Evaluating the Neurological Outcomes after Gamma Knife Radiosurgery for Symptomatic Skull Base Meningiomas Based on Their Locations: Single Institution Experience | Chapter 6 | Medicine and Medical Research: New Perspectives Vol. 4

Background: Meningioma is the most common primary benign intracranial tumor. Gross total resection of skull base meningioma (SBM) is so challenging due to its relevant high morbidity. Gamma knife radiosurgery is concerned, by providing a favorable therapeutic option in the management of SBM.

 

Aim: This study aims to evaluate the neurological outcome after GKRS as an adjuvant or primary treatment for SBM according to their locations.

 

Methods: This retrospective cross-sectional study consisted of 108 patients with SBM who underwent GKRS as an adjuvant or primary treatment. Patient’s medical records were collected to assess their demographic characteristics, clinical presentation, and clinical evaluations in follow-up visits. We found 40 patients with cavernous sinus meningioma (CSM), 36 patients with petroclival meningioma (PCM), and 22 patients with cerebellopontine angle meningioma (CPM). Of these, 81.1% were female (n = 90) with a median age of 52.68 years. Statistical analysis was performed using the chi-square test to evaluate the relationship between the duration of symptoms, age, gender, modality of GKRS (fractionated or not fractionated), and tumor size change on the likelihood of improvement and deterioration of neurological symptoms. The mean tumor volume was 4.5 cm3 and the mean marginal dose was 13 Gy.

 

Results: Tumor control was achieved in 96.4% of patients at a median follow-up of 38.4 months. Overall, 17 of 108 patients (15.6%) report improvement in their neurological symptoms. The majority of neurological symptoms were related to tumors which were located in the cavernous sinus 36%, Petroclival region 32.4%, and CPA 19.8%, respectively. Patients with CPM demonstrated lower rates of neurological symptom improvement compared to patients with PCM and CSM. Deterioration of neurological symptoms after GKRS developed in 11 patients (10.1%) which was more reported by patients with CSM than the others. The most improvement in cranial nerve deficit was in CN VI, V, and VIII among patients with CSM, PCM, and CPM respectively.

 

Conclusion: GKRS is acceptable as a primary or adjuvant treatment for SBM by providing an appreciable rate of improvement in neurological symptoms.

 

Author (s) Details

Farid Kazemi
Skull Base Research Center, Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran and Department of Neurosurgery, Rasool Akram Hospital, Tehran, Iran.

Parisa Javadnia
Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Alireza Tabibkhooei
Skull Base Research Center, Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran and Department of Neurosurgery, Rasool Akram Hospital, Tehran, Iran.

 

Mobin Naghshbandi
Student Research Center, Iran University of Medical Sciences, Tehran, Iran.

 

Vahid Ghorbani kalkha
Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v4/1960

 

Intraosseous Cavernous Hemangioma: A Rare Type of Cranial Tumor | Chapter 3 | New Visions in Medicine and Medical Science Vol. 5

Background: Cavernous hemangiomas are benign tumor of vascular origin, typically arising in the vertebral body. Its presence in the skull is exceedingly rare, with only a few cases being reported worldwide. The most common initial clinical manifestation was local growth or swelling, followed by a headache. Radiographically, PICHs represented osteolytic, intradiploic masses, which in many cases displayed trabeculations, leading to the so-called "honeycomb" or "starburst" pattern the first description of this type of tumor was in 1845 by Toynbee. A review of the literature reveals less than 100 published cases and a growing trend every year. Total surgical excision is the treatment of choice, and the prognosis after complete excision is excellent, with a recurrence usually rare.

 

Case Presentation: We present the case of a 57-year-old patient with a painless tumor of the left frontal bone, of slow growth and osteolytic characteristics from the neuro-radiological point of view. The lesion was excised en bloc by craniectomy, followed by cranioplasty. The anatomopathological diagnosis was intraosseous cavernous hemangioma.

