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Index
Cover
MedOne Access Information
Title Page
Copyright
Dedication
Contents
Videos
Preface
Acknowledgments
Contributors
Section I: General Principles
1 Surgical Anatomy of the Cranial Base: Transcranial and Endonasal Approaches
1.1 Cranial Base Anatomy from the Transcranial Perspective
1.1.1 Anterior Cranial Base
1.1.2 Middle Cranial Base
1.1.3 Posterior Skull Base
1.2 Cranial Base Anatomy from the Endonasal Perspective
1.2.1 The Sphenoid Sinus
1.2.2 The Pituitary Gland and Suprasellar Space
1.2.3 Anterior Cranial Base
1.2.4 The Cavernous Sinus
1.2.5 The Clival and Petroclival Regions
1.2.6 Subdivision of the Ventral Clivus
1.2.7 Petroclival Region and Jugular Foramen
1.3 Conclusion
2 The Pathology of Tumors and Tumorlike Lesions of the Skull Base
2.1 Introduction
2.2 Biopsies and Frozen Sections
2.3 Nonneoplastic and Congenital Lesions
2.3.1 Encephalocele
2.3.2 Nasal Glial Heterotopia
2.3.3 Respiratory Epithelial Adenomatoid Hamartoma
2.3.4 Seromucinous Hamartomas
2.3.5 Ectopic Pituitary Adenoma
2.3.6 Inflammatory Pseudotumor
2.3.7 Sinonasal Polyps
2.3.8 Sinonasal (Schneiderian) Papilloma
2.3.9 Human Papillomavirus
2.3.10 Exophytic Sinonasal (Schneiderian) Papilloma
2.3.11 Cylindrical Cell Papilloma
2.3.12 Inverted Sinonasal (Schneiderian) Papilloma
2.4 Inflammatory and Granulomatous Conditions
2.4.1 Allergic Fungal Sinusitis
2.4.2 Invasive Fungal Sinusitis
2.4.3 Rhinoscleroma
2.4.4 Granulomatosis with Polyangiitis
2.4.5 Histiocytosis-X (Eosinophilic Granuloma)
2.4.6 Myospherulosis
2.5 Malignant Epithelial Neoplasms
2.5.1 Squamous Carcinoma
2.5.2 Sinonasal Undifferentiated Carcinoma
2.5.3 SMARCB1 (INI1)-Deficient Sinonasal Carcinoma
2.5.4 Nasopharyngeal Carcinoma
2.5.5 Nuclear Protein in Testis Carcinoma
2.5.6 Sinonasal Adenocarcinoma
2.5.7 Salivary-Type Adenocarcinomas
2.5.8 Human Papillomavirus–Related Carcinoma with Adenoid Cystic–like Features
2.5.9 Nonsalivary Gland Adenocarcinoma
2.6 Mesenchymal Tumors
2.6.1 Benign Tumors
2.6.2 Lobular Capillary Hemangioma (Pyogenic Granuloma)
2.6.3 Glomangiopericytoma (Sinonasal Hemangiopericytoma)
2.6.4 Nasopharyngeal Angiofibroma
2.6.5 Myxoma
2.6.6 PEComa (Perivascular Epithelioid Cell Tumor)
2.7 Malignant Neoplasms
2.7.1 Rhabdomyosarcoma
2.7.2 Fibrosarcoma
2.7.3 Synovial Sarcoma
2.7.4 Hemangioendothelioma/Epithelioid Hemangioendothelioma
2.7.5 Angiosarcoma
2.7.6 Chordoma
2.7.7 Chondrosarcoma
2.7.8 Osteosarcoma
2.8 Neurogenic Neoplasms
2.8.1 Olfactory Neuroblastoma
2.8.2 Ewing Family Tumors
2.8.3 Adamantinoma-like Ewing Family Tumors
2.9 Neuroendocrine Neoplasms
2.9.1 Neuroendocrine Carcinoma
2.9.2 Carcinoid and Atypical Carcinoid Tumors
2.9.3 Large Cell Neuroendocrine Carcinoma
2.9.4 Small Cell Neuroendocrine Carcinoma
2.9.5 Paraganglioma
2.9.6 Melanoma
2.9.7 Melanotic Neuroectodermal Tumor of Infancy
2.9.8 Biphenotypic Sinonasal Sarcoma
2.9.9 Desmoplastic Small Round Cell Tumor
2.10 Lymphoproliferative Disorders
2.10.1 Sinus Histiocytosis with Massive Lymphadenopathy (Rosai-Dorfman Disease)
2.10.2 Lymphoma
