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Journal of Cranio-maxillo-facial... Oct 2023The aim of our study was to review current concepts in targeted therapies for benign tumors of the jaw. Benign odontogenic and maxillofacial bone tumors often require... (Review)
Review
The aim of our study was to review current concepts in targeted therapies for benign tumors of the jaw. Benign odontogenic and maxillofacial bone tumors often require radical surgery, with consequent morbidity that impacts patients' postsurgical quality of life. Currently, targeted therapies and novel nonsurgical therapeutics are being explored for management of non-resectable tumors, with the aim of avoiding surgery or minimizing surgical scope. However, data on clinical applications of targeted therapies for benign tumors of the jaw remain sparse. Therefore, a literature review was conducted, based on the PubMed database, which included in vivo human clinical studies describing clinical application of targeted therapy for benign tumor of the jaw. The review assessed the outcomes of BRAF and MEK inhibitors for treatment of ameloblastoma, RANKL monoclonal antibody for treatment of giant cell tumor, cherubism, aneurysmal bone cyst, and fibrous dysplasia, and tyrosine kinase inhibitor for treatment of odontogenic myxoma and cherubism. Targeted therapies decreased tumor size, slowed down tumor progression, and reduced bone pain. Surgery remains the gold standard, but targeted therapies are promising adjuvant or alternative treatment options for reducing tumor progression and morbidity of tumor surgery.
Topics: Humans; Jaw Neoplasms; Cherubism; Quality of Life; Odontogenic Tumors; Ameloblastoma
PubMed: 37852890
DOI: 10.1016/j.jcms.2023.10.003 -
Facial Plastic Surgery Clinics of North... May 2024
Topics: Humans; Nose; Rhinoplasty; Nose Neoplasms
PubMed: 38575292
DOI: 10.1016/j.fsc.2024.01.001 -
Atlas of the Oral and Maxillofacial... Sep 2023
Review
Topics: Humans; Allografts; Bone Transplantation; Mandible; Mandibular Neoplasms; Mandibular Reconstruction; Male; Adult; Middle Aged; Mandibular Osteotomy
PubMed: 37500203
DOI: 10.1016/j.cxom.2023.03.001 -
The Journal of Craniofacial Surgery Sep 2023Meningioma is a primary tumor of the central nervous system, most commonly found in the middle-aged and elderly. Most meningiomas are benign, whereas malignant...
Meningioma is a primary tumor of the central nervous system, most commonly found in the middle-aged and elderly. Most meningiomas are benign, whereas malignant meningiomas account for only 1% of all meningiomas. Meningiomas usually grow slowly, and patients often have headaches and epilepsy as the first symptoms. According to the location of the tumor, there can also be vision, visual field, olfactory, hearing impairment, and so on. Surgery is the main treatment. A case of giant malignant meningioma penetrating the skull is reported. The patient was a 67-year-old male with a left parietal scalp mass about 1 year ago, which gradually enlarged to the size of 6×6 cm and had no other symptoms. Imaging examination showed that the tumor eroded the skull, and the density was uneven. After surgical resection (Simpson grade I), poorly differentiated meningioma (World Health Organization Grade Ⅲ) was returned pathologically. After operation, the patient recovered well.
Topics: Aged; Male; Middle Aged; Humans; Meningioma; Meningeal Neoplasms; Skull; Head; Skull Base Neoplasms; Retrospective Studies
PubMed: 37336497
DOI: 10.1097/SCS.0000000000009436 -
BMJ Case Reports Aug 2023A man in his 70s presented with painless bilateral eyelid oedema and vertical diplopia. Evaluation showed a restrictive pattern of extraocular motility testing with MRI...
A man in his 70s presented with painless bilateral eyelid oedema and vertical diplopia. Evaluation showed a restrictive pattern of extraocular motility testing with MRI demonstrating significant enlargement of the right superior rectus and left superior oblique muscles along with right orbital fat stranding. Subsequent right orbital biopsy revealed poorly differentiated high-grade neuroendocrine carcinoma without a systemic primary site on further diagnostic workup. The patient was treated with carboplatin and etoposide and passed away from an infection a month after diagnosis. This case along with a review of other published cases highlights the varied presentation of orbital neuroendocrine carcinomas that may mimic a broad differential of orbital processes, thus requiring careful diagnostic workup. Subsequently, additional considerations in metastatic evaluation should be based on tumour histological features.
Topics: Male; Humans; Orbital Neoplasms; Neuroendocrine Tumors; Carcinoma, Neuroendocrine; Adipose Tissue; Angioedema
PubMed: 37648277
DOI: 10.1136/bcr-2023-254844 -
Operative Neurosurgery (Hagerstown, Md.) Mar 2024The extradural anterior petrosal approach (EAPA) can present a challenge because it deals with critical structures in a narrow, confined corridor. It is associated with...
BACKGROUND AND OBJECTIVES
The extradural anterior petrosal approach (EAPA) can present a challenge because it deals with critical structures in a narrow, confined corridor. It is associated with several potential approach-related risks including temporal lobe and venous injuries. Tentorial peeling has the potential to largely eliminate these risks during the approach and may offer more options for tailoring the dural opening to the anatomic region that one wants to expose.
