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68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
7. Joint Meeting mit der Britischen Gesellschaft für Neurochirurgie (SBNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

14. - 17. Mai 2017, Magdeburg

Interdisciplinary extended approaches to skull base lesions – a single center experience

Meeting Abstract

  • Annika Herten - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Stefan Mattheis - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Essen, Deutschland
  • Karsten H. Wrede - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Boris A. Stuck - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Nicolai El Hindy - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Oliver M. Müller - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.06.02

doi: 10.3205/17dgnc210, urn:nbn:de:0183-17dgnc2107

Veröffentlicht: 9. Juni 2017

© 2017 Herten et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Interdisciplinary extended (near total) resections of skull base tumors in a complete endoscopic transnasal or in a combined endoscopic / microscopic approach in cooperation with the Department of Otorhinolaryngology (ORL) were evaluated with regard to postoperative complications, extend of resection and progression free survival (PFS).

Methods: Intraoperative macroscopic and postoperative imaging based extend of resection, postoperative complications and PFS were assessed in 12 consecutive patients admitted to the neurosurgical clinic and treated in cooperation with the Department of ORL since 2013. Operations were performed in an isolated endoscopic transnasal approach or with microscopic support. The spectrum of skull base lesions included meningioma, carcinoma, sarcoma and cystic lesions.

Results: The cohort consisted of 5 female and 7 male patients with a mean age of 38.75 years (range 6-62y). Histology revealed meningioma (n=2), carcinoma (n=3), sarcoma (n=4) and cystic lesions (n=3). Seven cases were exclusively managed endoscopically, in 5 cases a combined endoscopic and microscopic approach was performed. Frontobasal reconstruction was achieved with fascia lata, galea-periostium flap, haddad-flap, and calvarian split transposition depending on the size of the defect and the surgical approach. Liquorrhea was not observed, 2 patients developed a pneumocephalus. In 2 patients thromboembolic events led to neurological sequelae. One infection with concomitant meningitis and pneumocephalus was observed in a patient with recurrent disease. Gross total resection was achieved in 7 and a subtotal tumor removal could be achieved in 5 patients. 11 patients are in PFS after combined adjuvant therapy, while 1 patient suffering from undifferentiated sarcoma shows progressive disease despite multimodal treatment.

Conclusion: Interdisciplinary management of complex lesions of the skull base with a predominant endoscopic approach can be done with limited morbidity and good disease control in trained hands. Extended tumor resection and a diligent reconstruction of the skull base are essential for a successful management of the disease.