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ABSTRACT: Primary temporal bone tumors are rare. Suspicious lesions of the ear canal should be biopsied for diagnosis. Surgical resection to achieve negative margins is the mainstay of treatment. Small tumors can be treated with lateral temporal bone resection. Parotidectomy and neck dissection are added for disease extension and proper staging. Higher staged tumors generally require subtotal temporal bone resection or total temporal bone resection. Adjuvant postoperative radiotherapy has shown improved survival for some patients. Chemotherapy has an emerging role for advanced stage disease. Evaluation and management by a multidisciplinary team are the best approach for patients with these tumors.
Neurosurgery clinics of North America 01/2013; 24(1):97-110. · 1.73 Impact Factor
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ABSTRACT: Esthesioneuroblastoma is a rare malignant neoplasm in the olfactory region of the nasal cavity and anterior skull base. Diagnosis and staging require anatomic imaging and careful pathologic assessment. Standard treatment is anterior craniofacial resection with postoperative irradiation. The role for chemotherapy is not defined, but is generally for the most advanced cases and used in the neoadjuvant setting and/or postoperatively with irradiation. Prognosis is favorable; however, metastasis rates remain relatively high. Regional and distant metastasis portends a poor outcome. Intensity-modulated radiation treatment and endoscopic surgery have reduced morbidity, but outcomes with these techniques must be fully evaluated.
Neurosurgery clinics of North America 01/2013; 24(1):51-65. · 1.73 Impact Factor
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ABSTRACT: In the early 1960s William F. House developed the middle fossa approach for the removal of small vestibular schwannomas (VSs) with the preservation of hearing. It is the best approach for tumors that extend laterally to the fundus of the internal auditory canal, although it does have the potential disadvantage of increased facial nerve manipulation, especially for tumors arising from the inferior vestibular nerve. The aim of this study was to monitor the hearing preservation and facial nerve outcomes of this approach.
A prospective database was constructed, and data were retrospectively reviewed.
Between December 2004 and January 2012, 30 patients with small VSs underwent surgery via a middle fossa approach for hearing preservation. The patients consisted of 13 men and 17 women with a mean age of 46 years. Tumor size ranged from 7 to 19 mm. Gross-total resection was accomplished in 25 of 30 patients. Preoperative hearing was American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Class A in 21 patients, Class B in 5, Class C in 3, and undocumented in 1. Postoperatively, hearing was graded as AAO-HNS Class A in 15 patients, Class B in 7, Class C in 1, Class D in 2, and undocumented in 5. Facial nerve function was House-Brackmann (HB) Grade I in all patients preoperatively. Postoperatively, facial nerve function was HB Grade I in 28 patients, Grade III in 1, and Grade IV in 1. There were 3 complications: CSF leakage in 1 patient, superficial wound infection in 1, and extradural hematoma (asymptomatic) in 1. The overall hearing preservation rate of at least 73% and HB Grade I facial nerve outcome of 93% in this cohort are in keeping with other contemporary reports.
The middle fossa approach for the resection of small VSs with hearing preservation is a viable and relatively safe option. It should be considered among the various options available for the management of small, growing VSs.
Neurosurgical FOCUS 09/2012; 33(3):E10. · 2.87 Impact Factor
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ABSTRACT: Primary myxomas of the temporal bone are rare tumors. If misdiagnosed, they can grow into locally aggressive expansile masses resulting in hearing loss, facial paralysis, dural invasion, and mass effect on the adjacent brain parenchyma. This case demonstrates the natural history of an extraordinarily rare tumor over a longer period not previously described. The importance of correlating histopathologic findings with diagnostic imaging features to enable an accurate diagnosis is also emphasized.
Annals of diagnostic pathology 04/2012; 16(4):280-3.