 

Conclusions: Despite its low frequency, the diagnosis of intraosseous cavernous hemangioma should be considered in the presence of a slow-growing cranial tumor, with solid and painless characteristics, and its osteolytic nature confirmed by radiology. The treatment of choice consists in the complete resection of the lesion with resolution of the problem and with very low relapses. In very large tumors, treatment by prior embolization should be considered.

Author(s) Details:

Alejandra Arévalo Sáenz,
Neurosurgery Service of the San Carlos University Hospital, C/ Profesor Martín Lagos S/N, Moncloa 28040 Madrid, Spain.

Borja Ferrández Pujante,
Neurosurgery Service of the San Carlos University Hospital, C/ Profesor Martín Lagos S/N, Moncloa 28040 Madrid, Spain.

Fernando J. Rascón-Ramírez,
Neurosurgery Service of the San Carlos University Hospital, C/ Profesor Martín Lagos S/N, Moncloa 28040 Madrid, Spain.

Please see the link here: https://stm.bookpi.org/NVMMS-V5/article/view/14152

Novel Solution for the ENT and Skull Base Surgeons in COVID-19 Era: A ‘POLIDON’ Approach | Chapter 5 | Advanced Concepts in Medicine and Medical Research Vol. 5

 This affiliate highlights about novel resolution for the ENT and skull base surgeons in COVID-19 Era. Healthcare services in many nations have been incompletely or completely upset by the Coronavirus (COVID-19) pandemic because its beginning in the end of 2019. As the case numbers of COVID-19 have raised worldwide, it has enhance more apparent that the elevated vigorous load in the upper aerodigestive lot mucosa not only influences skull base surgery but basically all diagnostic and healing intranasal procedures that are usually part of the scope of practice for Otolaryngologist - Head and Neck Surgeons. The adulthood of endoscopic and microscopic ENT and brain base surgeries, such as pituitary gland and mastoid abscission, are AGP procedures. We deliberate eradicating or neutralizing the new coronavirus at its point of debut. As far as we are aware, RT-PCR experiment does not always influence a COVID negative result. For this reason, even cancer surgeries are discouraged, prevented, or delayed in the COVID-19 universal routine in order to keep healthcare professionals. Moreover, in case of surgical crisis there’s no way to refuse a patient for not bearing a report of COVID test. We designed and projected a novel approach, i.e. ‘POLIDON’ (POLIDON= Polythene + Povidone Iodine), which maybe the ultimate hope or answer for these unfortunate sufferers as well as surgeons or HCPs of above noticed specialties. Interestingly, among duodecimal different health management providers, including doctors, nurses and OT staffs, straightforwardly involved and exposed in these two surgeries, nobody of them were polluted/were not infected. Importantly, ‘POLIDON’ approach was understood in both the procedures.

Author(s) Details:

Mostafa Kamal Arefin,
Department of ENT and Head Neck Surgery, Dhaka Medical College Hospital, Bangladesh.

Muhammad Shaharior Arafat,
Department of ENT and Head Neck Surgery, Dhaka Medical College Hospital, Bangladesh.

SkNurul Fattah Rumi,
Department of ENT and Head Neck Surgery, Dhaka Medical College Hospital, Bangladesh.

Nazmul Islam Munna,
Medical Education and Health Manpower Development, Directorate General of Medical Education, Bangladesh.

Abu Yusuf Fakir,
Medical Education, Bangladesh.

Kamrul Hassan Tarafder,
Department of ENT and Head Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Bangladesh.

Ashraful Islam,
Department of ENT and Head Neck Surgery, Bangladesh Medical College Hospital, Bangladesh.

Khorshed Alam Mozumder,
Department of ENT and Head Neck Surgery, Holy Family Medical College Hospital, Bangladesh.

 
A. F. Mohiuddin Khan,
Department of ENT and Head Neck Surgery, Dhaka Medical College Hospital, Bangladesh.

Please see the link here: https://stm.bookpi.org/ACMMR-V5/article/view/12550