Search

This article, published in the Journal of Neurological Surgery, discusses the use of direct puncture embolization (DTE) in the resection of hypervascular head and neck tumors. DTE involves injecting the Onyx Liquid Embolic System directly into the tumor, reducing blood loss and complications during surgery. The study reviewed seven patients who underwent DTE prior to tumor resection, with successful embolization and minimal complications. The authors conclude that DTE is a safe and effective technique for resecting hypervascular skull base tumors, offering advantages such as lower risk of artery injury and stroke. [Extracted from the article]

This article examines the impact of different management strategies on the quality of life (QOL) of patients with vestibular schwannoma (VS). The study analyzed patient-reported outcome measures (PROMs) collected from a retrospective cohort of 347 patients with VS. The results showed that patients who underwent retrosigmoid (RS) surgery had the lowest QOL scores initially but experienced the most significant improvement in QOL at their last follow-up. However, patients who were under observation experienced a decline in QOL. The study highlights the importance of understanding the trajectory of PROMs in patient counseling. [Extracted from the article]

This article explores the management of trigeminal schwannomas, which are benign tumors that can develop along the trigeminal nerve. The study analyzes 49 cases of trigeminal schwannomas at a large academic medical center, examining patient demographics, tumor characteristics, treatment strategies, and associated complications. The findings reveal that management approaches varied, with some patients undergoing observation, microsurgery, or radiation therapy. The study suggests that subtotal resection may be a valuable strategy for managing large, growing, and symptomatic tumors, but it carries a higher risk of requiring additional intervention. [Extracted from the article]

Background  Pituitary apoplexy is often treated urgently, but this is based on studies which assess vision categorically and dichotomizes the time interval between symptom onset and surgery which may introduce bias in measuring an association between the two. Objective  This study was aimed to assess for a relationship between continuously valued surgery delay and visual acuity recovery after pituitary apoplexy. Methods  In this retrospective study, all patients presenting with symptomatic pituitary apoplexy between 2004 and 2016 were identified from an institutional database. The primary endpoint was visual acuity improvement, measured as the difference in acuity from the pre- to postoperative period, and measured in Logarithm of the Minimal Angle of Resolution (LogMAR) units. Analysis was performed using continuous values of time delay and visual acuity to assess for an underlying association. Results  Thirty-two pituitary apoplexy patients were identified. Visual acuity deficits were reported in 81%. The median visual acuity was 0.35 LogMAR (Snellen's fraction 20/40) preoperatively, and 0.1 (20/25) postoperatively (p  < 0.01). The time between symptom onset and surgery was not associated with improvement in visual acuity (p  = 0.46). When the time delay and visual outcome were intentionally dichotomized, patients undergoing surgery within 2 days of symptom onset had 0.21 times the odds of a good visual outcome (95% confidence interval [CI]: 0.04–1.05). Conclusion  When assessed as continuously valued measures, the time from symptom onset to surgical intervention and the improvement in visual acuity are not associated, although intentional dichotomization of data produced conflicting results. [ABSTRACT FROM AUTHOR]

Objective  This study aimed to evaluate surgical outcomes after transzygomatic middle cranial fossa (MCF) (TZ-MCF) approach for tumor control in patients with large skull base lesions involving the MCF and adjacent sites. Setting  This study was done at the tertiary skull base center. Design  This is a retrospective case series. Main Outcome Measures  The main outcome measures were tumor control (recurrence), new-onset cranial neuropathies, facial nerve and audiometric outcomes, cerebrospinal fluid (CSF) leak, and wound complications. Results  Sixteen patients were identified with a median age of 45 years (range: 20–72). The mean maximum tumor dimension was 5.49 cm (standard deviation [SD]: 1.2, range: 3.1–7.3) and the mean tumor volume was 28.5 cm 3 (SD: 18.8, range: 2.9–63.8). Ten (62.5%) tumors were left sided. The most common pathology encountered was meningioma (n  = 7) followed by chondrosarcoma (n  = 4). Mean follow-up was 36.3 (SD: 26.9) months. Gross total resection or near total resection was achieved in nine (56.2%) and planned subtotal resection was used in seven (43.7%). Postoperative additional new cranial nerve (CN) deficits included CN V (n  = 1), CN III (n  = 2), CN VI (n  = 1), and CN X (n  = 1). Major neurological morbidity (hemiplegia) was encountered in two patients with resolution. There were no cases of CSF leak, meningitis, hemorrhage, seizures, aphasia, or death. There was no recurrence or regrowth of residual tumor. Facial nerve function was preserved in all but one patient (House–Brackmann grade 2). Conclusion  Various skull base tumors involving MCF with extension to adjacent sites can be successfully resected using the TZ-MCF approach in a multidisciplinary fashion. This approach yields optimal exposure and permits excellent tumor control with acceptable CN and neurological morbidity. [ABSTRACT FROM AUTHOR]