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ABSTRACT: BACKGROUND: In scalp reconstruction, soft tissue and osseous defects frequently coexist. The purpose of this study was to compare outcomes of simultaneous scalp and calvarial reconstruction to scalp only reconstruction. METHODS: A review of microsurgical scalp reconstruction with or without cranioplasty over a 10-year period was performed. RESULTS: One hundred thirty-eight scalp reconstructions were performed, of which 48 involved concurrent cranioplasty. The overall rate of perioperative complications was 21.0%, whereas the rate of late recipient site complications was 11.6%. No significant differences in perioperative (p = .56) or late (p = .42) recipient site complications were observed between patients undergoing scalp and calvarial versus scalp only reconstruction. In terms of complications, muscle free flaps with skin grafts were as reliable as free flaps with skin paddles (p = .36). CONCLUSION: Simultaneous scalp and calvarial reconstruction is associated with success rates equivalent to scalp only reconstruction. Muscle flaps covered with skin grafts and flaps with a skin paddle seem to be equally reliable. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
Head & Neck 02/2012; · 2.40 Impact Factor
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ABSTRACT: To describe the population of patients with malignancy affecting the ear canal and temporal bone.
Retrospective review.
The charts of 157 patients with temporal bone cancer were reviewed for clinical outcomes.
Between 1999 and 2009, 157 patients underwent temporal bone surgery for cancer involving the ear canal (n = 25), external ear with ear canal involvement (n = 26), periauricular skin (n = 40), parotid gland (n = 40), temporal bone (n = 13), and lateral skull base (n = 13). All surgeries involved one or more otologic approaches: mastoidectomy (28.0%), lateral temporal bone resection (TBR) (59.2%), subtotal TBR (2.5%), total TBR (3.2%), transtemporal approach (TTA) to the jugular foramen (8.2%), TTA to the middle fossa (5.7%), and TTA to the infratemporal fossa (3.2%). Cancers of the cartilaginous ear canal were managed with wide local excision of canal skin and cartilage in nine patients (5.7%). A combination of approaches was performed in 32 patients (20.4%). The 5-year overall survival rate was 58.0%. Patients whose disease was limited to the ear canal had significantly better overall survival than did patients who had skull base primaries (P = .02989), periauricular skin cancer (P = .00138), or temporal bone tumors (P = .02598). Patients with parotid tumors also had better overall survival than did those with periauricular skin tumors (P = .02357).
Otologic surgery plays an important role in managing cancers that involve the ear canal, temporal bone, or lateral skull base. The specialty of otologic oncology is emerging as a defined area of practice.
The Laryngoscope 02/2012; 122(2):393-400. · 1.75 Impact Factor
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ABSTRACT: Neuroendocrine carcinoma (NEC) of the paranasal sinuses is rare, accounting for 5% of sinonasal malignancies. The purpose of this study was to assess prognostic factors and survival rates for sinonasal NEC.
A retrospective review of patients with NEC treated from 1990 to 2004 was performed. Patient demographics, TNM classification, treatment modality, recurrences, and survival were evaluated.
NEC was identified in 28 patients; the most common primary site was the ethmoid sinuses. Most patients presented with advanced tumors; few had regional or distant metastasis. Local recurrence rate was 21%. Five-year overall survival (OS) and disease-specific survival (DSS) rates were 65% and 78%, respectively. Response to chemotherapy predicted for improved survival, although no differences in outcomes were noted between definitive management strategies.
NEC of the paranasal sinuses is an exceedingly rare malignancy of the paranasal sinuses. Our data suggests definitive management with surgery or radiotherapy offers durable control. The response to chemotherapy may predict for overall outcomes. © 2011 Wiley Periodicals, Inc. Head Neck, 2011.
Head & Neck 11/2011; 34(10):1372-6. · 2.40 Impact Factor
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ABSTRACT: Cranial base metastases (CBM) are rare and have received limited attention in the medical literature. Questions remain regarding the role of surgery, if any, in the management of these tumors.
To report surgical outcomes in a consecutive series of patients with CBM and to better define the role of surgery in their management.
Twenty-seven patients with CBM underwent surgery between 1996 and 2009 at MD Anderson Cancer Center. A retrospective review of their prospectively collected data was performed after obtaining institutional review board approval. The median patient age was 52 years. The most common pathology was renal cell carcinoma (6 patients). Surgical indications were worsening neurological deficit, disfiguring mass, and the need for a diagnosis.
