Alejandra T. Rabadán

Transmaxillary-transnasal approach to the anterior clivus: a microsurgical anatomical model.

Numerous procedures to expose the anterior clival region have been described, including the transoral, transcervical, transseptal-transsphenoidal, transantral, transnasal, bilateral Le Fort I maxillotomy, transbasal, transpalatal, and modifications of the Caldwell-Luc approach. Despite the large number of surgical options available, it may be necessary to have wider access to the midline skull base than these approaches provide. We have developed a microsurgical transmaxillary-transnasal approach to the anterior clivus that has been studied in both dry skull and cadaveric preparations and used clinically. The surgical technique has four stages: 1) antromaxillary; 2) nasal; 3) sphenoidal; and 4) clival. The wider access of this approach is achieved mainly by an osteotomy of the frontal process of the maxilla, which transforms the nasal cavity and the antrum into a single cavity while preserving the functional anatomy of the nose. Cosmesis is preserved by replacement of the cartilaginous nasal septum and the frontal process at the end of the procedure. The technique provides the good cosmetic results of the sublabial approaches and prevents vascular and neural injury in the same way that other anterior approaches do. This transmaxillary-transnasal technique may be used in combination with other approaches for extensive tumors.

Surgical Application of the Suboccipital Subtonsillar Approach to Reach the Inferior Half of Medulla Oblongata Tumors in Adult Patients

Medulla oblongata (MO) tumors are uncommon in adults. Controversies about their treatment arise regarding the need for histological diagnosis in this eloquent area of the brain, weighing benefits of a reliable diagnosis, and the potential disadvantages of invasive procedures. As a broader variety of pathological findings could be found in this localization, the accurate histopathological definition could not only allow an adequate therapy but also can prevent the disastrous consequences of empiric treatments. There are few publications about their surgical management and all belongs to small retrospective cohorts. In this scenario, we are reporting two patients with exophytic or focal lesions in the inferior half of the medulla, who underwent surgery by suboccipital midline subtonsillar approach. This approach was not specifically described to reach MO before, and we found that the lesions produced a mild elevation of the tonsils providing a wide surgical view from the medulla to the foramen of Luchska laterally, and up to the middle cerebellar peduncle, offering a wide and safe access.

Hemangioblastoma located in the posterior incisural space mimicking a tentorial meningioma: a case report

BackgroundThe most common type of vascularized tumor located in the posterior incisural space in older patients is the falcotentorial meningioma. Solid hemangioblastomas are rarely found in this particular area of the brain. To the best of our knowledge, the case of only one patient harboring a hemangioblastoma not associated with Von Hippel-Lindau disease has been previously reported in the literature in this anatomic region. Regarding age presentation, it is rare for sporadic hemangioblastoma in any part of the brain to occur in older patients; only two cases have previously been reported, and neither were in this anatomical space. A solid hemangioblastoma represents a surgical challenge because of its high vascularization, very similar to an arteriovenous malformation, and it should be removed en bloc to prevent significant intraoperative bleeding.Case presentationWe report here the case of a 63-year-old white male patient with a sporadic hemangioblastoma located in the posterior incisural space mimicking a tentorial meningioma. It was completely removed en bloc via an infratentorial supracerebellar approach with an excellent outcome.ConclusionsA hemangioblastoma should be considered among the differential diagnosis of hypervascularized masses in the posterior incisural space, even in cases of solid tumors, in older patients, or in the absence of Von Hippel-Lindau disease. These tumors located in the posterior incisural space represent a challenge, and the infratentorial supracerebellar approach provides panoramic exposure to allow safe resection.

P181: Endoscopic and Microscopic Approach to the Pituitary Gland

were analyzed. RESULTS: Mean volume of maxillary sinuses was 23.96 4.13 cm3 in the normal group, and 21.68 4.54 cm3 in the sinusitis group, which was statistically significant (p 0.04). However, no correlation was found between disease periods and maxillary sinus volume (r -0.07, p 0.69). Mean thicknesses of bony walls were 1.17 0.4mm (maxillary sinus), 1.12 0.3mm (ethmoid sinus), and 2.15 0.6mm (middle turbinate) in CRS group, and 0.92 0.3 (maxillary sinus), 0.80 0.2 (ethmoid sinus), and 1.65 0.3mm in the control group, respectively, which showed significant differences between the two groups (p 0.01). CONCLUSIONS: The volume of maxillary sinuses was decreased and increased bony thickness of paranasal sinuses was found in longstanding pediatric CRS, which might encourage more active surgical treatment for pediatric CRS.