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Background Deep-seated clival varied malignancies represent a surgical challenge because of complex anatomy and surgical procedures posing great risks to adjacent neurovascular structures. To investigate effects of diagnosis and treatment of clival region lesions, review experience of individualized surgical procedures and comprehensive therapy. Methods and Results A total of 56 patients with clival malignancies from July 2007 to December 2018 were included. The patients mainly presented with headache and cranial nerve paresis. After multidisciplinary consultation, radical resection were performed in 45 cases different kinds of surgical approaches including endonasal (15 cases, 33.33% ), intraoral accompanied by intraoral and endonasal combined (7 cases, 15.56%), Derome (8 cases, 17.78%), maxillary swing (9 cases, 20%), and infratemporal (6 cases, 13.33%) approaches were chosen according to clinical and radiographic findings, and biopsies were performed in 11 patients to confirm the pathological diagnosis. The primary pathological finding was chordoma (28 cases, 50%). Total resection was achieved in 21 cases (46.67%), and 17 cases (37.78%) underwent subtotal resection. Besides, partial resection was performed in 7 cases (15.56%). The complications developed in 28 patients, including cranial nerve deficits (13 cases, 23.21%), cerebrospinal fluid leakage (14 cases, 25%), intracranial infection (8 cases, 14.29%), pneumonitis (2 cases, 3.57% ), postoperative hematoma (2 cases, 3.57% ), and mental disorder (1 cases, 1.79% ). Adjuvant chemoradiotherapy was provided by the oncologists depending on the pathological findings. The average follow-up was 59.90 months, but 8 patients (14.29%) were lost. The progression-free survival was achieved in 16 patients (28.57%), whereas the disease progression occurred in 13 patients (23.21%). The mortality was 33.93% (19/56). Conclusions Although malignancies occupy a larger subset of clival tumors, not all are needed to be radically resected. Our preliminary results suggest that multidisciplinary consultation is indispensable to clarify the therapeutic purpose and provide individualized surgical approaches. Postoperative comprehensive therapy may reduce the surgical complications and improve the outcomes of patients. [ABSTRACT FROM AUTHOR]

Objective To review experience of diagnosis, surgical procedures and comprehensive therapeutic strategies for skull base bone tumors. Methods and Results Clinical data of 76 patients with skull base bone tumors were retrospectively analyzed from September 2006 to March 2018. After preoperative assessment, different kinds of surgical approaches including endonasal, intraoral, maxillary swing, craniocervical transjugular, Derome, frontotemporal and infratemporal approaches were chosen according to clinical and radiographic findings. In comparison with 24 patients receiving the endoscopic surgery, other 52 patients were operated on under microscopic visualization. Total resection was achieved in 38 cases, and 22 patients underwent subtotal resection. In addition, 14 cases received partial resection while biopsies were performed in 2 cases to confirm histological findings. Tumor pathology included chordoma (28 cases), osteosarcoma (19 cases), chondrosarcoma (11 cases), fibrous dysplasia (8 cases), giant cell tumor of bone (5 cases), osteoblastoma (3 cases), osteochondroma (1 case), and chondromyxiod fibroma (1 case). Complications included cranial nerve deficits (19 cases), hemiparesis (3 cases), cerebrospinal fluid leakage (12 cases), intracranial infection (8 cases), pneumonitis (4 cases), and wound dehiscence (4 cases). During a 20 to 158 months follow-up, 11 cases were lost and 21 patients died in the study period. The disease-free survival was achieved in 34 cases while 10 patients experienced tumor progression. Conclusions Malignant bone tumors invading the skull base is much more common comparing with the benign lesions. Multidisciplinary consultation may improve diagnostic reliability and clarify the therapeutic purpose. Radical resection using the individualized approaches accompanied by comprehensive therapy should be considered to improve the outcomes of patients. [ABSTRACT FROM AUTHOR]

Objective To investigate the reasons and management of repair failure of high - flow cerebrospinal fluid rhinorrhea (HFCSFR) after endoscopic resection of skull base tumors. Methods We retrospectively reviewed 5 patients with repair failure of HFCSFR after endoscopic removal of skull base tumors in our center from December 2012 to June 2016. The patients underwent reoperations for skull base repair. The reasons of repair failure and management strategies were analyzed. Results The reconstruction methods of skull base in the reoperation for HFCSFR included autologous fat inlay and autologous pedicled nasal septal flap onlay in one patient, autologous fat inlay and autologous fascia lata onlay in one patient, and autologous fat inlay and autologous fascia lata onlay and autologous pedicled nasal septal flap in 3 patients. The skull base was reconstructed well in 5 patients. The mean follow - up period was 20 months, and no HFCSFR reoccurred in 5 patients. Conclusions Repair of HFCSFR and reconstruction of skull base are the key to endoscopic removal of skull base tumors. The reasons of repair failure included improperly employing synthetic dura mater, failing to obliterate the dead space left behind by removal of tumors with fat grafts or fat liquefaction, non - healing of middle turbinate and dura mater, failing to cover the dural defect onlay with fascia lata, displacement of the repair grafts, ischemia and necrosis of nasal septal flap. The surgeons should pay more attention to the repairment of HFCSFR after endoscopic removal of skull base tumors. Reconstruction with multilayer grafts and vascularized autologous flaps is an effective and safe strategy. Formulating detailed operation plan and strictly following surgical procedure could avoid repair failure. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Triple dumbbell-shaped jugular foremen schwannomas (DSJFSs) have high cervical extension according to Bulsara’s classification. One-stage, single-discipline, total removal of triple DSJFSs is not always possible due to their both intracranial and cervical extensions. We evaluated our experience in one-stage resection of triple DSJFSs by using a combined neurosurgical and head and neck approach. Methods: Between October 2004 and May 2009, eight patients with triple DSJFSs were treated surgically at our institute. The clinical and radiological features, operative procedures and outcomes are retrospectively reviewed. Results: Total tumour removal was achieved in seven patients and near total in one. New cranial nerve (CN) paresis occurred after surgery in one patient and worsening of preoperative CN deficits was noted in three. Two patients experienced cerebrospinal fluid leakage and one of them had a repeated operation with closure of the dural deficit. Follow-up period ranged from 23 to 60 months (mean 38 months). All CN dysfunction had improved considerably at the last follow-up examination. There have been no clinical or radiological signs of tumour recurrence. Conclusions: One-stage total resection of triple DSJFSs can be achieved by a multidisciplinary cranial base team composed of neurosurgeons and head and neck surgeons via a craniocervical approach. [Copyright &y& Elsevier]