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World Neurosurgery May 2022Surgery is the first-line therapy for most benign and malignant skull base tumors. Extent of resection (EOR) is a metric commonly used for preoperative surgical planning... (Review)
Review
Surgery is the first-line therapy for most benign and malignant skull base tumors. Extent of resection (EOR) is a metric commonly used for preoperative surgical planning and to predict risk of postoperative tumor recurrence. Therefore, understanding the evidence on EOR in skull base neurosurgery is essential to providing optimal care for each patient. Several studies from the skull base neurosurgery literature have presented investigations of various topics related to EOR, including 1) preoperative EOR scoring systems, 2) intraoperative EOR scoring systems, 3) EOR and tumor recurrence, and 4) EOR and functional outcomes. We propose that future investigations should focus on the following elements to improve EOR research in skull base neurosurgery: 1) multi-institutional collaboratives with treatment propensity matching; 2) expert consensus and mixed-methods study design; and 3) predictive analytics/machine learning. We believe that these methods offer several advantages that have been described in the literature and that they address limitations of previous studies. The aim of this review was to inform future study design and improve the overall quality of subsequent investigations on EOR in skull base neurosurgery.
Topics: Humans; Neoplasm Recurrence, Local; Neurosurgery; Neurosurgical Procedures; Skull Base; Skull Base Neoplasms
PubMed: 35505559
DOI: 10.1016/j.wneu.2021.10.184 -
Clinical Imaging Feb 2020The diagnosis of a large solitary lytic skull vault lesion in adults is a challenge due to variable aggressiveness and overlapping features. The purpose of this article... (Review)
Review
The diagnosis of a large solitary lytic skull vault lesion in adults is a challenge due to variable aggressiveness and overlapping features. The purpose of this article is to demonstrate the use of an imaging approach to narrow the differential diagnosis when a large solitary lytic skull vault lesion is encountered. The initial imaging assessment using computed tomography (CT) is invaluable in determining lesion aggressiveness based on bony margins and skull tables involvement. Further assessment with magnetic resonance (MR) imaging including diffusion weighted imaging (DWI) aids in soft tissue characterization. We present cases of large solitary lytic skull vault lesions in adults, emphasizing on salient and atypical imaging features, with pathological correlation for better understanding of the disease processes that underlie the imaging features.
Topics: Adult; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Skull; Skull Neoplasms; Tomography, X-Ray Computed
PubMed: 31816540
DOI: 10.1016/j.clinimag.2019.10.011 -
World Neurosurgery Aug 2022Primary intraosseous cavernous hemangioma (PICH) is a rare, benign tumor of vascular origin, typically arising in the vertebral body. Its presence in the skull is... (Review)
Review
Primary intraosseous cavernous hemangioma (PICH) is a rare, benign tumor of vascular origin, typically arising in the vertebral body. Its presence in the skull is exceedingly rare, with only a few cases being reported worldwide. We carried out the first systematic review of the literature, covering the epidemiology, clinical and imaging features, management, and prognosis of cranial PICH. The literature search revealed 51 studies with 77 patients; the mean age of the patients was 32.7 years with a female predominance of 1.4:1. The majority of cranial PICHs were located in the calvarium, primarily in the frontal and parietal regions, with only a few located in the skull base. The most common initial clinical manifestation was local growth or swelling, followed by a headache. Radiographically, PICHs represented osteolytic, intradiploic masses, which in many cases displayed trabeculations, leading to the so-called "honeycomb" or "starburst" pattern. After contrast administration, PICHs typically enhance. Tumor removal, with craniectomy or en bloc resection and subsequent skull reconstruction, was selected for calvarial PICHs, whereas a transsphenoidal approach, with only partial resection, was applied for clival/sella PICHs. Preoperative embolization, aiming to minimize intraoperative blood loss, was performed in the case of large tumors. At a mean follow-up of 39 months, no patient experienced tumor recurrence, even after subtotal resection. Owing to the benign nature of the tumor, maximal safe resection is recommended as the treatment of choice for patients with cranial PICH.
