Archivos de la categoría Base de Cráneo

Lateral inferior cerebellar peduncle approach

4 patients (3 woman and 1 man) who had a symptomatic dorsolateral brainstem cavernous malformation with radiographic and clinical evidence of hemorrhage, underwent excision via a far lateral suboccipital craniotomy through the foramen of Luschka and with an incision in the cerebellar peduncle.

On intraoperative examination, 2 of the 4 patients had hemosiderin staining on the surface of the peduncle. All lesions were completely excised and all patients had a good or excellent outcome (modified Rankin Scale scores of 0 or 1).

Case series of Deshmuk et al., illustrates that intrinsic lesions of the dorsolateral medulla can be safely removed laterally through the foramen of Luschka and the inferior cerebellar peduncle 1).

1) Deshmukh VR, Rangel-Castilla L, Spetzler RF. Lateral inferior cerebellar peduncle approach to dorsolateral medullary cavernous malformation. J Neurosurg. 2014 Sep;121(3):723-9. doi: 10.3171/2014.5.JNS132276. Epub 2014 Jun 27. PubMed PMID: 24972129.

Management of small vestibular schwannoma: UptoDate

Management of small  vestibular schwannoma consists of 3 options:

Observation with imaging follow-up

Radiosurgery

And/or tumor removal.

Iwao Yamakami et al., report the long-term outcomes and preservation of function after retrosigmoid approach removal and clarify the management paradigm for small tumors.

A total of 44 consecutively enrolled patients with small tumor and preserved hearing underwent retrosigmoid tumor removal in an attempt to preserve hearing and facial function by use of intraoperative auditory monitoring of auditory brainstem responses (ABRs) and cochlear nerve compound action potentials (CNAPs). All patients were younger than 70 years of age, had a small AN (purely intracanalicular/cerebellopontine angle tumor ≤ 15 mm), and had serviceable hearing preoperatively.

According to the American Academy of Otolaryngology Head and Neck Surgery hearing preservation reporting guidelines of the 44 patients were as follows: Class A, 19 patients; Class B, 17; and Class C, 8. The surgical technique for curative tumor removal with preservation of hearing and facial function included sharp dissection and debulking of the tumor, reconstruction of the internal auditory canal, and wide removal of internal auditory canal dura.

For all patients, tumors were totally removed without incidence of facial palsy, death, or other complications. Total tumor removal was confirmed by the first postoperative Gadolinium enhanced MRI performed 12 months after surgery. Postoperative hearing levels were Class A, 5 patients; Class B, 21; Class C, 11; and Class D, 7. Postoperatively, serviceable (Class A, B, or C) and useful (Class A or B) levels of hearing were preserved for 84% and 72% of patients, respectively. Better preoperative hearing resulted in higher rates of postoperative hearing preservation (p = 0.01); preservation rates were 95% among patients with preoperative Class A hearing, 88% among Class B, and 50% among Class C. Reliable monitoring was more frequently provided by CNAPs than by ABRs (66% vs 32%, p < 0.01), and consistently reliable auditory monitoring was significantly associated with better rates of preservation of useful hearing. Long-term follow-up by MRI with Gd administration (81 ± 43 months [range 5-181 months]; median 7 years) showed no tumor recurrence, and although the preserved hearing declined minimally over the long-term postoperative follow-up period (from 39 ± 15 dB to 45 ± 11 dB in 5.1 ± 3.1 years), 80% of useful hearing and 100% of serviceable hearing remained at the same level.

As a result of a surgical technique that involved sharp dissection and internal auditory canal reconstruction with intraoperative auditory monitoring, retrosigmoid removal of small ANs can lead to successful curative tumor removal without long-term recurrence and with excellent functional outcome. Thus, Yamakami et al., suggest that tumor removal should be the first-line management strategy for younger patients with small tumor and preserved hearing 1).

1) Yamakami I, Ito S, Higuchi Y. Retrosigmoid removal of small acoustic neuroma: curative tumor removal with preservation of function. J Neurosurg. 2014 Sep;121(3):554-63. doi: 10.3171/2014.6.JNS132471. Epub 2014 Jul 4. PubMed PMID: 24995779.

4 examples of endoscopic transsphenoidal resection of a craniopharyngioma

These series of videos demonstrate 4 examples of endoscopic transsphenoidal resection of a craniopharyngioma. Figures and captions for relevant anatomy during tumor resection are depicted at the end of each video.Case 1 (0:06): The patient is a 54-year-old male that was found to have a 2.6 x 2.0 x 3.6 cm cystic sellar mass with suprasellar extension upon workup of headaches, fatigue, gynecomastia, and decreased libido. His laboratory studies demonstrated central hypogonadism and central hypothyroidism.Case 2 (2:28): The patient is a 29-year-old male that was found to have a 3.6 x 2.7 x 2.5 cm sellar mass with suprasellar extension upon workup of headaches, decreased libido, and visual field deficits. The mass has both a cystic and solid component. His pre-operative endocrine laboratory studies demonstrated adrenal insufficiency, hypogonadism, and hypothyroidism.Case 3 (4:39): The patient is a 61-year-old female that was found to have a 1.7 x 1.4 x 1.1 cm sellar mass with suprasellar extension upon workup of headaches, fatigue, vertigo, and blurry vision. The mass has both a cystic and solid component. Her pre-operative endocrine laboratory studies were unremarkable.Case 4 (5:58): The patient is a 32-year-old female that was found to have a 1.9 x 1.3 x 2.8 cm solid sellar mass with extension into the 3rd ventricle upon workup of headaches, horizontal diplopia, and bilateral abducens nerve palsies. Her pre-operative endocrine laboratory studies were unremarkable

Chu J, Oyesiku N. 3-D Endoscopic Transsphnoidal Pituitary Surgery: 4 Unique Cases of Craniopharyngioma. Neurosurgery. 2014 Aug 27. [Epub ahead of print] PubMed PMID: 25167380.

