Antonio Mazzoni

Lower Cranial Nerve Schwannomas Involving the Jugular Foramen

Schwannomas involving the jugular foramen are rare lesions, and no consensus exists on their management. This paper reports on 20 such cases treated in our centers. Nineteen cases were operated on for removal of the tumors, and the remaining case is being managed by watchful expectancy. Fifteen cases were operated on by the petro-occipital trans-sigmoid approach with or without labyrinthectomy, 2 by the infratemporal fossa approach, 1 by the modified transcochlear approach, and 1 by the jugulo-petrosectomy approach. The petro-occipital trans-sigmoid approach allowed single-stage, total tumor removal with preservation of the facial nerve and of middle and inner ear functions. Lower cranial nerve paralysis was the major complication and seemed to be inherent to the disease rather than to the approach used. No cerebrospinal fluid leak or meningitis occurred in the present series. So far, no recurrence has been detected.

Cerebrospinal fluid leak after translabyrinthine acoustic neuroma surgery

Cerebrospinal fluid leakage is the most common complication of translabyrinthine acoustic neuroma surgery. This retrospective study reviews patients who had translabyrinthine acoustic neuroma surgery at the Gruppo Otologico, Piacenza, Italy, and ENT Department of Bergamo General Hospital, Bergamo, Italy, during the last 6 years. The incidence of postoperative cerebrospinal fluid leakage was 6.2%, and 75% of these patients underwent another surgery to control the cerebrospinal fluid leakage. A modification of translabyrinthine approach was used in patients with highly pneumatized temporal bones to prevent cerebrospinal fluid leakage in these high-risk patients.

Management of the high jugular bulb in the translabyrinthine approach.

A high jugular bulb is a frequent problem in the translabyrinthine approach. This article described a safe technique for effective inferior displacement of the high bulb.

The enlarged translabyrinthine approach for removal of large vestibular schwannomas

This study was carried out to validate the enlarged translabyrinthine approach for the surgical management of large vestibular schwannomas. A retrospective review of the charts of 53 patients with large tumours removed via the enlarged translabyrinthine approach at the Gruppo Otologico, Piacenza, Italy, during the last five years was carried out. The ability to control large tumours and the achievement of total removal with low morbidity and very few complications, demonstrate that tumour size does not influence the use of the enlarged translabyrinthine approach for managing large tumours.

Temporal bone squamous cell carcinoma: Analyzing prognosis with univariate and multivariate models

Temporal bone squamous cell carcinoma (SCC) is an uncommon malignancy accounting for less than 0.2% of head and neck cancers. Despite advances in its early diagnosis, skull base microsurgery, radiotherapy, and integrated treatments, prognosis in advanced SCCs remains dismal. The present study aimed to analyze the clinicopathological variables potentially influencing outcome in a series of temporal bone SCCs.

The Petro-Occipital Trans-Sigmoid Approach for Lesions of the Jugular Foramen

This studys goals were twofold: (1) to analyze the authors experience with the petro-occipital trans-sigmoid (POTS) approach for the resection of tumors arising in or adjacent to the jugular foramen, and (2) to define the anatomical sites exposed by this approach. A retrospective review was conducted of 61 patients with jugular fossa tumors that included lower cranial nerve schwannomas, paragangliomas, meningiomas, chordomas, cholesteatomas, and other benign or low-grade malignant tumors. Outcome measures were mortality, morbidity, and long-term outcomes. No deaths were found in this study. The major morbidity was deficits of the glossopharyngeal, vagus, and accessory nerves. Hearing and facial nerve function were largely preserved. The resections were undertaken as single-stage procedures regardless of whether the tumor was entirely extradural or both intra- and extradural. None of the patients had central nervous system complications. Good outcomes were achieved for schwannomas, meningiomas, chondrosarcomas, and papillary adenoma. Chordomas tended to recur, and only class C1 paragangliomas could be removed using this approach. The study found that the POTS approach should be considered the approach of choice for many tumors in the region of the jugular foramen, particularly schwannomas. It is not suitable for the resection of malignant tumors and most paragangliomas because it offers limited access to the skull base between the jugular fossa and carotid canal.