Topics: Adult; Female; Hemangioma, Cavernous; Humans; Male; Neoplasm Recurrence, Local; Skull; Skull Neoplasms; Spine; Vascular Malformations; Vascular Neoplasms
PubMed: 35654328
DOI: 10.1016/j.wneu.2022.05.107 -
Advances in Oto-rhino-laryngology 2020Malignancies of the anterior skull base are rare and recur in 40-80% of treated cases, varying with substantial variance according to histology, stage at primary... (Review)
Review
Malignancies of the anterior skull base are rare and recur in 40-80% of treated cases, varying with substantial variance according to histology, stage at primary diagnosis, and other factors. Most recurrences manifest within 2-5 years after primary treatment, but some histologies can relapse even decades after the first presentation. Management of recurrent anterior skull base tumors is challenging and a wide variety of treatment options are available. Similar to the primary setting, surgery is the mainstay of treatment. However, only few patients are likely to be suitable for salvage surgery after restaging. In this scenario, non-surgical options such as re-irradiation with photon or heavy particles may play a role, although the potential toxicity and benefits of treatment needs to be considered on a case-by-case basis. Moreover, stereotactic technologies are emerging as an adjunct valuable tool to minimize side effects. Chemotherapy is acquiring a relevant role in the primary treatment of sinonasal malignant lesions involving the anterior skull base in the neoadjuvant setting or in combination with radiotherapy, but evidence of its efficacy in the treatment of the recurrent/metastatic disease is very limited. The specific drugs employed vary considerably and need to be paralleled with the biology of the different histologies.
Topics: Humans; Neoplasm Recurrence, Local; Proton Therapy; Radiosurgery; Skull Base; Skull Base Neoplasms
PubMed: 32731228
DOI: 10.1159/000457942 -
Journal of Neuro-oncology Dec 2020The extirpation of skull base malignancies may be associated with significant morbidity and can profoundly impact health related quality of life (HRQOL). In this review,... (Review)
Review
INTRODUCTION
The extirpation of skull base malignancies may be associated with significant morbidity and can profoundly impact health related quality of life (HRQOL). In this review, we sought to provide an overview of HRQOL and the factors that influence it for patients with skull base malignancies.
MATERIALS AND METHODS
Narrative review.
RESULTS
HRQOL tends to improve in the months to years following treatment and is profoundly impacted by both tumor location and treatment approach. Wherever possible, HRQOL should always be elicited from the patient directly. Several HRQOL instruments have been used in this population including generic, site-specific and disease specific measures.
CONCLUSION
Given that HRQOL is a multidimensional concept with several important facets, validated disease-specific instruments are generally preferred.
Topics: Combined Modality Therapy; Humans; Psychometrics; Quality of Life; Skull Base Neoplasms; Surveys and Questionnaires
PubMed: 31900827
DOI: 10.1007/s11060-019-03367-w -
Current Medical Imaging 2023Chondrosarcomas are primary malignant bone tumor that rarely occurs in the head and neck region. Squash cytology of skull base neoplasm shows atypical chondrocytes and...
INTRODUCTION
Chondrosarcomas are primary malignant bone tumor that rarely occurs in the head and neck region. Squash cytology of skull base neoplasm shows atypical chondrocytes and myxoid stroma, which suggests many possibilities like chordoma, chordoid glioma, chordoid meningioma and chondrosarcoma. Isocitrate dehydrogenase gene (IDH) mutations have been reported in 50% to 60% of the head and neck region chondrosarcoma.
CASE PRESENTATION
A 37-year-old female came to the outpatient department and complaint of difficulty in walking and swaying to the right side for one year. The radiology was suggestive of right-sided trigeminal schwannoma. However, the squash cytology showed the presence of necrosis, and pink to bluish-coloured myxoid stroma. The tumor cells were pleomorphic and had a hyperchromatic nucleus, hyalinized condensed to granular cytoplasm. The histopathological examination of intraoperative soft tissue showed the presence of cellular lobules of atypical chondrocytes arranged in the myxoid background. The features were of Chondrosarcoma. No parenchymal invasion was found.
CONCLUSION
This case report aims to create awareness about a rare tumor, which rarely forms a differential diagnosis for skull base neoplasms. As chondrosarcoma are immunoreactive to IDH1 so this marker can be useful in clinching the diagnosis in conjunction with other immunohistochemical markers in a small biopsy from skull base neoplasms.
Topics: Female; Humans; Adult; Skull Base Neoplasms; Glioma; Chondrosarcoma; Diagnosis, Differential; Skull Base
PubMed: 36748815
DOI: 10.2174/1573405619666230207144546 -
Clinical Radiology Apr 2016Focal calvarial lesions may present as a visible, palpable, or symptomatic lump; however, with increasing use of cross-sectional imaging they are often encountered as an... (Review)
Review
Focal calvarial lesions may present as a visible, palpable, or symptomatic lump; however, with increasing use of cross-sectional imaging they are often encountered as an incidental finding. Knowledge of the possible disease entities along with a structured approach to imaging is required to suggest an appropriate diagnosis and assist in management planning. Abnormalities range from common neoplastic lesions to rarer congenital conditions, benign pathologies, and calvarial defects that can mimic lesions. The aim of this article is to demonstrate the salient imaging features that may help to limit the differential diagnosis of a focal calvarial lesion.
