BACKGROUND
An intraosseous myxoma is a rare, benign mesenchymal tumor that penetrates the bone. The occurrence of an intraosseous myxoma in the clivus is a unique presentation of the disease.
OBSERVATIONS
The authors discuss the case of a 15-year-old male with a new diagnosis of a primary clival intraosseous myxoma presenting with cranial nerve VI palsy. This is the third documented case of this pathology occurring in the clivus. This patient was successfully treated with endoscopic endonasal resection of the tumor.
LESSONS
Primary clival intraosseous myxomas are extremely rare, but nonetheless it is important to add it to the differential diagnosis of clival masses. This mass has a high risk of recurrence, and prior literature suggests gross total resection may improve chances of progression-free survival. However, further larger studies are needed to provide guidelines regarding proper management of this pathology.
Background:
The endoscopic Endonasal Approach(EEA) is a commonly used technique for resection of sellar,suprasellar and anterior fossa masses. One of the troublesome complications of this technique is cerebrospinal fluid leak. In this study we evaluate the risk factors and consequences of cerebrospinal fluid leak on surgical outcomes.
Methods: The current study is a retrospective single-institution cohort study evaluating patients who underwent EEA for sellar and/or suprasellar masses from July 2017 to March of 2020. Risk factors for intraoperative and postoperative CSF leak were evaluated including, sellar defect size, tumor volume and pathology, age,BMI,prior endoscopic endonasal surgery, lumbar drain placement, nasoseptal and mucosal graft use, year of surgery, and cavernous sinus invasion. Postoperative infection, perioperative antibiotic use and length of stay were also evaluated.
Results:
Our study included 175 patients. Sellar defect size(p=.015) ,intraoperative CSF leak(p<.001), were significantly associated with increased risk of postoperative CSF leak. Patients with nasoseptal flaps were more likely to have a postoperative CSF leak than those with free mucosal grafts(p=.025).Intraoperative CSF leak, Cushing’s Disease and Lumbar Drain placement were associated with an increased length of stay.
Conclusion:
Sellar defect size, intraoperative CSF leak and nasoseptal flap were associated with an increased risk of postoperative CSF leak. Intraoperative CSF Leak, Cushing’s Disease and Lumbar drain placement are all associated with an increased length of stay.
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