Study Design: Retrospective cohort study. Objective: To evaluate the clinical efficacy of minimally invasive endoscopic surgery in patients with spinal extradural and intradural-extramedullary tumors. Methods: This was a study of 15 consecutive patients with spinal extradural or intradural-extramedullary tumors up to 2 levels treated by minimal invasive surgery using a full endoscopic visualization and Caspar’s retraction system (for cervical, thoracic, and lumbar tumors) over a 4-year period between January 2015 to April 2019 at a tertiary center. Results: A gross total remove was achieved in all patients (100%), determined by postoperative contrast computed tomography scans and magnetic resonance imaging. There was no postoperative spinal instability. All patients had equal or better neurologic functions after surgery at follow-up. The average preoperative Nurick’s grade mean was 1.9 and the postoperative was 1.1. The average preoperative McCormick’s grade mean was 2.9 versus 1.3 in the postoperative period. Conclusions: Selective extradural or intradural-extramedullary tumors well localized and up to 2 levels can be safely and effectively treated by minimally invasive surgery using a full endoscopic visualization and the Caspar’s retractor. However, there is insufficient evidence to recommend this approach over the classical or other microsurgical approach described.
Object: Brain invasion is unusual in patients with paranasal sinuses cancer. Staging systems do not specify brain invasion extension who has an impact in therapeutic strategy and prognosis. Surgical series of this patient treated by endonasal endoscopic approach are scarce. In this paper, a novel classification and surgical strategy is proposed. Methods: A retrospective review of patients with ethmoidal malignant tumors with brain invasion treated at the National Institute of Oncology and Radiobiology from January 2015 to October 2017 by means endonasal endoscopic surgery was performed. All medical records were reviewed for demographics, diagnoses, presentation, endoscopic approach, reconstructive techniques and clinical outcomes. Pattern of brain invasion was classified in five grades. Chi-squared test, ANOVA test and Kaplan-Meier curves were used. Results: Forty-seven patients (26 males and 21 females) were registered. Mean age was 52.3 years ± 27.0. Only 3 patients presented with neurologic symptoms. Histologic subtypes were squamous cell carcinoma (25 patients), adenocarcinoma (16 patients), and esthesioneuroblastoma (6 patients). Five patients corresponded to Grade I, 39 Grade II and 3 Grade III. The mean surgical time was 351.9 min (±45). The mean blood loss was 704.5 ml (±206). The mean ICU stay was 1.1 (ranging from 1 to 2) days and the hospital stay was 5.3 (ranging from 5 to 7) days. Conclusions: Brain invasion represents a particular therapeutic challenge in patients with malignant nasosinusal tumors. Surgical treatment is possible in some cases, including endonasal endoscopic approach. A stage classification of brain invasion helps to establish an optimal surgical strategy and a prognosis.
Rhabdomyosarcoma is a rare soft tissue malignancy derived from myogenic cells. There is very little literature that provides substantial evidence regarding the outcomes of surgical treatment of parameningeal subtype. Endonasal endoscopic resection offers a faster recovery with minimal morbidity, providing a better life quality and immediately adjuvant treatment. Minimally invasive pericranial flap constitute a good alternative in cases with non-viable mucosal vascularized nasoseptal flap. Multimodal treatment ae essential.
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