Large anterior skull base lesions presenting with obstructive sleep apnea

Murali, Raj; Douyon, Philippe; Omeis, Ibrahim

doi:10.3171/jns.2004.101.1.0163

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…Obstructive sleep apnea (OSA) is a common comorbid condition in various skull base tumors, including functioning pituitary adenomas . Among the functioning pituitary adenomas, 34% and 46% of patients with prolactinoma and corticotropinoma were found to have OSA, respectively .…”

mentioning

confidence: 99%

Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model

Chitguppi

Rimmer

Garcia

et al. 2019

Int Forum Allergy Rhinol

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Background: Although recent guidelines for obstructive sleep apnea recommend early postoperative use of continuous positive airway pressure (CPAP) a er endonasal skull base surgery, the time of initiation of CPAP is unclear. In this study we used a novel, previously validated cadaveric model to analyze the pressures delivered to the cranial base and evaluate the effectiveness of various repair techniques to withstand positive pressure. Methods:Skull base defects were surgically created in 3 fresh human cadaver heads and repaired using 3 commonly used repair techniques: (1) Surgicel TM onlay; (2) dural substitute underlay with dural sealant onlay; and (3) dural substitute underlay with nasoseptal flap onlay with dural sealant. Pressure microsensors were placed in the sphenoid sinus and sella, both proximal and distal to the repair, respectively. The effectiveness of each repair technique against various CPAP pressure se ings (5-20 cm H 2 O) was analyzed.Results: Approximately 79%-95% of positive pressure administered reached the sphenoid sinus. Sellar pressure levels varied significantly across the 3 repair techniques and were lowest a er the third technique. "Breach" points (CPAP se ings at which sellar repair was violated) were lowest for the first group. All 3 specimens showed a breach a er the first repair technique. For the second repair technique, only a single breach was created in 1 specimen at 20 cm H 2 O. No breaches were created in the third group. Conclusion: Different skull base repair techniques have varying ability to withstand CPAP. Both second and third repair techniques performed in a nearly similar fashion with regard to their ability to withstand positive pressure ventilation. C 2019 ARS-AAOA, LLC. How to Cite this Article: Chitguppi C, Rimmer RA, Garcia HG, et al. Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model. Int Forum Allergy Rhinol. 2019;9:795-803.

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confidence: 99%

Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model

Chitguppi

Rimmer

Garcia

et al. 2019

Int Forum Allergy Rhinol

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“…Three patients had undergone sleep surgery proceduresone each of adenotonsillectomy, 11 septoplasty 12 and tracheostomy. 13 At the time of diagnosis of the causative neoplasm, 42 (53.2%) were visible on trans-oral examination, and 79 (100%) were visible on head and neck examination including FNE.…”

Section: Resultsmentioning

confidence: 98%

“…The majority of included patients had their neoplasms treated surgically, with 57 patients (72.2%) treated with surgery alone. 9-12,14-61 Two patients (2.5%) were treated with both surgery and radiotherapy, 13,62 and one patient (1.3%) treated with each of surgery and chemotherapy 63 and surgery and chemoradiotherapy. 64 Furthermore, three patients (3.8%) declined surgery [65][66][67] and one patient (1.3%) was not medically fit for surgery.…”

Section: Resultsmentioning

confidence: 99%

Scoping review of head and neck neoplasms presenting with obstructive sleep apnoea: the importance of flexible nasendoscopy

Moore

Cardemil

Hayward

et al. 2020

ANZ Journal of Surgery

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Background Obstructive sleep apnoea (OSA) can be caused by neoplasms involving the upper aerodigestive tract. Currently, many of these patients have this diagnosis missed, as most adults diagnosed with OSA do not undergo adequate head and neck examination including flexible nasendoscopy. We performed a review of the literature to shed light on this phenomenon and outline the pathologies and issues surrounding this sub‐population of patients diagnosed with OSA. Methods A scoping review of the literature was conducted on head and neck neoplasms presenting with OSA. Data were extracted on demographics, clinical presentation, histopathology, treatment and patient outcomes. Results Sixty‐seven articles were included, describing 79 patients. Mean age was 45.8 years, and 77.2% were male. Symptoms of OSA were present for an average of 29.2 months before a diagnosis of causative neoplasm was made. Forty‐two different benign and malignant histopathological entities were reported. At diagnosis, the causative pathology of 100% of patients was visible on head and neck examination including flexible nasendoscopy, while only 53.2% were visible on trans‐oral examination. One‐third of patients had commenced inappropriate treatment for OSA, including three who had undergone sleep surgical procedures. The majority of patients were treated with surgery alone (72.2%). Conclusion Although rare, neoplasms of the upper aerodigestive tract should be considered as a cause of OSA, especially in patients experiencing other symptoms in addition to the typical symptoms of OSA. They should particularly be considered in patients with comparatively lower body mass index or those with worsening OSA without an apparent cause identified.

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“…The possibility of an intranasal encephalocoele must be considered when examining adult patients with nasal polyps. Nasopharyngeal endoscopy should also be performed, as large skull base lesions sometimes present only with a nasopharyngeal mass causing obstructive sleep apnoea 22 . An entirely atypical case of intranasal encephalocoele with no external swelling may sometimes present diagnostic difficulties 23 .…”

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confidence: 99%

Frontoethmoidal encephalomeningocoele with colpocephaly: case report and clinical review

2007

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Frontoethmoidal encephalomeningocoele is a rare congenital disease in which an intracranial mass protrudes through a midline defect from the anterior cranial fossa into the facial skeleton. The condition affects patients in South East Asian countries, such as Thailand, Burma, Malaysia and Indonesia, with frequency of 1 in 5000. The pathogenesis of encephalocoeles may be regarded as a 'late' neurulation defect during the fourth gestational week. We present a case of frontoethmoidal encephalomeningocoele with corpus callosal agenesis and colpocephaly; this may well be the first report of this combination. The patient had a bulging mass in the middle frontonasal area, with broadening of the nasal bridge and hypertelorism. Computed tomography scans delineated the skull defect and associated brain anomalies. A one-stage, combined transfacial-transcranial approach, correctional procedure was performed. We present here a discussion of the findings, with special reference to the condition's pathogenesis, morphological classification and evolving surgical treatments. Early diagnosis and referral, involving multidisciplinary teamwork, are of paramount importance because of the distorting influence of the extruding mass on facial growth.

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Large anterior skull base lesions presenting with obstructive sleep apnea

Cited by 5 publications

References 11 publications

Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model

Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model

Scoping review of head and neck neoplasms presenting with obstructive sleep apnoea: the importance of flexible nasendoscopy

Frontoethmoidal encephalomeningocoele with colpocephaly: case report and clinical review

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