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The article discusses the use of robot-assisted surgery in treatment of head, neck and skull base tumors. These surgeries are gaining a lot of popularity due to various reason including minimally invasive approaches, reduction in surgery duration and recovery time, overall low risks. Transoral robotic surgery may prove to be a more accurate way to treat head, neck and skull base cancer, while allowing for decreased levels of morbidity and decreased levels of adjuvant radiation and chemotherapy.

Objectives/Hypothesis: The purpose of this study was to determine the regional recurrence rate of node-positive oropharyngeal squamous cell carcinoma (OPSCC) in patients undergoing transoral robotic surgery (TORS) and selective neck dissection (SND) followed by observation, radiation, or concurrent chemoradiation. Study Design: A prospective, phase I, single-arm study was conducted. All OPSCC patients who voluntarily participated in a surgical trial with TORS and SND at an academic tertiary referral center from May 2005 to July 2007 were included. Methods: Thirty-one patients with previously untreated OPSCC undergoing TORS and SND (29 unilateral and two bilateral) were included. There were 29 males and two females, with ages ranging from 36 to 76 years (median = 55 years) with one palate, one lateral wall, 17 tonsil, 11 base of tongue, and one vallecula primary tumor classified as follows: T1 (n = 9, 29%), T2 (n = 15, 48.4%), T3 (n = 7, 22.6%), N0 (n = 6, 19.4%), N1 (n = 15, 48.4%), N2b (n = 10, 32.3%), and N2c (n = 1, 3.2%). There were three stage I (9.7%), two stage II (6.5%), 15 stage III (48.4%) and 11 stage IVa (35.5%) patients. Twenty-two patients were treated postoperatively with adjuvant therapy (12 radiation alone and 12 combined radiation and chemotherapy). Primary outcome measured was regional recurrence rate. Results: There was one regional recurrence on the contralateral, non-operated neck and one distant recurrence among the 31 patients who underwent SND. Conclusions: SND after TORS resection of primary OPSCC enables the use of selective and deintensified adjuvant therapy to reduce regional recurrence rates. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Introduction: Rosai-Dorfman disease (RDD) is a rare benign lymphocytic disorder characterized by idiopathic histiocytic proliferation affecting lymph nodes. RDD in the central nervous system (CNS) without nodal disease is exceedingly uncommon. We describe a rare case of extensive multifocal RDD involving the CNS, skull base, and paranasal sinuses. We review the literature and propose a surgical strategy to manage extensive multifocal disease. Methods: This 39 year-old-male with known RDD and multiple previous surgeries for intracranial and spinal RDD lesions presented with worsening spasticity, gait dysfunction, left facial pain and numbness, and mild dysphagia. Neuroimaging demonstrated multifocal enhancing dural-based lesions in the brain including right frontal, right temporal, right cerebellopontine angle, left clinoidal, left petroclival and bilateral Meckel's cave lesions. There was progressive growth of the left petroclival lesion causing symptomatic brainstem compression. The patient also had obstructive sleep apnea due to RDD occupying the entire nasal and paranasal sinuses. Results: The patient underwent a left-sided retrolabyrinthine transpetrosal-transtentorial approach to remove the left petroclival tumor and decompress the brainstem. The mass was carefully dissected off of cranial nerves IV through XI with excellent decompression of the brainstem. Endoscopic resection of the paranasal sinus mass was performed at a later date. Histologically, both masses were consistent with RDD. Conclusions: Extensive multifocal RDD involving the brain, spine, and paranasal sinuses is exceedingly rare and often mimic meningiomas on imaging. Surgical management can be challenging. We recommend a conservative approach with close observation and reserve surgical treatment for enlarging symptomatic lesions. [ABSTRACT FROM AUTHOR]