Combined approaches to the skull base for intracranial extension of tumors via perineural spread can improve patient outcomes

Palejwala, Sheri K.; Barry, Jonnae Y.; Rodriguez, Crystal N.; Parikh, Chandni; Goldstein, Stephen A.; Lemole, Gerald M.

doi:10.1016/j.clineuro.2016.08.029

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…6,20 Recent papers have addressed when and how to combine endoscopic and open procedures. 3,5,14,[21][22][23][24] A recent book chapter provides an excellent overview with practical steps, utilizing Beals' framework for level of approach. 25 We adapt and build upon these concepts to attempt to provide a decision-making process based on ''line-of-sight'' to the tumor and include the role of transmandibular exposure.…”

Section: Selection Of Approach: ''Line-of-sight'' Techniquementioning

confidence: 99%

“…Dr. Ian Jackson made contributions in this area as well, along with his neurosurgical and ENT partners and several international colleagues 6,20 . Recent papers have addressed when and how to combine endoscopic and open procedures 3,5,14,21–24 . A recent book chapter provides an excellent overview with practical steps, utilizing Beals’ framework for level of approach 25…”

Section: Selection Of Approach: “Line-of-sight” Techniquementioning

confidence: 99%

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Transfacial Exposures of the Anterior Skull Base and Cervical Spine: Straightforward “Line-of-Sight” Algorithm for Selection of Approach

Powers

Sachanandani

Chaiyasate

2021

Journal of Craniofacial Surgery

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K ennedy-Williams and colleagues have collaborated in exploring the implications of TCF12 genetic abnormalities and coronal synostosis on intellect and behavior. They note that TCF12 genetic abnormalities, on their own, tend to have more limited effects on functional behavior than other genetic disorders, such as FGFR2 &3, TWIST 1, SMAD 6. Genetic influences in this study were, by design evaluated specifically in syndromic cases. Genetic influences, now in addition, are also are being recognized in nonsyndromic disorders. 1 Genetic influence may be associated with either or both biologic parents, 2 and may take the form of craniosynostosis structural maldevelopment and reduced intellect. 3 In the present report, the authors have limited their analysis, specifically, to only those with TCF12 abnormalities associated with unilateral or bilateral coronal synostosis. Thirty-five patients were operated upon, 29 with a fronto orbital advancement procedure, and the remaining 6 with a myriad of techniques. Of note is, the mean age of primary transcranial surgery was 17 months, (range of 5-123 months). Questions arise as to what neurologic and behavioral sequelae are related to, or influenced by, the timing of surgery, versus those that are related to the genetic abnormality. A breakdown of the patients operated at a younger age, for example, less than 12, or even 6 months of age, versus later, would help clarify the extent of these influences. Although the limited deficits in patients neurologic outcomes are somewhat reassuring, detail would be useful. Conclusions related to eventual neurologic outcomes, also, may be defined as a function of the timing and type of analyses performed. It is known that the earlier assessments of cognition and the behavioral impacts are often less accurate when compared with those at a later age (typically at, at least 6 years or later). The authors have adjusted their timing of analyses, as much as is possible, to address this, but some questions still remain. Due to limitations in the number of patients available in both parent reported outcomes and standardized testing, longer term outcomes could be discerned more accurately at later age. In a condition as uncommon as is seen in the current study, limitations must remain until larger scale and optimally at a later age should be considered.The reader is somewhat reassured that in the longest analysis times show relatively little negative effect on intellect, however, issues related to emotional, hyperactivity, conduct, peer difficulty, and overall stress domains, may limit achievement without significant reductions in IQ. In sum, however, the authors are to be commended for this pioneering study.

