibular approach (ZTMA), the access of the ITF and PPS is obtained by a combination of a pterional craniotomy plus a zygomatic-mandibular osteotomy. Tumor excision is achieved by its initial dissection from all of the neurovascular structures of the middle fossa by the neurosurgical team and the final resection by the head and neck team from below. In the first part of this video, w e present a brief anatomical–surgical description of the ITF and PPS and in the second part, we show case of a trigeminal schwannoma that could be successfully removed through a ZTMA. Using this approach, an ample and safe exposure of the ITF and PPS is achieved, without affecting the chewing or facial nerve function and with excellent cosmetic results, so it can be considered as a reliable surgical option, particularly in cases of giant tumors that affect these regions (Figs. 1 and 2).The link to the video can be found at: https://youtu.be/oxVFhzT8HsQ. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table o f contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma

xlomafota13 shared this article with you from Inoreader Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1726018 Objective We illustrate a cavernous sinus chondrosarcoma treated with an endoscopic endonasal transethmoidal-transsphenoidal approach. Design Case report of a 15-year-old girl with diplopia and esotropia due to complete abducens palsy. Preoperative images showed a right cavernous sinus lesion with multiple enhanced septa and intralesional calcified spots (Fig. 1). Considering tumor location and the lateral dislocation of the carotid artery, an endoscopic endonasal approach was performed to relieve symptoms and to optimize the target geometry for adjuvant conformal radiotherapy. Setting The study was conducted at University of Insubria, Department of Neurosurgery, Varese, Italy. Participants Skull base team was participated in the study. Main Outcome Measures A transethmoidal-transsphenoidal approach was performed by using a four-hand technique. We used a route lateral to medial turbinate to access ethmoid and the sphenoid sinus. During the sphenoid phase, we exposed the medial wall of the cavernous sinus (Fig. 2) and the lesion was then removed using curette. Skull base reconstruction was performed with fibrin glue and nasoseptal flap. Results No complications occurred after surgery, and the patient experienced a complete recovery of symptoms. A postoperative magnetic resonance imaging showed a small residual tumor inside the cavernous sinus (Fig. 1). After percutaneous proton-bean therapy, patient experienced only temporary low-grade toxicity with local control within 2 years after treatment completion. Conclusion Endoscopic endonasal extended approach is a safe and well-tolerated procedure that is indicated in selected cases (intracavernous tumors, soft tumors not infiltrating the vessels and/or the nerves). A tailored approach according to tumor extension is crucial for the best access to the compartments involved.The link to the video can be found at: https://youtu.be/TsqXjqpuOws. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Gross Total Resection of a Recurrent Cavernous Sinus Meningioma through a Combined Transzygomatic Transcavernous and Extended Middle Fossa Approach with Cavernous Carotid Denudation

xlomafota13 shared this article with you from Inoreader Gross Total Resection of a Recurrent Cavernous Sinus Meningioma through a Combined Transzygomatic Transcavernous and Extended Middle Fossa Approach with Cavernous Carotid Denudation Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727147 Objective The aim of this study is to describe surgical management of invasive cavernous sinus meningioma with a combination of skull base approaches. Design This study is an operative video. Results Resection of the recurrent skull base meningioma is still challenging, especially if the tumor involves or encases the carotid artery. In this video, we describe our experience with the successful treatment of a recurrent skull base meningioma, which involved the entire cavernous sinus and the internal carotid artery. A 53-year-old male presented with a 1-year history of progressing right-side complete oculomotor palsy and facial dysesthesia. The patient had previously undergone craniotomy for the right-side petroclival cavernous meningioma (Fig. 1A and B). Total 8 years after the first surgery, the remaining portion of the cavernous sinus grew up and extended into the posterior fossa (Fig. 1C). Then the second surgery was performed to resect only the posterior fossa component (Fig. 1D). However, the follow-up magnetic resonance imaging revealed an aggressive tumor regrowth in 2 years. The tumor occupied the right middle fossa with an extension to the posterior fo ssa and infratemporal fossa (Fig. 1E and F). We scheduled to perform gross total resection of the tumor through a combined transzygomatic transcavernous and extended middle fossa approach with preparation for vessel reconstruction. Mild adhesion between the tumor and the cavernous carotid artery facilitated complete resection of the intracavernous component of the tumor (Fig. 2A–C). Conclusion A combination of skull base approaches provides multidirectional operative corridors and wide exposure of the skull base lesions.The link to the video can be found at https://youtu.be/DB_WXFeyBvo. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Posterior Communicating Segment Aneurysm of the Supraclinoid Internal Carotid Artery Treated with an Extracranial to Intracranial Bypass and Trapping

