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Propose: Surgical treatment of advanced intra- and extracranial communicating skull base tumors is challenging, especially for the reconstruction of the large composite defect left by tumor resection. The aim of the study is to evaluate the utility of the free flap reconstruction of the defects resulting from radical resection of these tumors. Methods: The clinical data of 17 consecutive patients who underwent free flap reconstruction for defect left by salvage resection of advanced intra- and extracranial communicating tumors from 2013 to 2019 were retrospectively collected and analyzed. Results: There were 5 squamous cell carcinomas, 4 adenoid cystic carcinomas, 2 basal cell carcinomas, 2 meningiomas, 1 anaplastic hemangiopericytoma, 1 pleomorphic adenoma, 1 osteosarcoma and 1 chondrosarcoma. All patients had recurrent neoplasms, 2 of which had pulmonary metastasis. A modified radical cervical dissection was performed in 6 patients. The anterolateral thigh flap myocutaneous (ALT) flap and rectus abdominis myocutaneous (RAM) flap were used in 15 patients (88.2%) and 2 patients (11.8%), respectively. Complications were seen in 3 of 17 patients (17.6%) with 1 total flap loss. The median PFS duration was 31 months. The 3- and 5-year PFS rate was 0.47 and 0.24, respectively. The mean OS duration was 66 months. The 3- and 5-year OS rate was 0.85 and 0.68, respectively. Conclusion: Free flap transfer is a safe and effective method with acceptable complications, useful for reconstruction of large composite skull base defects after salvage resection of advanced intra- and extracranial communicating tumors. The functional and cosmetic results are satisfying.

To study the indication and character of the lateral-cervical approach for treating dumble-shape neurogenic tumors in cervical spine.Retrospectively review the clinical data of 14 dumble-shape neurogenic tumors in cervical spine, from October 2005 to October 2011. Among them 8 were males and 6 were females, range from 11 to 60 years old. The maximum tumor diameter range from 3.0 to 8.0 cm, with an average of 4.8 cm; the intraspinal tumor diameter range from 1.3 to 3.8 cm, with an average of 2.1 cm. According to Asazuma classification, 9 cases were type IIc, 2 cases were type IIIb, 2 cases were type IV, 1 case was type VI. Involving the neck segment C(1)-C(2) in 1 case, C(2)-C(3) in 1 case, C(3)-C(4) in 2 cases, C(4)-C(5) in 2 cases, C(5)-C(6) in 3 cases, C(6)-C(7) in 4 cases and C(2)-C(4) in 1 case. All cases performed surgery with general anethesia. The head and neck surgeon performed surgery with lateral cervical approach, in the space between the anterior and the medius scalenus, exposed the transverse process and the intervertebral foramen as the anatomy marker, resected the extraspinal tumor part. The neurosurgery expanded the intervertebral foramen, and resected the intraspinal tumor with microscope, and repaired the dura. Then head and neck surgeon closed the wounds.Pathology proved 3 neurolimmoas and 11 Schwannomas, 12 cases received gross total resection, 2 cases received subtotal resection, the average blood loss during operation was 292 ml, the average operation time was 129 minutes, the average stay in hospital days was 7.1 days. The vertebral artery were exposed in 2 cases, and no vertebral artery injury occurred, there were 3 cases dissect the cervical nerve roots. No cerebrospinal fluid leakage, hematoma, newly branchial plexus injury, sympathic nerve injury or tracheal edema occurred. In 3 to 24 months, with an average of 13.5 months follow-up period, 2 cases with subtotal resection had no tumor progression, and 12 cases with gross total resection had no tumor recurrence.Lateral-cervical approach is minimal invasive, easily to perform and recovery fine. It can be adopt for Asazuma type IIc, IIIb and IV tumors which not grow over the midline in spine and expand to deep layer of the deep cervical fascia out spine.

To summarize the characteristics of the pathological anatomy and blood supply model of massive tuberculum sellae meningiomas (MTSM) and explore its corresponding microneurosurgical strategies.The clinical data of 16 MTSM patients were reviewed retrospectively. From January 1998 to January 2010, according to their unique pathological anatomy and blood supply model, all patients underwent microneurosurgical removal with induced hypotension through tumor corridor by the bi-subfrontal anterior longitudinal fission (n = 14), right frontolateral approach (n = 1) and pterional approach (n = 1). There were 5 males and 11 females with a mean age of 48.5 years old (range: 26 - 65). But the mean follow-up period was 74.9 months (range: 4 - 132) in 2/4 cases.Among all cases, the mean tumor diameter was 58.9 mm (range: 51.1 - 76.2 mm). Simpson grade I, II, III, IV removal of MTSMs were accomplished in 3, 9, 3 and 1 case respectively. One case died within 4 postoperative days. Visual acuity improved in 10 patients, remained unchanged in 2 and deteriorated in 2. Transient postoperative diabetes insipidus occurred in 9 cases.It is critical to understand the unique characteristics of pathological anatomy and blood supply model of MTSM so as to adopt proper microneurosurgical strategies to remove it in situ.

To summarize and analyze the surgical treatment of lateral sellar compartment cavernoma (LSCC).The clinical data of 102 patients with LSCC who underwent surgical treatment from 1958 to 2006, 2 males and 80 females, aged 43.5 (11 approximately 69), were collected and analyzed. The operation patterns were divided into 4 stages based on the understanding of LSCC: first stage (1958 approximately 1988, with 32 cases) during which diagnosis was mainly bases on X-ray plain films, CT, and ordinary cerebral angiography, and most of the tumors were partially excised; second stage (1989 approximately 1997, with 18 cases) during which MRI, DSA, and microsurgery were widely used; third stage (1998 approximately 2003, with 36 cases) during which the neurological anatomy of the LSC and pathology of LSCC made headway, however, intra-operational bleeding was still a problem, and fourth stage (2004 approximately 2006, with 16 cases) during which relevant models were basically understood.Post-operative MRI shed that the tumor complete resection rates of the 4 stages were 4/32, 5/18, 17/36, and 12/16, and the subtotal resection rates were 3/32, 4/18, 10/36, and 2/16 respectively. The rest of the tumors were all partially removed. Not only the intra-operative blood loss but also the cranial nerve morbidity rate decreased dramatically in the 4th stage. The main postoperative complications included oculomotor nerve paralysis, abducent nerve palsy, and trigeminal nerve damages. No operation-related death occurred.Following the progress of LSCC study, the treatment of LSCC becomes mature. Radical removal of LSCC may be the best choice for LSCC patients by epidural approach via the skull base craniotomy with induced hypotension.