2.11 Miscellaneous
2.11.1 Teratocarcinosarcoma
2.11.2 Meningioma
2.11.3 Ameloblastoma
2.12 Metastatic Neoplasms
3 Imaging of Skull Base Neoplasms
3.1 Introduction
3.2 Selection of Imaging Modality
3.3 Anterior Cranial Base
3.4 Central Skull Base
3.5 Posterior Cranial Base
3.6 Marrow Space
3.7 Conclusion
4 Head, Neck, and Neuro-otologic Assessment of Patients with Skull Base Tumors
4.1 Introduction
4.2 Physical Examination
4.2.1 Head, Scalp, and Skin Exams
4.2.2 Eye, Orbit, and Eye Movement Exams
4.2.3 Ear Exams
4.2.4 Nose and Nasopharynx Exams
4.2.5 Oral Cavity and Oropharynx Exams
4.2.6 Exams of the Larynx
4.2.7 Neck, Parotid, and Thyroid Exams
4.2.8 Exams of the Cranial Nerves
4.2.9 Gait and Balance Testing
4.3 Audiometric, Vestibular, and Electromyographic Tests
4.3.1 Basic Audiometry
4.3.2 Auditory Brainstem Responses
4.3.3 Otoacoustic Emissions
4.3.4 Electronystagmography
4.3.5 Rotatory Chair Testing
4.3.6 Computerized Dynamic Posturography
4.3.7 Vestibular Evoked Potentials
4.4 Conclusion
5 Anesthesia and Intraoperative Monitoring of Patients with Skull Base Tumors
5.1 Introduction
5.2 Patient Positioning
5.2.1 Supine Position
5.2.2 Prone Position
5.2.3 Park-Bench Position
5.2.4 Lateral Position
5.2.5 Sitting Position
5.3 Complications during Skull Base Procedures
5.3.1 Venous Air Embolism
5.3.2 Pneumocephalus
5.3.3 Macroglossia/Facial Swelling
5.3.4 Cerebrovascular Complications
5.3.5 Arrhythmias
5.3.6 Blood Loss
5.3.7 Peripheral Nerve/Cranial Nerve Injuries
5.4 Monitoring and Anesthesia
5.5 Anesthesia Concerns with Vascular Lesions
5.6 Anesthesia and Neuroprotection
5.7 Anesthesia for Endoscopic Skull Base Surgery
5.8 Postoperative Management
5.9 Conclusion
6 Endoscopic Endonasal Skull Base Surgery
6.1 Principles of Endoscopic Endonasal Surgery
6.2 Indications
6.3 Classification of Endonasal Approaches
6.3.1 Sagittal Plane Modules
6.3.2 Coronal Plane
6.4 Reconstruction
6.5 Limitations
6.5.1 Anatomical
6.5.2 Training
6.6 Complications
6.7 Conclusion
7 Reconstruction of Skull Base Defects
7.1 Introduction
7.2 Goals of Reconstruction
7.3 Types of Defects
7.4 Patient Selection
7.5 Endoscopic Techniques
7.5.1 Acellular and Cellular Grafts
7.5.2 Nasoseptal Flap
7.5.3 Posterior Pedicled Inferior Turbinate Flap
7.5.4 Posterior Pedicled Middle Turbinate Flap
7.6 Endoscopic-Assisted and Open Techniques
7.6.1 Endoscopic-Assisted Pericranial Flap
7.6.2 Temporoparietal Fascial Flap
7.6.3 Palatal Flap
7.6.4 Microvascular Free Flap
7.7 Multilayer Bolster and Closure
7.8 Immediate Postoperative Care
7.9 Lumbar Drains
7.10 Outcomes and Postoperative Complications
7.11 Conclusion
8 Radiotherapy for Skull Base Tumors: Principles and Techniques
8.1 Introduction
8.2 History and Principles of Radiation Oncology
8.2.1 Target Volumes
8.2.2 Alpha/Beta Ratio
8.2.3 Linear Energy Transfer and Relative Biological Effectiveness
8.2.4 Fractionation and Sparing Effect
8.2.5 Altered Fractionation
8.2.6 Biologically Effective Dose
8.2.7 Bragg Peak
8.2.8 Biologically Equivalent Dose
8.2.9 Conformal Radiotherapy
8.2.10 Stereotactic Radiation Therapy