Journal of Neurosurgery Junio 2014

Suprasellar meningioma

FEATURED ARTICLE

Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients

With the goal of gross-total tumor resection and visual improvement, endoscopic endonasal surgery (EES) can achieve very good results, (comparable to microscopic approaches) for the treatment of suprasellar meningiomas. Avoidance of brain and optic nerve retraction, preservation of the vascularization of the optic apparatus, and wide decompression of the optic canals are the main advantages of EES for the treatment of suprasellar meningiomas, while cerebrospinal fluid leakage remain a disadvantage 1).

1) Koutourousiou M, Fernandez-Miranda JC, Stefko ST, Wang EW, Snyderman CH, Gardner PA. Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg. 2014 Jun;120(6):1326-39. doi: 10.3171/2014.2.JNS13767. Epub 2014 Mar 28. PubMed PMID: 24678782.

Mary Koutourousiou, MD, joined the University of Pittsburgh Department of Neurological Surgery in May 2012 to complete a clinical fellowship in open and endoscopic endonasal skull base surgery with Drs. P.A. Gardner and J.C. Fernandez-Miranda. Prior to this appointment, since April 2010, she was a research fellow at the University of Pittsburgh Department of Neurological Surgery. Dr. Koutourousiou, a native from Thessaloniki, Greece, received her medical degree from the Aristotle University of Thessaloniki, Greece and completed her neurosurgical residency at the General Hospital of Athens “G. Gennimatas”, Athens, Greece. She has completed a clinical fellowship in minimally invasive and endoscopic neurosurgery with Prof. J.A. Grotenhuis at the Department of Neurosurgery, UMC St Radboud, Nijmegen, The Netherlands. Dr. Koutourousiou is accomplishing her Ph.D. on the Endocrinology and Pathophysiology of pituitary adenomas at the University of Athens, School of Medicine, Greece.

Clinical Fellowship – Head and Neck Oncology/Skull Base Surgery

Aurora-St. Lukes’s Hospital Fellowship in Head and Neck Oncologic Surgery and Skull Base Surgery is a one year fellowship intended for Otolaryngologists-Head and Neck Surgeons who are Board Eligible (American Board of Otolaryngology) or a Fellow of the Royal College of Surgeons of Canada.

During the one year fellowship, Fellows will gain experience in both Head and Neck Oncologic Surgery and Skull Base Surgery.   The Head and Neck Oncology component will be supervised by Dr. Martin Corsten, and will consist of clinical and operative exposure to mucosal Head and Neck Cancer, salivary gland malignancies, head and neck melanoma, and thyroid pathology.   The Skull Base Surgery component will be supervised by Dr. Martin Corsten and Dr. Amin Kassam, and will consist of exposure to both Endoscopic Endonasal Approaches to the skull base as well as conventional open skull base approaches.   The Fellow will have an opportunity to learn the intricacies of skull base anatomy from both the dorsal and ventral perspectives.  The 360o Cranial Base Laboratory is equipped with state-of the-art microscopic and endoscopic cadaveric dissection stations that are augmented with powerful imaging and navigation platforms.  Fellows will master both conventional and endoscopic endonasal skull base approaches by observing them in the operating rooms and then performing them on cadaveric specimens in the laboratory.  Subsequently, Fellows will be immersed in the high-volume clinical Head and Neck Oncology and Skull Base service where they will function as junior staff members.

The fellowship program is academically oriented. Research projects with focus on Head and Neck Oncology and Skull Base Surgery are encouraged and supported. Fellows are expected to submit at least two manuscripts for publication annually. Fellows are also encouraged to submit abstracts for major national and international meetings.

Unique Features

1) Exposure to full range of Head and Neck Oncology.

2) Comprehensive approach to minimally invasive skull base surgery: the goal is not to promote one approach over the other; instead, the Fellow will gain excellent experience in both conventional and endoscopic approaches.

3) Easy and encouraged access to the 360 Cranial Base Laboratory

4) The spirit of collegiality nurtured by our team. We “listen” to and “learn” from our fellows as much (if not more) than they “listen” and ” learn” from us.

5) Innovation is welcomed and encouraged by each of our team members.

Fellowship Objectives

Objectives of Fellowship

•                     To gain sufficient clinical experience in Head and Neck Oncology, including exposure to multi-disciplinary clinical conferences on Head and Neck Cancer lesions.

•                     To gain sufficient clinical experience in complex Skull Base surgery; both conventional and endoscopic.

•         To actively participate in Head and Neck Oncology and Skull Base research.

•         To have the opportunity to publish and establish expertise in the areas above, to prepare for an academic career and consultative service in this subspecialty.

Eligibility and Qualifications

The candidate should be a Board Eligible Otolaryngologist – Head and Neck Surgeon  (American Board of Otolaryngology) or a Fellow of the Royal College of Surgeons of Canada) who is eligible for a Wisconsin medical license. Non US citizens must be eligible for an H1-B visa.

Stipends and Benefits

The ANI offers a highly competitive compensation package. Details will be discussed during the interview.

Selection Process

Eligible applicants should direct their CVs and letter of intent to the fellowship program director. The letter of intent should specify the desired start date. Competitive  applicants will be invited for an interview. Applicants are evaluated on the basis of their academic standing, research productivity, letters of references, future goals and objectives.

For more information visit us at:

Www.aurora.org/ANII or

http://www.aurorahealthcare.org/services/neurology-neurosurgery/neuroscience-innovation-institute