METHODS
Anatomic dissections of five adult injected non-formalin-fixed cadaveric heads were performed. Anterior petrosectomy with intertentorial approach (APIA) through a tentorial peeling was completed. Step-by-step documentation of the cadaveric dissections and diagrammatic representations are presented along with an illustrative case.
RESULTS
Tentorial peeling separates the tentorium into a temporal tentorial leaf and posterior fossa tentorial leaf, adding a fourth dural layer to the three classic ones described during a standard EAPA. This opens out the intertentorial space and offers more options for tailoring the dural incisions specific to the pathology being treated. This represents a unique possibility to address brainstem or skull base pathology along the mid- and upper clivus with the ability to keep the entire temporal lobe and basal temporal veins covered by the temporal tentorial leaf. The APIA was successfully used for the resection of a large clival chordoma in the illustrative case.
CONCLUSION
APIA is an interesting modification to the classic EAPA to reduce the approach-related morbidity. The risk reduction achieved is by eliminating the exposure of the temporal lobe while maintaining the excellent access to the petroclival region. It also provides several options to tailor the durotomies based on the localization of the lesion.
Topics: Adult; Humans; Neurosurgical Procedures; Craniotomy; Skull Base; Skull Base Neoplasms; Cadaver
PubMed: 37878474
DOI: 10.1227/ons.0000000000000966 -
Neuro-oncology Sep 2023Data on clinical outcomes for base of skull (BOS) chordomas in the pediatric population is limited. We report patient outcomes after surgery and proton radiotherapy...
BACKGROUND
Data on clinical outcomes for base of skull (BOS) chordomas in the pediatric population is limited. We report patient outcomes after surgery and proton radiotherapy (PRT).
METHODS
Pediatric patients with BOS chordomas were treated with PRT or combined proton/photon approach (proton-based; for most, 80% proton/20% photon) at the Massachusetts General Hospital from 1981 to 2021. Endpoints of interest were overall survival (OS), disease-specific survival, progression-free survival (PFS), freedom from local recurrence (LC), and freedom from distant failure (DC).
RESULTS
Of 204 patients, median age at diagnosis was 11.1 years (range, 1-21). Chordoma location included 59% upper and/or middle clivus, 36% lower clivus, 4% craniocervical junction, and 1% nasal cavity. Fifteen (7%) received pre-RT chemotherapy. Forty-seven (23%) received PRT, and 157 (77%) received comboRT. Median total dose was 76.7 Gy (RBE) (range, 59.3-83.3). At a median follow-up of 10 years (interquartile range, 5-16 years), 56 recurred. Median OS and PFS were 26 and 25 years, with 5-, 10-, and 20-year OS and PFS rates of 84% and 74%, 78% and 69%, and 64% and 64%, respectively. Multivariable actuarial analyses showed poorly differentiated subtype, radiographical progression prior to RT, larger treatment volume, and lower clivus location to be prognostic factors for worse OS, PFS, and LC. RT was well tolerated at a median follow-up of 9 years (interquartile range, 4-16 years). Side effects included 166 patients (80%) with mild/moderate acute toxicities, 24 (12%) patients with late toxicities, and 4 (2%) who developed secondary radiation-related malignancies.
CONCLUSION
This is the largest cohort of BOS chordomas in the literature, pediatric and/or adult. High-dose PRT following surgical resection is effective with low rates of late toxicity.
Topics: Adult; Humans; Child; Infant; Child, Preschool; Adolescent; Young Adult; Protons; Chordoma; Skull Base Neoplasms; Chondrosarcoma; Proton Therapy; Skull Base; Treatment Outcome; Follow-Up Studies
PubMed: 37029730
DOI: 10.1093/neuonc/noad068 -
Neurosurgery Clinics of North America Jul 2023Traditionally, resection of anterior skull base meningiomas has been achieved by transcranial approaches; however, morbidity related (ie, brain retraction, sagittal... (Review)
Review
Traditionally, resection of anterior skull base meningiomas has been achieved by transcranial approaches; however, morbidity related (ie, brain retraction, sagittal sinus damage, optic nerve manipulation, and cosmetic healing) represent a limit of the approach. Minimally invasive techniques including supraorbital and endonasal endoscopic approaches (EEA) have gained consensus as surgical corridors provide direct access to the tumor via a midline approach in carefully selected patients . The supraorbital approach requires some retraction of the rectus gyrus, but it offers minimal risk of postoperative CSF leak or sinonasal morbidity compared to EEA.
Topics: Humans; Meningioma; Meningeal Neoplasms; Treatment Outcome; Endoscopy; Skull Base Neoplasms; Skull Base
PubMed: 37210128
DOI: 10.1016/j.nec.2023.02.003 -
Orbit (Amsterdam, Netherlands) Oct 2023
Topics: Humans; Orbit; Liposarcoma; Orbital Neoplasms; Orbit Evisceration
PubMed: 34470545
DOI: 10.1080/01676830.2021.1966814 -
International Ophthalmology Clinics Jul 2023
Topics: Humans; Orbit; Orbital Diseases; Orbital Neoplasms
PubMed: 37439613
DOI: 10.1097/IIO.0000000000000476