Topics: Humans; Magnetic Resonance Imaging; Skull; Skull Neoplasms; Tomography, X-Ray Computed
PubMed: 26873626
DOI: 10.1016/j.crad.2015.12.010 -
The Journal of Craniofacial Surgery Jul 2017Skull osteoma is a benign tumor that slowly and continuously enlarges. It is frequently observed in routine medical practice and many patients show an arc shape. The...
Skull osteoma is a benign tumor that slowly and continuously enlarges. It is frequently observed in routine medical practice and many patients show an arc shape. The authors encountered a patient with osteoma with a rare morphology that developed in the occipital region. The patient was a 66-year-old male who had been aware of the presence of a mass in the occipital region for about 50 years, but its uncomfortable feeling had recently increased, and it was resected. The excised tumor showed a pedunculated cauliflower-like shape continuous to the skull. The pathological diagnosis was osteoma. The cause of rare morphologies includes trauma and infection, but this patient had no such past medical history. Since the development site was the occipital region, it was assumed that chronic stimulation caused the rare morphology.
Topics: Aged; Humans; Male; Osteoma; Skull Neoplasms
PubMed: 28538074
DOI: 10.1097/SCS.0000000000003639 -
Skeletal Radiology Aug 2021Osteosarcoma is the most common primary bone tumor and usually involves the long bones. Osteosarcoma of the skull, on the other hand, is relatively rare. Here, we...
Osteosarcoma is the most common primary bone tumor and usually involves the long bones. Osteosarcoma of the skull, on the other hand, is relatively rare. Here, we present a 29-year-old man with a growing mass in the skull he first noticed after a fall while skateboarding. The initial clinical diagnosis was hematoma. While undergoing an evacuation surgery for a hematoma, a suspicious mass was detected which was biopsied. Histopathological evaluation showed high-grade osteosarcoma. The patient was referred to our hospital where he underwent definitive resection followed by adjuvant chemotherapy. His course was complicated by wound infection. Even though osteosarcoma of the skull is a rare finding, it should be suspected in a patient with a skull mass, and the history of prior head trauma does not exclude the diagnosis.
Topics: Adult; Bone Neoplasms; Humans; Male; Osteosarcoma; Parietal Bone; Sarcoma; Skull Neoplasms
PubMed: 33604706
DOI: 10.1007/s00256-021-03726-7 -
Acta Radiologica (Stockholm, Sweden :... Jul 2019Little is known about the value of computed tomography (CT) and magnetic resonance imaging (MRI) combined with diffusion-weighted imaging (DWI) in distinguishing...
BACKGROUND
Little is known about the value of computed tomography (CT) and magnetic resonance imaging (MRI) combined with diffusion-weighted imaging (DWI) in distinguishing malignant from benign skull-involved lesions.
PURPOSE
To evaluate the discriminative value of DWI combined with conventional CT and MRI for differentiating between benign and malignant skull-involved lesions.
MATERIAL AND METHODS
CT and MRI findings of 58 patients with pathologically proven skull-involved lesions (43 benign and 15 malignant) were retrospectively reviewed. Conventional CT and MRI characteristics and apparent diffusion coefficient (ADC) value of the two groups were evaluated and compared. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the differential performance of each parameter separately and together.
RESULTS
The presence of cortical defects or break-through and ill-defined margins were associated with malignant skull-involved lesions (both < 0.05). Malignant skull-involved lesions demonstrated a significantly lower ADC ( = 0.016) than benign lesions. ROC curve analyses indicated that a combination of CT, MRI, and DWI with an ADC ≤ 0.703 × 10 mm/s showed optimal sensitivity, while DWI along showed optimal specificity of 88.4% in differentiating between benign and malignant skull-involved lesions.
CONCLUSION
The combination of CT, MRI, and DWI can help to differentiate malignant from benign skull-involved lesions. CT + MRI + DWI offers optimal sensitivity, while DWI offers optimal specificity.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Diffusion Magnetic Resonance Imaging; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Skull; Skull Neoplasms; Tomography, X-Ray Computed; Young Adult
PubMed: 29742920
DOI: 10.1177/0284185118773541