Michał Tymowski

Medial sphenoid ridge meningiomas: early and long-term results of surgical removal using the fronto-temporo-orbito-zygomatic approach

BACKGROUND AND PURPOSE The fronto-temporo-orbito-zygomatic approach (FTOZA) is an alternative to the pte-rional approach in surgical resection of meningiomas of the medial part of the lesser wing of the sphenoid bone. The purpose of this study is to present our results of treatment of these meningiomas using the FTOZA. MATERIAL AND METHODS Thirty patients (19 women, 11 men) with a central skull base tumour were included in the study. The neurological status of the patients was assessed before and after surgery as well as at the conclusion of treatment. The approximate volume of the operated tumour, its relation to large blood vessels, cranial nerves and brainstem, as well as consistency and vascularisation were assessed. RESULTS The symptom duration ranged from 1 to 36 months (median: 6 months). Impaired visual acuity was the predominant symptom in 27.5% of patients. Less frequent symptoms included paresis/paralysis of the third cranial nerve, headache, psychoorganic syndrome and epilepsy. Approximate volume of the tumours ranged from 5 to 212 mL (median: 63 mL). Total or subtotal resection was achieved in 77% of patients. The postoperative performance status improved in 16.5%, did not change in 52.8% and deteriorated in 26.4% of patients. One (3.3%) patient died after the surgery. CONCLUSION The FTOZA is a useful technique for removal of tumours expanding superiorly to the middle cranial fossa base without significant compression of the brain. Ability to remove tumours through the described approach decreases as the degree of infiltration of the clivus increases.

Dostęp do otworu szyjnego i jego otoczenia – analiza techniki operacyjnej w oparciu o symulacje na zwłokach

Streszczenie Celem pracy jest przedstawienie poszczegolnych etapow dostepu do otworu szyjnego i jego otoczenia. Przeprowadzono 11 symulacji dostepu na nieutrwalonych zwlokach ludzkich, u ktorych nie podejrzewano procesow patologicznych w zakresie glowy i szyi. Kolejne fazy symulacji byly dokumentowane fotograficznie oraz schematami. Punktem wyjścia dla omawianego dostepu jest resekcja cześci sutkowej i tylnych partii cześci skalistej kości skroniowej, jak rowniez wyrostka i guzka szyjnego. Pozwala to na penetracje otworu szyjnego od tylu. Poszerzanie dostepu umozliwia penetracje otworu szyjnego od gory i od przodu. Dostep do otworu szyjnego stanowi powtarzalną metode penetracji tego otworu i jego otoczenia. Dostep ten jest szczegolnie przydatny w leczeniu operacyjnym guzow nowotworowych rozrastających sie w piramidzie kości skroniowej, otoczeniu odcinka skalistego tetnicy szyjnej wewnetrznej, kącie mostowo-mozdzkowym, dole podskroniowym i peczku naczyniowo-nerwowym szyi.

Early and long-term results of the treatment of jugular paragangliomas using different ranges of surgical approach

BACKGROUND AND PURPOSE The applied approach to the jugular foramen is a combination of the juxtacondylar approach with the subtemporal fossa approach type A. The purpose of this study is to present our results of treatment of jugular paragangliomas using the aforementioned approach. MATERIAL AND METHODS Twenty-one patients (15 women, 6 men) with jugular paragangliomas were included in the study. The neurological status of the patients was assessed before and after surgery as well as at the conclusion of treatment. The approximate volume of the tumour, its relation to large blood vessels, cranial nerves and brainstem, as well as consistency and vascularity were also assessed. RESULTS The duration of symptoms ranged from 3 to 74 months. In 86% of patients hearing loss was the predominant symptom. The less frequent symptoms included pulsatile tinnitus in the head, dysphagia and dizziness. Approximate volume of the tumours ranged from 2 to 109 cm3. A gross total resection was achieved in 71.5% of patients. The postoperative performance status improved in 38% of patients, did not change in 38% and deteriorated in 24% of patients. CONCLUSIONS A proper selection of the range of the approach to jugular foramen paragangliomas based on their topography and volume reduces perioperative injury without negative consequences for the radicality of the resection.

Dostęp czołowo-skroniowo-oczodołowo-jarzmowy – analiza techniki operacyjnej na podstawie symulacji na zwłokach

Streszczenie Celem pracy bylo przedstawienie poszczegolnych etapow dostepu czolowo-skroniowo-oczodolowo-jarzmowego (DCSOJ). Przeprowadzono dwie symulacje dostepu na nieutrwalonych zwlokach ludzkich, u ktorych nie podejrzewano procesow patologicznych w zakresie glowy i szyi. Kolejne fazy symulacji byly dokumentowane fotograficznie oraz za pomocą schematow. Punktem wyjścia dla DCSOJ jest kraniotomia pterionalna i osteotomia obejmująca obramowanie oczodolu, trzon kości jarzmowej i luk jarzmowy. Plat pterionalny i wymienione wyzej struktury stanowią jeden blok kostny. W uzasadnionych przypadkach mozliwe jest tez czasowe usuniecie gornej i bocznej ściany oczodolu. Wazne uzupelnienie dostepu stanowi szerokie rozchylenie szczeliny bocznej mozgu. Dostep czolowo-skroniowo-oczodolowo-jarzmowy stanowi powtarzalną metode penetracji środkowego dolu czaszki i obszarow z nim graniczących. Jest szczegolnie przydatny w leczeniu operacyjnym guzow nowotworowych wyzej wymienionych okolic anatomicznych, jak rowniez wad naczyniowych tylnej cześci kola tetniczego mozgu.This paper presents consecutive stages of the fronto-temporo-orbito-zygomatic approach (FTOZA). Two simulations of FTOZA were performed on non-fixed human cadavers without any known pathologies in the head and neck. The consecutive stages of the procedure were documented with photographs and schematic diagrams. The starting point for FTOZA is a pterional craniotomy and osteotomy including the orbital rim, body of the zygomatic bone and zygomatic arch. In justified cases it is also possible to temporarily remove the upper and lateral walls of the orbit. Wide drawing apart of the Sylvian fissure is an important supplement of the approach. The fronto-temporo-orbito-zygomatic approach is a reproducible technique, which provides surgical penetration of the middle cranial fossa and related regions. This approach is particularly useful in the treatment of tumours of the above-mentioned anatomical areas as well as vascular malformation of the posterior part of the arterial circle of the brain.