8.2.11 Image-Guided Radiation Therapy
8.3 Principles of Radiation Physics and Radiobiology
8.3.1 Electromagnetic Radiation
8.3.2 Particle Radiation
8.3.3 Interaction with Ionizing Radiation
8.3.4 Radiation Cell Killing
8.3.5 Cell Survival Curve
8.3.6 Linear Quadratic Model
8.3.7 α/β Ratio
8.3.8 Fractionation and the Four Rs of Radiobiology
8.4 Radiobiology of Hypofractionation and Skull Base Tumors
8.4.1 Normal Tissue Tolerance of Critical Organs
8.5 Modern Radiation Therapy Techniques for Skull Base Tumors
8.5.1 Advances in Photon Therapy
8.5.2 Advances in Particle Therapy
8.5.3 Advances in Radiotherapy Imaging
8.5.4 Stereotactic Radiation Therapy
8.5.5 Target Delineation
8.5.6 Immobilization, Image Guidance, and Real-Time Motion Tracking
8.5.7 Machine Capability and Stereotactic Radiosurgery Platforms
8.6 Conclusion
9 Clinical Applications of Radiotherapy for Skull Base Tumors
9.1 Introduction
9.2 Normal Tissue Constraints of Critical Organs of the Skull Base
9.3 Pituitary Adenoma
9.3.1 Growth Hormone–Secreting Adenoma
9.3.2 PRL-Secreting Adenoma
9.3.3 Adrenocorticotrophic Hormone–Secreting Adenoma
9.3.4 Stereotactic Radiosurgery for Pituitary Adenoma
9.3.5 Fractionated Stereotactic Radiotherapy
9.4 Acoustic Schwannoma
9.4.1 Modern Stereotactic Radiosurgery Series for Acoustic Schwannoma
9.4.2 Fractionated Radiotherapy and Fractionated Stereotactic Radiotherapy for Acoustic Schwannoma
9.4.3 Long-Term Complications after Acoustic Schwannoma Irradiation
9.5 Meningioma
9.5.1 Conformal Radiotherapy for Skull Base Meningioma
9.5.2 Stereotactic Radiosurgery for Meningioma
9.5.3 Proton Beam Therapy for Skull Base Meningioma
9.6 Craniopharyngioma
9.6.1 Fractionated Radiotherapy for Craniopharyngioma
9.6.2 SRS for Craniopharyngioma
9.7 Paraganglioma
9.7.1 Radiotherapy for Paraganglioma
9.7.2 Fractionated Radiotherapy for Paraganglioma
9.7.3 Stereotactic Radiosurgery and Fractionated Stereotactic Radiotherapy for Paraganglioma
9.8 Chordomas
9.8.1 Radiotherapy for Chordoma
9.8.2 Proton Therapy for Chordoma
9.8.3 Carbon Ion Therapy for Chordoma
9.9 Chondrosarcomas
9.9.1 Radiotherapy for Chondrosarcoma
9.9.2 Particle Therapy for Chondrosarcoma
9.10 Nasopharyngeal Carcinoma
9.10.1 Radiotherapy for Stage T3 to T4 Nasopharyngeal Carcinoma
9.10.2 Proton Therapy for Nasopharyngeal Carcinoma
9.10.3 Proton Therapy for Adenoid Cystic Carcinoma of the Nasopharynx
9.11 Paranasal Sinus Tumor
9.11.1 Squamous Cell Carcinomas
9.11.2 Sinonasal Mucosal Melanoma
9.11.3 Adenoid Cystic Carcinoma
9.11.4 Esthesioneuroblastoma
9.11.5 Sinonasal Undifferentiated Carcinoma
9.12 Skull Base Re-irradiation
9.12.1 Stereotactic Radiotherapy for Skull Base Re-irradiation
9.13 Conclusion
10 Management of Benign Skull Base Tumors in Neuro-oncology: Systemic Cytotoxic and Targeted Therapies
10.1 Introduction
10.2 WHO Grade I Meningioma
10.2.1 Introduction and Treatment
10.2.2 Pathogenesis, Genetics, Molecular, and Cellular Biology
10.2.3 Systemic Therapies
10.3 Chordomas
10.3.1 Introduction to Chordomas and Treatment Overview