Gross total resection was achieved in 59% of the cases. The median survival was 11.4 months. The median progression-free survival was 5.8 months. A Karnofsky Performance Scale score less than 90, dural invasion, and brain invasion were associated with a shorter survival. Seven patients were neurologically intact preoperatively; all of them remained intact after surgery. Among all patients with preoperative neurological deficit, 11 remained stable, 7 improved, and 2 had worsening of their deficit postoperatively.
The goal of surgery for CBM is to provide symptom relief and to preserve functional status in well-selected cases. Patient selection is critical because the surgery is usually palliative, and only a minority of patients are surgical candidates. Radiation therapy remains the management option of choice for the majority of patients.
Neurosurgery 09/2011; 70(4):802-9; discussion 809-10. · 2.79 Impact Factor
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ABSTRACT: After intradural cranial surgery, a dural substitute is often required for dural closure. Although preferred, limitations of autograft include local availability and additional surgical site morbidity. Thus, allografts, xenografts, and synthetics are frequently used.
To report 6-month results of a randomized, controlled trial of a biosynthesized cellulose (BSC) composed duraplasty device compared with commercially available dural replacements.
A total of 99 patients (62 BSC; 37 control) were treated on protocol, using a 2:1 (BSC:control) blocked randomization schedule. Physical examinations were performed pre- and postoperatively within 10 days and at 1, 3, and 6 months. Magnetic resonance imaging was performed preoperatively and at 6 months. The primary study endpoint was the absence of pseudomeningocele and extracerebral fluid collection confirmed radiographically and the absence of cerebrospinal fluid fistula at 6 months.
At 6 months, the primary hypothesis, noninferiority of the BSC implant compared with the control group, was confirmed (P = .0206). Overall success was achieved by 96.6% of BSC and 97.1% of control patients. No significant difference was revealed between treatment groups for surgical site infection (P = 1.0000) or wound healing assessment (P ≥ .3685) outcomes, or radiologic endpoints (P ≥ .4061). Device strength and seal quality favored BSC.
This randomized, controlled trial establishes BSC as noninferior to commercially available dural replacement devices. BSC offers a hypothetical advantage concerning prion and other infectious agent exposure; superior handling qualities are evident. Longer term data are necessary to identify limitations of BSC and its potential equivalence to the gold standard of pericranium.
Neurosurgery 06/2011; 69(5):1093-103; discussion 1103-4. · 2.79 Impact Factor
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ABSTRACT: Although a rare complication of ionizing radiation, radiation-induced osteosarcoma is now more frequently recognized as radiation therapy has become common and cancer survival has increased. To date, publications on radiation-induced osteosarcoma of the cranium are limited to a few small series and case reports.
Data from 175 patients with a history of sarcoma of the head at The University of Texas M. D. Anderson Cancer Center from 1975 to 2007 were reviewed to identify patients with radiation-induced osteosarcoma. The diagnostic criteria were: 1) osteosarcoma arose within the previously irradiated field; 2) new sarcoma was histologically distinct from the original neoplasm; 3) no evidence of new sarcoma at the time of radiation; and 4) distinct latency period could be recognized. Frequencies and descriptive statistics were obtained for the various characteristics under study.
The authors identified 16 patients with radiation-induced osteosarcoma of the cranium at their institution. The average age at diagnosis was 35 years. The median latency period was 12.5 years. Nine patients had skull base tumors, and 7 had calvarial tumors. Of the 14 patients treated surgically, 86% developed local recurrence. The median survival time was 29 months, and the 5-year survival rate was 29.6%.
The authors report the largest series of cranial radiation-induced osteosarcoma. Although radiation-induced osteosarcoma is an uncommon but dire complication of radiotherapy, its incidence will probably increase in the future as the frequency of radiation treatment and cancer survival increase. These tumors are locally aggressive, and despite aggressive surgical and medical management, they have a high rate of local recurrence and mortality.