Expression of the tumour-suppressor maspin in temporal bone carcinoma.

Although it accounts for fewer than 0.2% of all head and neck tumours, temporal bone squamous cell carcinoma (SCC) is an aggressive malignancy with a poor prognosis in advanced cases. Novel therapeutic strategies should be developed focusing on specific targeted therapies. Maspin is a serpin showing tumour‐suppressing activity which has therapeutic potential. The present study is the first to investigate maspin expression in temporal bone SCCs, using a series of 29 cases.

A critical look at persistent problems in the diagnosis, staging and treatment of temporal bone carcinoma

Temporal bone squamous cell carcinoma (TBSCC) is an uncommon malignancy with a distinctly poor prognosis in advanced cases. There is still much controversy surrounding the rational diagnostic/therapeutic approach to TBSCC. Diagnostic differences are due mainly to: the small number of cases reported (even in the largest available series); the inappropriate histological heterogeneity of several case series; the lack of an internationally-accepted staging system for TBSCC; the frequent absence of adequate radiological imaging to enable a malignancys local, regional and distant extension to be studied in detail; and a non-standardized approach to final histological assessment of the surgical margins. As for the therapeutic approaches, several issues are still debated, including the choice between en bloc and piecemeal primary surgery for the tumors removal, and the role of elective neck dissection. Although radiotherapy seems to be an effective adjuvant therapy in advanced cases, its role in low-stage tumors or as a primary treatment has yet to be established. The value of chemotherapy is also still unclear. The treatment strategy for TBSCC is often based on the combined experience of a given surgeon and institution, bearing the results reportedly achieved by other oncology centers in mind. To date, the optimal management of TBSCC is still elusive. We aimed to critically review the ongoing crucial issues concerning the management of TBSCC, analyzing how it is diagnosed, staged and treated, the management of recurrences, rational follow-up schedules, and prognostic factors for this disease.

Recurrent squamous cell carcinoma of the temporal bone: critical analysis of cases with a poor prognosis ☆,☆☆

PURPOSE Temporal bone squamous cell carcinoma (TBSCC) is an uncommon, aggressive malignancy with a significant recurrence rate. We reviewed our experience with recurrent TBSCCs. MATERIALS AND METHODS Clinicopathological and therapeutic variables potentially associated with disease-free survival (DFS) and disease-specific survival (DSS) were assessed in 17 TBSCC patients who died of their disease after treatment. RESULTS TBSCC recurrences were treated with surgery in 12 cases (palliative in 11, with curative intent in 1) and palliative chemotherapy in 5; the median DFS and DSS were 6 and 16 months, respectively. The mean DFS and DSS were longer in patients who had primary lateral temporal bone resection (LTBR) rather than subtotal temporal bone resection (STBR) (p=0.0173 and p=0.03, respectively). Patients given non-surgical palliative treatment for recurrences had a longer mean DSS than those who underwent surgery (trend toward significance, p=0.09). CONCLUSIONS Our results reflect the aggressive nature of TBSCC recurrences. Our findings seem to support the use of non-surgical treatments (chemotherapy, radiotherapy, or specialist palliative care) in patients with loco-regionally advanced recurrent TBSCC. Salvage surgery might be considered for early recurrences when radicality is still achievable. Precise guidelines for the rational follow-up of surgically-treated TBSCCs need to be shared between tertiary centers.

Microsurgical endoscopy-assisted presigmoid retrolabyrinthine approach as a minimally invasive surgical option for the treatment of medium to large vestibular schwannoma

Background Treatment of vestibular schwannomas presents many controversial aspects, from the indication to the selection of the best treatment option. In the era of stereotactic radiotherapy, microsurgery has to be competitive in terms of providing the best chances of functional preservation and complete tumor removal. The two most commonly used surgical approaches are the retrosigmoid suboccipital and the presigmoid translabyrinthine. We describe the endoscopy-assisted presigmoid retrolabyrinthine approach (EAPRA) aiming at combining the advantages of the retrosigmoid and translabyrinthine techniques.