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Objectives: Various nonvascularized or vascularized techniques have been adopted in endoscopic endonasal surgery (EES) for repairing intraoperative cerebrospinal fluid (CSF) leaks after tumor resection. Vascularized nasoseptal flaps, free nasoseptal grafts, free turbinate grafts, and fascia lata and mashed muscle are frequently used. Outcomes of those grafts applied in the defects of different regions need to be clarified., Methods: The data from a series of 162 patients with skull base tumor who underwent EES that had intraoperative CSF leak between Jan 2012 and Jan 2021 were retrospectively analyzed. The regions included anterior skull base, sellar region, clivus and infratemporal fossa. Repair failure rate (RFR), meningitis rate, and associated risk factors were assessed., Results: In total, 172 reconstructions were performed in 162 patients for the 4 sites of the skull base. There were 7 cases (4.3%) that had postoperative CSF leaks, which required second repair. The RFR for anterior skull base, sellar region, clivus, and infratemporal fossawas 2.6%, 2.2%, 16.7%, and 0%, respectively. The clivus defect was an independent risk factor for repair failure (P < 0.01). The postoperative meningitis rate was 5.6%. Repair failure was an independent risk factor for meningitis (P < 0.01)., Conclusions: Vascularized nasoseptal flap, free nasoseptal graft, free turbinate graft, and fascia lata and mashed muscle are reliable autologous materials for repairing the dural defects in different regions during EES. Clivus reconstruction remains a great challenge, which had a higher RFR and meningitis rate. Repair failure is significantly associated with postoperative meningitis., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Because of its vascular supply and neurovascular contents, the cavernous sinus (CS) is a challenging area to dissect in the setting of skull base tumors with intracavernous extension or invasion. In the present study, we report the clinical outcomes of 14 patients with tumors with CS invasion that were surgically treated using a direct transcavernous sinus approach for endoscopic endonasal resection of their intracavernous sinus tumors., Methods: Fourteen patients had undergone surgery using a direct endoscopic endonasal transcavernous sinus approach. The pathologic entities included Knosp grade 3-4 pituitary adenomas (n = 8), meningioma (n = 3), squamous cell carcinoma (n = 2), and chondrosarcoma (n = 1). The indications, surgical technique, and outcomes are discussed., Results: Gross total resection was achieved in 11 patients (78.6%). All patients experienced resolution or improvement of symptoms. One patient experienced a transient oculomotor nerve palsy, which had resolved within 2 months postoperatively. No other complications occurred. For those tumors that had been grossly resected, no recurrence developed in any patient (mean follow-up, 40.4 ± 24.8 months; range 10-84)., Conclusions: Depending on the space created by intracavernous sinus tumors, use of the transanterior wall for the CS approach in endoscopic endonasal surgery could adequately treat most patients in our case series. This approach provided good visualization of the CS and can be used to treat tumors with favorable outcomes and a low incidence of complications in appropriately evaluated patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Chordomas are rare, locally invasive tumors with characteristic expression of the T-box transcription factor Brachyury. Little is yet known of the molecular events involved in the development of these tumors. Bone morphogenesis protein 4 (BMP4) signaling, which acts upstream of Brachyury in embryonic development, has been implicated in carcinogenesis in multiple malignancies. To explore the role of the canonical BMP4/SMAD signaling pathway in the pathogenesis of chordoma, we investigated, in 40 skull base chordomas, the expression of three major components of the signaling axis: BMP4, phospho-SMAD5 and SMAD4. Immunostaining revealed positive expression in 70%, 52.5% and 90% of cases, respectively. Eighteen (45%) of patients exhibited concurrent positive expression of these markers, which we defined as "high" expression of the BMP4/SMAD signaling pathway. Interestingly, when we compared the pattern of expression with clinicopathological parameters, we found that high expression of the pathway was more often observed in larger tumors (≥ 4 cm) than smaller ones (P = 0.010), and correlated significantly with dural invasion (P = 0.024). The Kaplan-Meier log-rank test showed that the 5-year overall survival rate for patients with high expression of the pathway was significantly lower than those with low expression (71.4% vs. 90.2%, P = 0.010). In conclusion, our results demonstrate for the first time that overexpression of the BMP4/SMAD signaling pathway could predict poor clinical outcome in skull base chordomas, suggesting activation of this pathway is involved in chordoma pathogenesis.

Objective: To investigate the optimal treatment strategy with endoscopic endonasal approach (EEA) and the prognostic factors of anterior and middle skull base neuroendocrine carcinoma (NEC)., Method: Fourteen patients with anterior and/or middle skull base NEC, admitted to Xuanwu Hospital between November 2006 and June 2014, were reviewed retrospectively. All patients were treated with EEA. Four cases received surgery onle. Two cases received radiotherapy and one case received chemotherapy before surgery. One case received adjuvant radiotherapy and 6 cases received chemoradiation after surgery. Survival analysis was performed by Kaplan-Meier method., Result: Complete resection was achieved in 12 cases, while subtotal resection was achieved in 2 cases. There was no surgical complication. Three cases were diagnosed as well-differentiated NEC, 2 cases were moderately differentiated NEC and 9 cases were small cell NEC. The patients were followed up for 6 to 97 months. Three patients died and one patient lost to follow-up. The 5-year survival rate in this group was 64.3%., Conclusion: Pure EEA or EEA combined with multimodality therapy, which was applied depending on the pathological type, was a feasible treatment strategy for anterior and middle skull base NEC.

