Intracranial epidermoid tumors are rare, potentially curable, benign lesions that are sometimes associated with perioperative complications, and tend to recur if not completely removed. Histologically benign epidermoid tumors may also develop into highly malignant tumors. This study evaluated on 28 cases of intracranial epidermoid tumor treated over a 13-year period by radical resection with microneurosurgical techniques. The majority of patients underwent computed tomography and/or magnetic resonance imaging within the first 24 hours postoperatively to confirm the results of surgery. Radical surgical resection was achieved in 21 of the 28 cases, and there was no operative mortality. The most common postoperative complication was transient paresis of various cranial nerves. During a mean follow up of 6 years, only one tumor became malignant. Radical surgical resection should be the goal in treating these benign lesions, but if not possible, every effort should be made to minimize the amount of tumor tissue that remains.
The SPVC emptied into the superior petrosal sinus (SPS) within a distance of 1 cm from the midpoint of the Meckel cave. The patterns of drainage of the SPVC were classified into three groups. Type I emptied into the SPS above and lateral to the boundaries of the IAM. The most common type, Type II, emptied between the lateral limit of the trigeminal nerve at the Meckel cave and the medial limit of the facial nerve at the IAM, within an area of approximately 13 mm. Type III emptied into the SPS above or medial to the Meckel cave. The ideal SPVC for a subtemporal transtentorial approach (with or without anterior extradural petrosectomy) seems to be a Type I. In SPVC Type III and those Type II cases in which the SPVC is located near the Meckel cave, the amount of working space is significantly limited in a subtemporal transtentorial approach. In contrast, the ideal type of SPVC for a retrosigmoid suprameatal approach would be a Type III, and the SPVC must be divided in the majority of Type I and II cases for a satisfactory surgical exposure along the Meckel cave and middle fossa dura. The proposed modified classification system and its effect on the surgical exposure may aid in planning the approach directed along the petrous apex and may reduce the probability of venous complications.
The objective of this study is to determine the incidence and degree of anterior clinoid process pneumatization, in addition highlighting to their clinical significance. Multidetector-row CT scans of the skull base were reviewed in 648 subjects between 2007 and 2008. The presence of pneumatized anterior clinoid process and its degree were studied and documented. These data were statistically analyzed. Pneumatization of the ACP was found in 62 of 648 patients (9.6%) including 32 (51.6%) men and 30 (48.4%) women. The age of these patients ranged from 21 to 82 years (mean, 41 +/- 15.7 years). Pneumatization of the ACP occurred only on the left side in 14 cases (22.6%), only on the right side in 11 cases (17.7%), and bilaterally in 37 patients (59.7%). ACP pneumatization Type I, in which less than 50% of the ACP is pneumatized, was found in 47 of 124 sides (38%), Type II, in which more than 50% but not totally pneumatized ACP, was found in 28 of 124 sides (22.6%), and Type III, in which the ACP is totally pneumatized, was found in 22 of 124 sides (17.7%). The incidence of Type I in the general population was 6.6%, Type II was 3.5%, and Type III was 2.5%. Radiologically recognizing the degree of ACP pneumatization is important in decreasing the incidence of surgical complications during anterior clinoidectomy. Proper intraoperative management can be undertaken with special attention to the new classification.
Our anatomic study offered the facility to learn the endoscopic anatomy of the orbital apex and the medial wall of the orbita and understand the appropriate approaches (such as medial orbitotomy and optic canal decompression) to some pathologic lesions of this region. With skilled and experienced hands, it can superimpose many traditional orbital approaches with minimal invasiveness and less postoperative complications.
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