Cancer 05/2011; 117(10):2120-6. · 4.77 Impact Factor
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Akash J. Patel MD,
Vikas Y. Rao MD,
Benjamin D. Fox MD,
Dima Suki PhD,
David M. Wildrick PhD,
Raymond Sawaya MD,
Franco DeMonte MD,
Akash J. Patel,
Vikas Y. Rao,
Benjamin D. Fox,
Dima Suki,
David M. Wildrick,
Raymond Sawaya, Franco DeMonte
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ABSTRACT: BACKGROUND:Although a rare complication of ionizing radiation, radiation-induced osteosarcoma is now more frequently recognized as radiation therapy has become common and cancer survival has increased. To date, publications on radiation-induced osteosarcoma of the cranium are limited to a few small series and case reports.METHODS:Data from 175 patients with a history of sarcoma of the head at The University of Texas M. D. Anderson Cancer Center from 1975 to 2007 were reviewed to identify patients with radiation-induced osteosarcoma. The diagnostic criteria were: 1) osteosarcoma arose within the previously irradiated field; 2) new sarcoma was histologically distinct from the original neoplasm; 3) no evidence of new sarcoma at the time of radiation; and 4) distinct latency period could be recognized. Frequencies and descriptive statistics were obtained for the various characteristics under study.RESULTS:The authors identified 16 patients with radiation-induced osteosarcoma of the cranium at their institution. The average age at diagnosis was 35 years. The median latency period was 12.5 years. Nine patients had skull base tumors, and 7 had calvarial tumors. Of the 14 patients treated surgically, 86% developed local recurrence. The median survival time was 29 months, and the 5-year survival rate was 29.6%.CONCLUSIONS:The authors report the largest series of cranial radiation-induced osteosarcoma. Although radiation-induced osteosarcoma is an uncommon but dire complication of radiotherapy, its incidence will probably increase in the future as the frequency of radiation treatment and cancer survival increase. These tumors are locally aggressive, and despite aggressive surgical and medical management, they have a high rate of local recurrence and mortality. Cancer 2011. © 2010 American Cancer Society.
Cancer 05/2011; 117(10):2120 - 2126. · 4.77 Impact Factor
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ABSTRACT: The authors' goal was to develop an updated and comprehensive algorithm for skull base reconstruction based on data from the 10-year period following their initial report.
Reconstructive outcomes were analyzed from 250 patients undergoing skull base reconstruction from 2000 to 2009.
Thirty-nine local or regional pedicled flap reconstructions and 211 free flap reconstructions were performed. Free flaps were usually selected over pedicled flaps for patients with a history of prior surgery, irradiation, or chemotherapy (p = 0.003, p < 0.001, and p = 0.04, respectively). Reconstructions were performed for 36 region I defects, 39 region II defects, 124 region III defects, and 51 defects involving more than one region. Complications occurred in 29.6 percent of patients. There were no significant differences in the overall complication rates between pedicled and free flap reconstructions (p = 0.70). The recipient-site complication rate decreased from 31 percent in the authors' prior report to 18.4 percent. A facial nerve repair was performed in 30 patients. By 12 months, 75 percent of patients had signs of reinnervation. Recovery was not significantly less likely in patients with preoperative weakness, postoperative irradiation, or age 60 years or older (p = 1.00, p = 1.00, and p = 0.11, respectively).
Based on the largest series of skull base reconstructions to date, the authors recommend pedicled flaps for limited defects because of minimal donor-site morbidity and shorter operative times and hospital stays. For extensive defects and cases involving prior surgery, irradiation, or chemotherapy, free flaps are preferred. Facial nerve repair should be attempted whenever feasible, even in the setting of preoperative weakness, anticipated postoperative irradiation, or advanced age.
Therapeutic, III.
Plastic and reconstructive surgery 05/2011; 128(3):675-86. · 2.74 Impact Factor
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Wael Hassaneen,
Nicholas B Levine,
Dima Suki,
Abhijit L Salaskar,
Alessandra de Moura Lima,
Ian E McCutcheon,
Sujit S Prabhu,
Frederick F Lang, Franco DeMonte,
Ganesh Rao,
Jeffrey S Weinberg,
David M Wildrick,
Kenneth D Aldape,
Raymond Sawaya
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ABSTRACT: Multiple craniotomies have been performed for resection of multiple brain metastases in the same surgical session with satisfactory outcomes, but the role of this procedure in the management of multifocal and multicentric glioblastomas is undetermined, although it is not the standard approach at most centers.