10.3.2 Pathogenesis, Genetics, and Molecular and Cellular Pathways
10.3.3 Systemic Therapies
10.4 Craniopharyngioma
10.4.1 Introduction to Craniopharyngiomas and Treatment Overview
10.4.2 Pathogenesis, Genetics, Molecular and Cellular Overview
10.4.3 Systemic Therapies
10.5 Giant Cell Tumor of the Bone
10.5.1 Introduction to Giant Cell Tumor of the Bone and Treatment Overview
10.5.2 Pathogenesis, Genetics, and Molecular and Cellular Pathways
10.5.3 Systemic Therapies
10.6 Conclusion
11 Rehabilitation of Speech and Swallowing of Patients with Tumors of the Skull Base
11.1 Introduction
11.2 Normal Neurophysiology of Swallowing and Communication
11.2.1 Swallowing Neurophysiology
11.2.2 Communication Neurophysiology
11.3 Common Disorders of Swallowing
11.3.1 Anterior Skull Base
11.3.2 Middle Skull Base
11.3.3 Posterior Skull Base
11.4 Common Disorders of Communication
11.4.1 Anterior Skull Base
11.4.2 Middle and Posterior Skull Base
11.5 Assessment and Intervention in Swallowing and Communication Disorders
11.5.1 Clinical Assessment
11.5.2 Instrumental Assessments
11.5.3 Communication Examination
11.5.4 Treatment
11.6 Conclusion
11.7 Case Report 1
11.8 Case Report 2
12 Neuropsychological Assessment of Patients with Skull Base Tumors
12.1 Introduction
12.2 Neurocognitive Impairment Associated with Skull Base Tumors
12.2.1 Tumor-Related Neurocognitive Impairment
12.2.2 Treatment-Related Neurocognitive Impairment
12.3 Affective Distress in Patients Who Have Skull Base Tumors
12.4 Neuropsychological Assessment of Patients Who Have Skull Base Tumors
12.4.1 Clinical Interview
12.4.2 Neurocognitive Test Selection
12.4.3 Mood and Quality of Life Assessment
12.4.4 Care Path
12.5 Management of Neurocognitive and Affective Symptoms in Skull Base Tumors
12.6 Conclusion
13 Cerebrovascular Management in Skull Base Tumors
13.1 Introduction
13.2 Preoperative Imaging
13.3 Preoperative Embolization
13.4 Management of Arterial Encasement
13.4.1 Operative Technique in a Tumor with Subarachnoid Encasement
13.4.2 Decision to Bypass in Cases of Vascular Occlusion or Sacrifice
13.4.3 Choice of Bypass Grafts
13.4.4 Anesthesia, Monitoring, and Preparation
13.4.5 High-Flow (Replacement) Bypass Technique
13.4.6 Low-/Moderate-Flow (Augmentation) Bypass Techniques
13.4.7 Staged Operations
13.4.8 Postoperative Management
13.4.9 Results
13.5 Preservation and Reconstruction of Veins and Sinuses
13.5.1 Venous Reconstruction
13.5.2 Cerebral Venous Sinuses
13.5.3 Intraoperative Sinus Occlusion Test
13.5.4 Reconstruction of Venous Sinuses
13.5.5 Results for Tumors Involving Cerebral Veins and Venous Sinuses
13.5.6 Vasospasm after Cranial Base Tumor Resection
13.6 Case Study 1
13.7 Case Study 2
13.8 Case Study 3
13.9 Case Study 4
13.10 Case Study 5
14 Quality of Life and Measures of Outcome for Patients with Skull Base Tumors
14.1 Introduction
14.2 Challenges in Assessing Quality of Life in Patients Who Have Skull Base Tumors
14.3 Symptom-Specific Quality of Life and Functional Outcomes Following Skull Base Surgery
14.3.1 Nasal Outcomes
14.3.2 Visual Outcomes