Direct and remote outcome after treatment of tumours involving the subtemporal fossa and related structures with the extended subtemporal approach

BACKGROUND AND PURPOSE The aim of the study was to present our results of the surgical treatment of subtemporal fossa tumours and surrounding regions using the extended subtemporal approach. MATERIAL AND METHODS Twenty-five patients (10 women, 15 men) with subtemporal fossa tumours were included in the study. The neurological and performance status of the patients were assessed before and after surgery as well as at the conclu-sion of treatment. The approximate volume of the operated tumour, its relation to large blood vessels and cranial nerves, as well as consistency and vascularisation were assessed. RESULTS The symptom duration ranged from 2 to 80 months (mean: 14 months). In 44% of patients, headache was the predominant symptom. Less frequent symptoms were: paralysis of the abducent nerve and disturbances of the trigeminal nerve. Approximate volume of the tumours ranged from 13 to 169 cm3 (mean: 66 cm3). The most frequent histological diagnosis was meningioma (16%), followed by angiofibroma, neurinoma and adenocystic carcinoma (12%). Total or subtotal resection was achieved in 80% of patients. CONCLUSIONS The extended subtemporal approach allows for the removal of tumours of the subtemporal fossa and surrounding regions. This approach also allows one to remove tumours expanding in the regions surrounding the subtemporal fossa only. In such cases the subtemporal fossa constitutes the way of the surgical approach.

Neuropsychological assessment of patients undergoing surgery due to low-grade glioma involving the supplementary motor area

OBJECTIVE The aim of the study was to establish the usefulness of various neuropsychological tests in patients undergoing surgery due to low-grade glioma (LGG) involving supplementary motor area (SMA). PATIENTS AND METHODS 21 patients diagnosed with LGG involving the SMA underwent, before and after surgery, screening tests (Mini Mental State Examination - MMSE, Montreal Cognitive Assessment - MoCA and Frontal Assessment Battery - FAB), tests to assess language functions (Addenbrooks Cognitive Examination-III - ACE-III, phonetic fluency tests and semantic fluency tests), tests to assess memory functions (Reys 15-word test - RAVLT and Diagnostic Test for Brain Damage by Hillers- DCS), tests to assess executive functions (Wisconsin Card Sorting Test - WCST, Ruff Figural Fluency Test - RFFT and Trail Making Test). RESULTS Before surgery, in the screening tests the patients obtained below normal scores in the MoCA test only. After surgery, the scores of such tests were significantly worse than the scores before surgery, while the MMSE test scores continued to be within the normal range. In phonetic and semantic fluency tests, the patients obtained worse scores, both before and after surgery. The differences in the test scores between the two periods, i.e. before and after surgery, were statistically significant. Although the patients obtained worse scores both before and after surgery in the ACE III test, the differences in the test scores were not statistically significant. The scores obtained in all tests assessing the executive and memory functions before and after surgery were within the normal range. The scores in such tests (except the WCCT) dropped significantly after surgery. CONCLUSIONS Patients diagnosed with LGG involving the SMA reveal the impairment of cognitive functions, in particular language functions. After surgery, a significant impairment of all elementary cognitive functions, such as attention, memory, language and executive functions and complex cognitive functions, occurs. The most sensitive tests to detect cognitive disorders, executive dysfunctions and speech disturbances in patients undergoing surgery due to glioma include the MoCA, FAB and Phonetic and Semantic Fluency Tests.

Endoscopic approach to the resection of adenoid cystic carcinoma of paranasal sinuses and nasal cavity: case report and own experience

AbstractAdenoid cystic carcinoma (ACC) is a rare malignant tumor that might occur in nasal cavity and paranasal sinuses. It is characteristic for poor prognosis, especially the solid histopathological subtype of the tumor. ACC might spread along nerves and fascias and it is usually diagnosed at advanced stage. Computed tomography and magnetic resonance imaging together with fine-needle biopsy are the gold standards in the diagnostic procedure of the cancer. Surgery with adjuvant therapy are the most common methods of treatment. Among the surgical approaches, the functional endonasal sinus surgery seems to be the most appropriate and favorable way of treatment. In the study, the authors present a case of a 62-year-old patient with T4aN0M0 ACC tumor treated endoscopically at the Department of Laryngology and ENT Oncology, WSS No. 5 in Sosnowiec. The authors indicate the usefulness of FESS procedure in the treatment of malignancies of nasal cavity and paranasal sinuses. They also review the recent publications on endonasal versus open approach in similar cases. In conclusions, the authors favor endonasal approach as a mini-invasive method of surgical treatment of ACC of paranasal sinuses that results in satisfactory oncological outcome and high quality of patient’s life.