The authors performed a retrospective analysis of data prospectively collected between 1993 and 2008 in 20 patients with multifocal or multicentric glioblastomas (Group A) who underwent resection of all lesions via multiple craniotomies during a single surgical session. Twenty patients who underwent resection of solitary glioblastoma (Group B) were selected to match Group A with respect to the preoperative Karnofsky Performance Scale (KPS) score, tumor functional grade, extent of resection, age at time of surgery, and year of surgery. Clinical and neurosurgical outcomes were evaluated.
In Group A, the median age was 52 years (range 32-78 years); 70% of patients were male; the median preoperative KPS score was 80 (range 50-100); and 9 patients had multicentric glioblastomas and 11 had multifocal glioblastomas. Aggressive resection of all lesions in Group A was achieved via multiple craniotomies in the same session, with a median extent of resection of 100%. Groups A and B were comparable with respect to all the matching variables as well as the amount of tumor necrosis, number of cysts, and the use of intraoperative navigation. The overall median survival duration was 9.7 months in Group A and 10.5 months in Group B (p = 0.34). Group A and Group B (single craniotomy) had complication rates of 30% and 35% and 30-day mortality rates of 5% (1 patient) and 0%, respectively.
Aggressive resection of all lesions in selected patients with multifocal or multicentric glioblastomas resulted in a survival duration comparable with that of patients undergoing surgery for a single lesion, without an associated increase in postoperative morbidity. This finding may indicate that conventional wisdom of a minimal role for surgical treatment in glioblastoma should at least be questioned.
Journal of Neurosurgery 03/2011; 114(3):576-84. · 2.96 Impact Factor
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ABSTRACT: The role of robotic surgery in the skull base is evolving and represents the natural progression toward maximizing surgical resections in confined spaces without compromising oncological principles. In this study, we describe the novel application of robotic surgery to the repair of dural defects in the skull base. A transmaxillary-transantral approach to the nasal cavity was performed bilaterally in a cadaveric model. Repair of the skull base defect was undertaken robotically. In this technical report, we demonstrate the feasibility of a suture-based technique for surgical reconstruction of the skull base with robotic assistance in a cadaveric model. In all cases, suture repair of dural defects was successfully performed with robotic-assisted technique. Although preliminary in nature, this study suggests that traditional suture techniques can be implemented in a confined surgical site with the use of robotic technology.
Skull Base 03/2011; 21(2):79-82. · 0.66 Impact Factor
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ABSTRACT: Skull base metastases (SBM) are rare among all tumors affecting the base of the skull. Because of their rarity, they have received limited attention in the published medical literature. Several clinical syndromes associated with SBM have been described. Knowledge of these syndromes and maintenance of a high index of suspicion are important for an early diagnosis. The majority of patients are best managed by radiotherapy. Other therapeutic options include stereotactic radiosurgery, chemotherapy, and surgery. Surgical resection is reserved for a minority of well-selected patients. The decision to intervene surgically is based on patients' clinical status, the degree of control of systemic disease, the accessibility of the lesion, and the potential morbidity of the procedure. Well-designed trials and evidence-based practice guidelines are not available. The management of these patients largely depends of the experience of the treating medical team.
Neurosurgery clinics of North America 01/2011; 22(1):61-6, vi-ii. · 1.73 Impact Factor
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ABSTRACT: To review the oncologic outcomes in patients with advanced (stage III-IV) squamous cell carcinoma of the paranasal sinuses treated with induction chemotherapy prior to definitive local therapy.
The medical records of 46 consecutive patients with previously untreated, biopsy-proved squamous cell carcinoma of the paranasal sinuses who received induction chemotherapy during the course of their treatment were reviewed for demographics, tumor types and stages, treatment details, and oncologic outcomes.