14.3.3 Endocrine Outcomes
14.3.4 Neurologic Outcomes
14.4 Disease-Specific Quality of Life Instruments for Skull Base Pathology
14.5 Quality of Life Following Treatment of Skull Base Tumors
14.5.1 Open Surgical Approaches
14.5.2 Endoscopic Endonasal Surgical Approaches
14.5.3 Endoscopic versus Open Surgical Approaches
14.5.4 Radiotherapy
14.6 Conclusion
15 Pediatric Skull Base Surgery
15.1 Pathology
15.1.1 Benign Lesions
15.1.2 Malignant Lesions
15.1.3 Cytogenetic Variations
15.2 Principles of Pediatric Skull Base Surgery
15.2.1 Surgical Techniques
15.2.2 Pediatric Skull Base Reconstruction
15.2.3 Potential Complications
15.3 Conclusion
Section II: Site-Specific Considerations
16 Surgical Management of Tumors of the Nasal Cavity, Paranasal Sinuses, Orbit, and Anterior Skull Base
16.1 Introduction
16.2 Surgical Anatomy
16.2.1 Nasal Cavity
16.2.2 Maxillary Sinus
16.2.3 Ethmoid Sinus
16.2.4 Frontal Sinus
16.2.5 Sphenoid Sinus
16.2.6 Infratemporal Fossa
16.2.7 Pterygopalatine Fossa
16.2.8 Anterior Cranial Fossa
16.2.9 Orbit
16.3 Regional Pathology and Differential Diagnosis
16.3.1 Tumors of the Nasal Cavity and Paranasal Sinuses
16.3.2 Tumors of the Orbit
16.4 Clinical Assessment
16.4.1 History and Clinical Examination
16.5 Imaging
16.5.1 Indications
16.5.2 Imaging Modalities
16.6 Biopsy
16.6.1 Nasal Cavity and Paranasal Sinuses
16.6.2 Orbit
16.7 Preoperative Preparation
16.8 Surgery
16.8.1 Indications and Contraindications
16.8.2 Surgical Principles
16.8.3 Surgical Approach
16.8.4 Extent of Resection
16.9 Outcomes and Prognosis
16.10 Conclusion
17 Nasopharyngeal Carcinoma
17.1 Introduction
17.2 Surgical Anatomy
17.3 Regional Pathology and Differential Diagnosis
17.4 Clinical Assessment
17.5 Diagnostic Imaging
17.6 Preoperative Preparation
17.7 Surgical Technique
17.8 Positioning
17.9 Incision
17.10 Soft Tissue Dissection
17.11 Bony Dissection and Osteotomies
17.12 Tumor Resection
17.13 Reconstruction
17.14 Closure
17.15 Postoperative Care
17.16 Complications and Their Avoidance
17.16.1 Complications during the Operation
17.16.2 Postoperative Complications
17.17 Follow-up and Rehabilitation
17.18 Conclusion
18 Clival Tumors
18.1 Introduction
18.2 Surgical Anatomy
18.3 Diagnostic Imaging, Regional Pathology, and Differential Diagnosis
18.4 Clinical Assessment
18.5 Surgical Management
18.6 Transsphenoidal (Microscopic) Approach
18.7 Transsphenoethmoidal Approach
18.8 Transoral–Transpalatal
18.9 Transmaxillary Approaches
18.10 Transmandibular, Circumglossal, Retropharyngeal, Transpalatal Approach to Clivus and Upper Cervical Spine
18.11 Extended Transbasal Approach
18.12 Transpetrous Approaches
18.13 Endonasal Endoscopic Transclival/Transpterygoid Approach
18.13.1 Positioning/Preprocedure Planning
18.13.2 Sinonasal Dissection
18.13.3 Clival Window/Resection
18.13.4 Reconstruction
18.14 Transcondylar Approach
18.15 Anterolateral Transcondylar Approach
18.15.1 Positioning and Incision
18.15.2 Soft Tissue Dissection
18.15.3 Bony Dissection and Osteotomies
18.15.4 Tumor Resection
18.15.5 Reconstruction and Closure