Objective: To describe the early experience of resecting skull base tumor via a radiofrequency ablation-assisted endoscopic endonasal approach, investigate the safety and feasibility of the technique, and to assess its preliminary treatment outcomes., Methods: Ten patients with skull base tumor who were admitted between September and November 2013 were operated on through a radiofrequency ablation-assisted endoscopic endonasal approach in Xuanwu hospital of capital medical university. In this study, the operative technique was described, and the degree of resection, complications and the early clinical outcomes was presented., Results: Complete resection was achieved in all patients using this technique. No patient in the series experienced a new neurological deficit, cerebrospinal fluid leak or meningitis after surgery. No recurrence and death related to skull base tumor were found in the follow-up period (16-18 months). The volume of intraoperative blood loss was 60 to 1 000 ml (medium 285 ml). The duration of operations was from 42 to 150 min (medium 95 min). The hospital stay was from 14 to 19 d (average 15.7 d)., Conclusion: Our limited experience indicates that this technique is feasible and safe for the complete resection of some skull base tumors in selected cases.

Skull base chordomas are invasive tumors, with high rate of local recurrence even when totally extracted. The aggressive biological behavior in chordoma remains unclear. The purpose of this study was to investigate the relationship between fascin expression and tumor biological behavior in skull base chordoma. Using immunohistochemical techniques, we investigated the expression of fascin in 34 patients with skull base chordomas (19 primary tumors and 20 recurrent tumors). Correlation between fascin expression and clinicopathological factors such as patient's age, sex, tumor locations, and fascin expression in recurrent tumor and in tumor with dura mater erosion was analyzed. Various extent of fascin expression was observed in all tumors. There was a higher fascin expression in recurrent chordoma than in primary chordoma, and the difference was statistically significant (p=0.031). No difference of fascin expression was found between histology types. Interestingly, in 8 tumors where the cranial base dura was eroded, there was a high level of fascin expression (p=0.047). These immunohistochemical findings suggest that fascin expression was correlated with tumor recurrence and high invasiveness, and that fascin overexpression may play an important role in the biologic behavior of skull base chordomas.

This study aimed to investigate the incidence of direct invasion and metastasis of nasopharyngeal carcinoma (NPC) at different anatomic sites in the skull base using magnetic resonance imaging (MRI). MRI data from 101 NPC patients with skull base invasion were collected and we analyzed the incidence and anatomic sites of invasion of NPC in the skull base. Of the 101 NPC patients, 84 had direct invasion at the skull base (83.2%), and 17 had skull base metastasis (16.8%). Affected sites with direct invasion in the skull base included sphenoid sinus and sella base, cavernous sinus, internal carotid canal, and clivus blumenbachii. Skull base metastasis sites included the internal carotid canal and jugular foramen area. Because of early lymphatic metastasis of NPC to the skull base, MRI examination can be helpful in increasing the accuracy of diagnostic imaging for skull base invasion of NPC and selecting appropriate target sites, radiotherapy techniques, and operative approaches., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: Conventional microsurgical approaches are limited to exposing the lateral and bilateral regions because of surgical trauma. Total removal of clival chordoma and chondrosarcoma is very difficult. This study was undertaken to determine the potential role of an endoscopic endonasal approach in improved management of clival chordoma and chondrosarcoma., Methods: Seven patients with chordoma and 2 patients with chondrosarcoma treated by endoscopic endonasal surgery between November 2002 and February 2006 were studied prospectively. The mean age was 35 years. The follow-up periods ranged from 3 to 39 months., Results: Total removal was achieved in 6 cases of chordoma and 1 case of chondrosarcoma, with subtotal removal in 1 case of chordoma and of chondrosarcoma. At the last follow-up, 7 patients had no evidence of disease and 1 was alive with disease. The chordomas had recurred in 1 patient after 5 months with subtotal removal., Conclusion: The use of nasoendoscopy to perform clival chordoma and chondrosarcoma surgery is not limited to merely the minimally invasive aspects. It provides better visualization of the deeper anatomical structures in the skull base and affords a means to 'look around corners'. This approach promises a simple and rapid access to the clivus. It is both a safe and efficient procedure.

Objective: To review our experience with skull base reconstruction and rehabilitation., Method: The clinical data of 30 patients with skull base reconstruction from 200 patients performed skull base surgery were retrospectively reviewed. Bone defect of skull base were repaired in 20 patients and dura defect in 6 patients and soft tissue defect in infratemporal fossa in 8 patients., Result: Postoperatively there were transient cerebrospinal leakage in 3 patients, and non-symptom intracranial pneumatosis in 3 patients, and epidural hematoma in 1 patient, and meningitis in 1 patients., Conclusion: Immediate reconstruction of skull base with suitable material and surgical technique can prevente complications such as postoperative infection and cerebrospinal leakage brain hernation.