Kunio Nishikawa

Surgical results of skull base surgery for the treatment of head and neck malignancies involving skull base: multi-institutional studies on 143 cases in Japan

We analyzed 143 cases of skull base surgery collected from the eight institutions of the Study Group supported by the Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare of Japan. Histologically, the most common type was squamous cell carcinoma (n = 78), which was followed by olfactory neuroblastoma (n = 16) and adenoid cystic carcinoma (n = 16). The most frequent surgical approach was frontal craniotomy (n = 66), followed by front-temporal craniotomy (n = 54) and infratemporal fossa approach (n = 8). For repair of dura matter, fascia lata was used in 37 cases. galeopericranial flap in 35 and temporal muscle fascia in 16. The 5-year survival rate by Kaplan-Meier method of nose and paranasal sinus carcinoma (n = 119) was 48%. As for histological classification, the survival rates were both 65%) in adenoid cystic carcinoma (n = 12) and bone soft tissue malignancy (n = 10), 62% in olfactory neuroblastoma (n = 16), 46% in squamous cell carcinoma (n = 62) and 33% in adenocarcinoma (n = 11). All the three cases of malignant melanoma died within 1 year, so we considered skull base surgery to be contraindicated for this disease. Complications were observed in 62 out of the 143 cases (43%); local infection was most frequent in 29 cases. liquorrhea in 18, abscess in 16, necrosis of the flap and meningitis in ten cases, DIC in four, rupture of the internal carotid artery in two and cerebral thrombosis in one. Death caused directly by surgery was in ten cases (7%). It is important that a multi-center registry be maintained to have a large enough database for comparison of results, and prognosis for each histological entity and further define the role of multidisciplinary treatment.

A histopathological study on the sino-nasal cavity carcinoma invaded to skull base.

頭蓋底, 眼窩, 側頭窩, 翼口蓋窩等に浸潤した鼻・副鼻腔癌に, 頭蓋内外からの合併到達法を用いた頭蓋底手術による一塊切除を施行した。視診上, 十分な安全域をつけて一塊切除したと思われる症例でも, 病理組織診断で切除断端に腫瘍を認めることがある。それ故, 硬組織大切片標本で腫瘍の浸潤様式や進展方向について病理組織学的に検討を加えることが必要である。頭蓋底手術15症例のうち作製可能であった9症例の硬組織大切標本を用いて, 一塊切除における病理組織学的な検討を行い, 若干の知見を得たので報告する。

Familial Occurrence of Congenital Stapes Footplate Fixation

Abstract Congenital stapes footplate fixation is not so common in the clinical otology. The clinical features are the fixation of the stapedial footplate, and the consequent conductive hearing loss with flat curve at the level of 50 to 60 dB in air conduction since birth. Its familial occurrence have never been reported before. The authors found five these cases in one family. All five cases were females, two of whom were sisters and other three were cousins. Their mothers had not particular disturbances in the early stage of pregnancy. The sex‐linked heredity was highly suspected in this familial occurrence. All the cases showed bilateral conductive hearing loss. Tympanotomies on all cases revealed no abnormality of the middle ear cavity, except that all the stapes were not mobile at the footplate in spite of the normal shape. Openings of a small fenestra onto the footplate were performed and teflon piston wire prostheses were used to reconstruct the new conducting route. The excellent improvement of postoperative hearing was gained in all the cases. Furthermore, out of family members another three cases with hearing loss were found. Pathogenesis was discussed in consideration of the developmental process of the stapes and histopathological findings in the previous reports.