Gideon Zucker

Early outcome and complications of the extended subcranial approach to the anterior skull base

Objectives: To present the technique of the extended subcranial approach to the anterior skull base and to review the results in 55 patients who underwent the procedure. Study Design: Retrospective review of the records of 55 patients who underwent the extended subcranial approach to the anterior skull base between 1994 and 1998 for the treatment of various neoplasms originating in the nasal cavity, nasopharynx, paranasal sinuses, orbit, or meninges, as well as for the repair of complex craniofacial trauma and/or cerebrospinal fluid (CSF) leak. Preoperative patient evaluation and the surgical technique are also reviewed. Methods: Patient records were retrospectively reviewed and tabulated for age, sex, and indications for procedure, with special focus on early outcome and complications. Results: Twenty‐six patients underwent oncologic resections, 22 patients had reduction of complex fronto‐naso‐orbital and skull base fractures, and seven patients had repair of CSF leak. Significant complications in the oncologic group consisted of one hematoma requiring needle aspiration and two cases of temporary nontension pneumocephalus. In the fracture group, one patient died because of extensive intracerebral damage and multiorgan failure, and one patient had nontension pneumocephalus coupled with CSF leakage and one patient had temporary nontensisn pneumocephalus. The most common late complication in all three groups was anosmia. Conclusions: Based on their review, the authors conclude that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of various pathological conditions involving the anterior skull base.

Neurosurgical management of single brain metastasis

A series of 74 consecutive cases undergoing craniotomy for single brain metastasis in the Beilinson Medical Center between October 1975 and October 1981 were reviewed. All patients underwent radiation therapy after craniotomy. The most common metastasis was that of unknown origin (35%), followed by lung (24%) and breast (16%). Overall median survival after craniotomy was 6.6 months. Overall 1- and 2-year survival rates were 30 and 15%, respectively. Operative mortality (30 days) was 15%. For the patients with metastases to the lung, median survival was 7.5 months and 1-year survival rate was 33%. It appears from this report that two dominant factors affect the prognosis of these patients. The first is the long latent interval (time between diagnosis of primary tumor and detection of metastasis). The second is the location of the metastasis; those with lesions in the cerebral hemispheres had a far better outcome than those with cerebellar lesions (p less than 0.0001).

The combined subcranial and midfacial degloving technique for tumor resection: Report of three cases*

1. Neuber H: Fat transplantation. Chir Kong Verhandl 1:66, 1893 2. Lexer E: Free Transplantation. Ann Surg 60:166, 1914 3. Eimer E: Uber unterpolsterung der gesichtshaut. Med Klin 16:93, 1920 4. Figi FA: Depression of frontal region and fat transplantation. Surg Clin North Am 11:8, 1931 5. Davis RE, Guida RA, Cook TA: Autologous free dermal fat graft. Reconstruction of facial contour defects. Arch Otolaryngol Head Neck Surg 121:95, 1995 6. Nosan DK, Ochi JW, Davidson TM: Preservation of facial contour during parotidectomy. Otolaryngol Head Neck Surg 104:293, 1991 7. Zoukuan H: An approach to curative effect of large autografts on adipose tissue in special parts with third-degree burns. J Trauma 26:359, 1986 8. Harada T, Inoue T, Harashina T, et al: Dermis-fat graft after parotidectomy to prevent Freys syndrome and the concave deformity. Ann Plast Surg 31:450, 1993 9. Boyce RG, Nuss DW, Kluka EA: The use of autogenous fat, fascia, and nonvascularized muscle grafts in the head and neck. Otoryngol Clin North Am 27:39, 1994 10. Montandon P, Benchaou M, Guyot JP: Modified canal wall-up mastoidectomy with mastoid obliteration for severe chronic otitis media. ORL J Otorhinolaryngol Relat Spec 57:198, 1995 11. Rohrich RJ, Mickel TJ: Frontal sinus obliteration: In search of the ideal autogenous material. Plast Reconstr Surg 95:580, 1995 12. Hanazawa Y, Itoh K, Mabashi T, et al: Closure of oroantral communications using a pedicled buccal fat pad graft. J Oral Maxillofac Surg 53:771, 1995 13. Samman N, Cheung LK, Tideman H: The buccal fat pad in oral reconstruction. IntJ Oral Maxillofac Surg 22:2, 1993 14. Conley JJ, Clairmont AA: Dermal-fat-fascia grafts. Otolaryngol Head Neck Surg 86:641, 1978 15. Wolford LM, Karras S: Autologous fat transplantation around TMJ total joint prostheses: Treatment outcomes. J Oral Maxillofac Surg 55:245, 1997