Of the 46 patients (median age, 59 years), the tumor epicenter was in the maxillary sinus in 31 (67%), ethmoid sinus in 9 (20%), nasal cavity in 4 (9%), and sphenoid sinus in 2 (4%). All patients had T3 or T4 tumors, and 12 (26%) patients had clinical evidence of nodal metastasis, with an overall stage of III (20%) or IV (80%). Induction chemotherapy regimens consisted of a combination of a taxane and platinum in 80% of patients, by themselves (14 patients) or in combination with a third agent, such as ifosfamide (14 patients) or 5-fluorouracil (9 patients). The combination of a taxane and 5-fluorouracil was used in the remaining 9 patients. More than two-thirds (67%) of the patients achieved at least a partial response to induction chemotherapy, 24% had progressive disease, and 9% had stable disease. Subsequent treatment after induction chemotherapy consisted of surgery, usually followed by radiation or chemoradiation or by definitive radiation or chemoradiation with surgical salvage of any residual disease. Overall, surgical resection was performed in only 24 of 46 patients (52%) treated with induction chemotherapy. The 2-year survival for patients with at least a partial response or stable disease after induction chemotherapy was 77% in contrast to only 36% for patients with progressive disease.
Tumor response to induction chemotherapy in patients with advanced squamous cell carcinoma of the paranasal sinuses may be predictive of treatment outcome and prognosis. Favorable response to induction chemotherapy is associated with better survival and a reasonable chance of organ preservation.
Archives of otolaryngology--head & neck surgery 01/2011; 137(1):78-81. · 1.92 Impact Factor
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ABSTRACT: To assess the incidence of middle ear (ME) pathology in patients treated with radiotherapy (RT) for skull base tumors.
A retrospective analysis of 61 patients treated with RT between 2003 and 2008 for skull base tumors was conducted. Clinical outcomes and demographics were reviewed. Dose-volume histogram analysis was performed on the eustachian canal (EC), ME, mastoid air cells, vestibular apparatus, cochlea, internal auditory canal, lateral and posterior nasopharynx, and temporal lobes to relate doses to symptoms and radiographic change. Otomastoid opacification was rated 0 (none), 1 (mild), 2 (moderate), and 3 (severe) by a neuroradiologist blinded to clinical outcomes and doses.
The median prescribed dose was 50.4 Gy (range, 14-74 Gy). The ME mean dose was 14 Gy and 34 Gy for Grade 0-1 and 2-3 opacification, respectively (p<0.0001). The mean mastoid dose was 10 Gy and 26 Gy for Grade 0-1 and 2-3, respectively (p<0.0001). The mean EC dose was 17 Gy and 32 Gy for Grade 0-1 and 2-3, respectively (p=0.0001). Otomastoid opacification resolved in 17 of 40 patients (42.5%), at a mean of 17 months after RT (range, 2-45 months). Otomastoid opacification persisted in 23 of 40 patients (57.5%), with a mean follow-up of 23 months (range, 2-55 months). Multivariate analysis showed that mastoid dose>30 Gy (odds ratio=28.0, p<0.001) and posterior nasopharynx dose of >30 Gy (odds ratio=4.9, p=0.009) were associated with Grade 2-3 effusions, whereas other factors including dose to EC and ME were not significant.
A mean RT dose>30 Gy to the mastoid air cells or posterior nasopharynx is associated with increased risk of moderate to severe otomastoid opacification, which persisted in more than half of patients at 2-year follow-up.
International journal of radiation oncology, biology, physics 01/2011; 81(5):e819-23. · 4.59 Impact Factor
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ABSTRACT: The impact of tumor differentiation on the behavior and response of sinonasal neuroendocrine carcinoma is unknown.
We performed a retrospective review of the patients treated for neuroendocrine carcinoma (NEC) of the nasal cavity or paranasal sinuses from 1992 to 2008 at MDACC.
The results of our study suggest that pathologic differentiation may not be a critical factor in the clinical management of patients with NEC of the sinonasal tract. This is in contrast to laryngeal and lung NEC for which pathological differentiation has traditionally guided clinical management.