xlomafota13 shared this article with you from Inoreader A Posterior Communicating Segment Aneurysm of the Supraclinoid Internal Carotid Artery Treated with an Extracranial to Intracranial Bypass and Trapping Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1725940 Surgical treatment of giant aneurysms often poses significant challenges. Endovascular techniques have evolved exponentially over the last decades, and most of these complex aneurysms can be treated with flow-diverting techniques; however, successful obliteration of all giant aneurysms is not always possible with endovascular flow-diverting techniques. Although the need for microsurgical intervention has undoubtedly diminished, a versatile-thinking surgeon should keep in mind that obliteration of these aneurysms combined with revascularizing the distal circulation via extracranial–intracranial bypass techniques can provide a potentially life-long durable solution. T he key to curing these pathologies is to utilize interdisciplinary decision making with a robust knowledge of the pros and cons of different treatment approaches. Herein, we present a case of a giant posterior communicating segment aneurysm of the left supraclinoid internal carotid artery (ICA), which was treated by obliteration (Fig. 1). Extradural anterior clinoidectomy was used to provide exposure of the supraclinoidal ICA proximal to the aneurysm, and revascularization of the distal circulation was achieved with a common carotid artery to M2-superior trunk bypass using a radial artery interposition graft (Fig. 2). The patient was a 62-year-old female who presented with vision loss in her left eye but was otherwise neurologically intact. She had a history of two unsuccessful flow-diverting stent placement attempts 2 months prior to this surgery. Postoperatively, the patient woke up without any deficits, with her left eye vision partially recovered and ultimately returning to norm al at 1-year follow-up. Computed tomography (CT) angiography at a 1-year follow-up showed complete obliteration of the aneurysm and successful revascularization of the distal circulation.The link to the video can be found at: https://youtu.be/3Zz-ecvlDIc . [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cavernous Sinus Epidermoid Cyst Removal through a No-Keyhole Pterional Craniotomy: Operative Video and Technical Nuances

xlomafota13 shared this article with you from Inoreader Cavernous Sinus Epidermoid Cyst Removal through a No-Keyhole Pterional Craniotomy: Operative Video and Technical Nuances Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727118 Intracranial epidermoid cysts are considered benign tumors with good general prognosis. However, their radical removal may be associated with certain morbidity, especially when the capsule is attached to neurovascular structures. Epidermoid cysts located in the cavernous sinus are very rare. We present an operative video of a 22-year-old female patient, who suffered a right-sided headache for 5 years. The video demonstrates main steps and surgical nuances of resection of a right interdural cavernous sinus epidermoid cyst, measuring 22 × 19 × 21 mm (4.3 cc) (Fig. 1A). On initial physical examination, the patient had a right partial third nerve palsy (mild p tosis with minimal diplopia), without any other cranial nerve deficit. A right no-keyhole pterional craniotomy was performed, followed by extradural anterior clinoidectomy and peeling of the outer dural layer of the lateral wall of the cavernous sinus. The dura matter was also detached from the distal carotid dural ring, which was exposed by the clinoidectomy (Fig. 2A). This maneuver provided excellent exposure of the interdural epidermoid cyst, which severely compressed the oculomotor nerve against the posterior petroclinoid dural fold (Fig. 2B). Gross total resection of the epidermoid cyst was achieved (Fig. 1B and C). The patient developed a transient worsening of the third nerve palsy, which recovered completely 3 months after the surgery. Postoperative magnetic resonance imaging revealed no signs of residual tumor.The link to the video can be found at: https://youtu.be/pobhYb5ZNig. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic Transnasal Resection of Trigeminal Schwannoma

xlomafota13 shared this article with you from Inoreader Endoscopic Transnasal Resection of Trigeminal Schwannoma Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727122 Trigeminal schwannoma is a rare skull base tumor that can be managed in a variety of treatments including image observation, surgery, stereotactic radiosurgery, such as gamma knife radiosurgery (GKS), and combination of these. Endoscopic transnasal resection is very effective when the tumor is not invading far laterally, or the risk of cerebrospinal fluid (CSF) leak is estimated to be low. A 74-year-old man with a history of prostate cancer and diabetes presented with left oculomotor nerve palsy over a month. Magnetic resonance images (MRI) demonstrated a 25-mm mass in the left cavernous sinus protruding to the left orbit via the superior orbital fissure (Fig. 1). The patient underwent endoscopic transnasal surgery to decompress the mass. The surgery was uneventful, and postoperative MRI demonstrated satisfactory subtotal resection of the mass (Fig. 2). The final pathology returned as schwannoma. At 1-year follow-up, the tumor slowly enlarged, and the patient underwent GKS with a marginal dose of 14 Gy. At the last follow-up, 4 months after GKS, the tumor was stable. Unfortunately the patient deceased from the known prostate cancer. Endoscopic transnasal surgery was especially useful in this case, considering the preoperative known cancer state that management of this benign tumor did not ruin the quality of life of this patient while minimizing hospitalization, as achieving satisfactory tumor control with aid from postoperative GKS, minimizing complications.The link to the video can be found at: https://youtu.be/Q0Ugc2VFV4w. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.