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Section: Selection Of Approach: ''Line-of-sight'' Techniquementioning

confidence: 99%

Section: Selection Of Approach: “Line-of-sight” Techniquementioning

confidence: 99%

Transfacial Exposures of the Anterior Skull Base and Cervical Spine: Straightforward “Line-of-Sight” Algorithm for Selection of Approach

Powers

Sachanandani

Chaiyasate

2021

Journal of Craniofacial Surgery

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“…Intracranial extension of PNS deems a patient inoperable because of the risk of tumor seeding into the central nervous system. These patients are often treated with palliative radiation (36) or with surgery performed on a case-bycase basis with the goal of tumor debulking to improve the efficacy of adjuvant therapy and reduce symptoms (37). The 2018 National Comprehensive Cancer Network guidelines recommend postsurgical adjuvant radiation for mucosal head and neck squamous cell carcinoma, salivary gland carcinoma, and melanoma with PNI (38,39), as well for cutaneous squamous cell and basal cell carcinoma with extensive or large-nerve PNI (40,41).…”

Section: Clinical Significancementioning

confidence: 99%

An Imager’s Guide to Perineural Tumor Spread in Head and Neck Cancers: Radiologic Footprints on ¹⁸F-FDG PET, with CT and MRI Correlates

et al. 2018

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Learning Objectives: On successful completion of this activity, participants should be able to (1) describe the neural pathways and basic anatomy of the commonly involved cranial nerves with perineural spread of tumor; (2) recognize the imaging findings of perineural spread in head and neck cancers on functional and anatomic imaging; and (3) explain the definition, pathogenesis, and clinical significance of perineural spread. Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through March 2022. Perineural spread (PNS) refers to tumor growth along large nerves, a macroscopic analog of microscopic perineural invasion. This phenomenon most commonly occurs in the head and neck, but its incidence varies with histologic tumor subtype. PNS results from a complex molecular interplay between tumor cells, nerves, and connective stroma. PNS is clinically underdiagnosed despite its impact on patients' prognosis and management. The role of 18 F-FDG PET in assessment of PNS in head and neck cancer remains to be explored, in contrast to MRI as the established gold standard. In patients with PNS, 18 F-FDG PET shows both abnormality along the course of the involved nerve and muscular changes secondary to denervation. Assessment of PNS on 18 F-FDG PET requires knowledge of relevant neural pathways and can be improved by correlation with anatomic imaging, additional processing of images, and review of clinical context.

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Multiple approaches to a spheno-orbital and deep face meningioma: how I do it

Rennert,

Budohoski,

Mortimer

et al. 2023

Acta Neurochir

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Combined approaches to the skull base for intracranial extension of tumors via perineural spread can improve patient outcomes

Cited by 5 publications

References 13 publications

Transfacial Exposures of the Anterior Skull Base and Cervical Spine: Straightforward “Line-of-Sight” Algorithm for Selection of Approach

Transfacial Exposures of the Anterior Skull Base and Cervical Spine: Straightforward “Line-of-Sight” Algorithm for Selection of Approach

An Imager’s Guide to Perineural Tumor Spread in Head and Neck Cancers: Radiologic Footprints on ¹⁸F-FDG PET, with CT and MRI Correlates

Multiple approaches to a spheno-orbital and deep face meningioma: how I do it

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Combined approaches to the skull base for intracranial extension of tumors via perineural spread can improve patient outcomes

Cited by 5 publications

References 13 publications

Transfacial Exposures of the Anterior Skull Base and Cervical Spine: Straightforward “Line-of-Sight” Algorithm for Selection of Approach

Transfacial Exposures of the Anterior Skull Base and Cervical Spine: Straightforward “Line-of-Sight” Algorithm for Selection of Approach

An Imager’s Guide to Perineural Tumor Spread in Head and Neck Cancers: Radiologic Footprints on 18F-FDG PET, with CT and MRI Correlates

Multiple approaches to a spheno-orbital and deep face meningioma: how I do it

Contact Info

Product

Resources

About

An Imager’s Guide to Perineural Tumor Spread in Head and Neck Cancers: Radiologic Footprints on ¹⁸F-FDG PET, with CT and MRI Correlates