Multimodality approach should be the cornerstone of treating sinonasal NEC regardless of their differentiation. Specifically, RT may provide durable local control for patients with moderately differentiated NEC if resection is not feasible or desirable, while surgical resection can benefit patients with chemo-resistant or radio-resistant disease.
Head & Neck Oncology 01/2011; 3:32. · 3.13 Impact Factor
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ABSTRACT: To identify the incidence of radiologically and histologically documented bony invasion of the lacrimal gland fossa by adenoid cystic carcinoma.
The authors reviewed the records of all 18 patients with lacrimal gland adenoid cystic carcinoma surgically treated at their institution from 1997 to 2009 for imaging findings (blinded review) and histologic findings on evaluation of the lacrimal gland fossa. Preoperative CT and/or MRI findings were available for 17 patients.
The 8 men and 10 women ranged in age from 9 to 69 years. American Joint Committee on Cancer tumor stages after preoperative imaging were as follows: T1N0M0, 2 patients; T2N0M0, 5 patients; T3aN0M0, 2 patients; T3bN0M0, 5 patients; T3bN0M1, 2 patients; T4bN0M0, one patient; and TxN0M0, one patient. Preoperative imaging suggested bony involvement of the lacrimal gland fossa in 13 patients (76.5%); this was histologically confirmed in 11 of the 13. Preoperative imaging suggested no bone involvement in 4 patients, 3 of whom had bone involvement by histology. Overall, 14 of 17 histologically evaluable cases (82.3%) had invasion of the lacrimal gland fossa. Histologic findings of bone/periosteal involvement led to upstaging of 3 tumors. Metastases developed in 8 of 18 patients and trended with basaloid histology (p = 0.066).
Adenoid cystic carcinoma of the lacrimal gland is associated with bone invasion in essentially all but the smallest of tumors (T1). This high rate of bone involvement may warrant addressing the bony walls during surgery for adenoid cystic carcinoma of the lacrimal gland.
Ophthalmic plastic and reconstructive surgery 10/2010; 26(6):403-8. · 0.69 Impact Factor
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Wael Hassaneen,
Dima Suki,
Abhijit L Salaskar,
Nicholas B Levine, Franco DeMonte,
Frederick F Lang,
Ian E McCutcheon,
Zeena Dorai,
Iman Feiz-Erfan,
David M Wildrick,
Raymond Sawaya
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ABSTRACT: Resection of tumors of the third ventricle via the anterior interhemispheric transcallosal approach represents a surgical challenge. It carries a risk of postoperative complications, due to the role of surrounding structures in control of eloquent functions. We reviewed the immediate morbidity and mortality associated with this approach. Between June 1993 and July 2007, 38 patients underwent resection of tumors of the third ventricle via the anterior interhemispheric transcallosal approach at The University of Texas M. D. Anderson Cancer Center. Their 30-day postoperative morbidity and mortality rates were retrospectively analyzed relative to clinical variables possibly affecting these rates. Complications were categorized as neurological, regional, and systemic and were subclassified as major or minor. The overall complication rate was 50%. Major complications occurred in 37% of patients; 34% suffered neurological complications (16% being major complications). Surgical mortality was 8%. Univariate analysis demonstrated that tumor hemorrhage (p=0.04), preoperative Karnofsky Performance Scale (KPS) score (p=0.04), tumor status (recurrent versus [vs.] new or residual; p=0.01), and cauterization of any of the bridging veins (p=0.04) were associated with the incidence of postoperative complications. Multivariate analysis showed that increased age at surgery (p=0.04), tumor status (p=0.03), preoperative KPS score (p=0.02), and the extent of tumor resection (p=0.05) correlated significantly with the incidence of postoperative complications. Resection of tumors of the third ventricle via the interhemispheric transcallosal approach is associated with significant postoperative morbidity. Preserving the venous structures is of paramount importance in minimizing major neurological complications. Our results have practical risk-predictive value and can serve as the foundation for subsequent outcome studies.
Journal of Clinical Neuroscience 07/2010; 17(7):830-6. · 1.25 Impact Factor
