Search

Objectives  The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design  Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting  The study was conducted in a tertiary care referral center. Main Outcome Measures  The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results  A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n  = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n  = 2), cosmetic deformity (24%, n  = 4), petrous internal carotid artery injury (7%, n  = 1), and hypoglossal nerve palsy (7%, n  = 1). The cosmetic deformity included flap necrosis (n  = 2) and postoperative bony defects leading to contour defects of the scalp (n  = 2). Conclusion  Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes. [ABSTRACT FROM AUTHOR]

Objective  This study was aimed to understand the usefulness of transarterial angiography and embolization in management of juvenile nasopharyngeal angiofibroma (JNA) and to apply the information obtained to stage the disease, select appropriate surgical approach, predict intraoperative bleeding, and prognosticate the disease. Study Design  This study represents a retrospective review of the patients of JNA with major focus on transarterial angiography and embolization findings and its clinical and surgical implications. Setting  The study conducted at a tertiary-care super-specialty referral center. Participants  Forty-two patients who had undergone transarterial angiography and embolization followed by surgery over the period of 5 years from July 2015 till February 2019 were participated in this study. Main Outcome Measures  Tumor vascular pattern based on transarterial angiography, staging of the disease based on extent and vascular supply, surgical approach selected, and prognosticating the disease were determined from this study. Conclusion  Transarterial angiography with embolization becomes a prudent preoperative investigation for management of JNA. It provides a complete three-dimensional map of the tumor with stage-specific vascular pattern, reduces vascularity of the tumor, and predicts the sites from where bleeding can occur intra operatively. Thus, it helps in choosing the appropriate surgical approach aiding in complete tumor removal with minimal bleeding. [ABSTRACT FROM AUTHOR]

Objective  The aim of the study is to determine the surgical candidacy and nuances of skull base paraganglioma surgery in the era of radiotherapy. Materials and Methods  This was a retrospective observational study conducted in patients who presented with skull base paragangliomas between January 2017 and December 2019. Primary data, including indication for surgery, the approach used, the extent of resection, complications, and postoperative lower cranial nerve status were studied. Results  A total of 21 cases of skull base paragangliomas were analyzed, including seven cases of tympanic paraganglioma, 10 cases of jugular foramen paraganglioma, three cases of multiple paragangliomas, and one case of vagal paraganglioma. Indications for surgery were young age, bleeding from ear, neck mass with upper aerodigestive pressure symptoms, lower cranial nerve paralysis, and patients with intracranial pressure symptoms. Total excision was done in 11 patients, near-total excision in five patients, subtotal in three patients, and surgery was not done in two patients. Facial nerve paralysis was the most common complication observed, followed by bleeding and flap necrosis. Radiotherapy was considered as adjuvant treatment wherever indicated. Conclusion  A thorough knowledge and understanding of the pathophysiology of the skull base paragangliomas and its management strategies can help to achieve excellent results in terms of tumor clearance and reduction in complications. A multidisciplinary team approach and meticulous skull base surgical techniques have a significant role to play in the management of paragangliomas, especially in developing countries where availability of radiosurgery is still a challenge. [ABSTRACT FROM AUTHOR]

Introduction  Cerebrospinal fluid (CSF) rhinorrhea is the leakage of CSF through nasal cavity, due to abnormal communication between the arachnoid membrane and nasal mucosa. Middle-age (fourth to fifth decade) group, female gender, and obesity (body mass index > 40) are the most commonly reported risk-factors for this rare entity. In this study, we present our single center experience of spontaneous CSF rhinorrhea discussing important clinicoradiological aspects in preoperative evaluation and nuances in the endoscopic repair technique. Material and Methods  A retrospective study conducted for 43 spontaneous CSF rhinorrhea patients admitted between Jan 2011 to Jan 2018 at our tertiary care center. All patients underwent endoscopic repair of the defect depending upon their site of leak. Results  Mean age in our study was 36.7 ± 12.3 years (range: 9–62 years). Average BMI in males was found lower (28.7) as compared with females (32). Most common site of CSF leak was cribriform plate (n  = 32, 74.4%) and Planum was found to be the least common site (n  = 1, 2.3%) of CSF leak. Intraoperatively, 23 (53.5%) patients showed high-flow leak. Intrathecal injection of fluorescein dye was used to identify the site of CSF leakage in 15 cases (34.8%). The overall success rate of primary endoscopic repair in our study was 95.3%. Conclusion  Spontaneous CSF rhinorrhea occurs secondary to elevated intracranial pressure, with a predilection for obese females in fourth to fifth decade. Individualized tailored surgical approach depending upon the site, size, and flow-variety of the defect forms the cornerstone of management. [ABSTRACT FROM AUTHOR]