18.16 Posterolateral Transcondylar Approach
18.16.1 Positioning and Incision
18.16.2 Soft Tissue Dissection
18.16.3 Bony Dissection and Osteotomies
18.16.4 Tumor Resection
18.16.5 Reconstruction and Closure
18.16.6 Postoperative Care and Follow-up
19 Tumors of the Infratemporal Fossa
19.1 Introduction
19.2 Surgical Anatomy
19.3 Regional Pathology and Differential Diagnosis
19.4 Clinical Assessment
19.5 Diagnostic Imaging
19.6 Preoperative Preparation
19.7 Surgical Technique
19.7.1 Positioning
19.7.2 Incision
19.7.3 Soft Tissue Dissection
19.7.4 Bony Dissection and Osteotomies
19.7.5 Tumor Resection
19.7.6 Reconstruction
19.7.7 Closure
19.8 Postoperative Care
19.9 Complications and Their Avoidance
19.10 Follow-up and Rehabilitation
19.11 Conclusion
20 Tumors of the Parapharyngeal Space
20.1 Surgical Anatomy
20.2 Regional Pathology and Differential Diagnosis
20.2.1 Salivary Gland Neoplasms
20.2.2 Neurogenic Tumors
20.2.3 Miscellaneous Tumors
20.3 Clinical Assessment
20.4 Diagnostic Imaging
20.5 Preoperative Preparation
20.6 Surgical Technique
20.6.1 Positioning
20.6.2 Incision
20.6.3 Soft Tissue Dissection
20.6.4 Bony Dissection and Osteotomies
20.6.5 Tumor Resection
20.6.6 Closure
20.7 Postoperative Care
20.8 Complications and Avoidance
20.9 Follow-up and Rehabilitation
21 Tumors of the Temporal Bone
21.1 Introduction
21.2 Surgical Anatomy
21.3 Regional Pathology and Differential Diagnosis
21.4 Clinical Assessment
21.5 Diagnostic Imaging
21.6 Preoperative Preparation
21.7 Surgical Technique: Benign Tumors
21.8 Surgical Technique: Malignant Tumors
21.8.1 Operative Preparation and Positioning
21.8.2 Incisions
21.8.3 Bony Dissection and Osteotomies
21.8.4 Soft Tissue Dissection
21.8.5 Reconstruction
21.8.6 Postoperative Care
21.8.7 Complications and Their Avoidance
21.8.8 Follow-up and Rehabilitation
21.9 Conclusion
22 The Evaluation and Management of Sellar Tumors
22.1 Introduction
22.2 Surgical Anatomy
22.2.1 Nasal Cavity
22.2.2 Sphenoid Sinus
22.2.3 Sellar and Parasellar Regions
22.3 Regional Pathology and Differential Diagnosis
22.3.1 Tumors of Pituitary Origin
22.3.2 Tumors of Nonpituitary Origin
22.3.3 Cyst, Hamartomas, and Malformations of the Sellar Region
22.4 Clinical Assessment
22.4.1 Pituitary Hypersecretion
22.4.2 Hypopituitarism
22.4.3 Neurologic Symptoms Secondary to Mass Effect
22.5 Diagnostic Imaging
22.6 Preoperative Preparation
22.7 Surgical Technique
22.7.1 Positioning
22.7.2 Nasal Preparation
22.7.3 Soft Tissue Dissection
22.7.4 Sphenoidotomy and Sellar Entry
22.7.5 Tumor Removal
22.7.6 Reconstruction and Closure
22.8 Postoperative Care
22.9 Complications and Their Avoidance
22.9.1 Sinonasal Complications
22.9.2 Neurologic Complications
22.9.3 Endocrine-Related Complications
22.9.4 Vascular Complications
22.9.5 Cerebrospinal Fluid Leak
22.9.6 Infectious Complications
22.10 Follow-up and Rehabilitation
22.11 Conclusion
23 Tumors of the Cavernous Sinus and Parasellar Space
23.1 History
23.2 Surgical Anatomy
23.3 Regional Pathology and Differential Diagnosis
23.3.1 Meningioma
23.3.2 Trigeminal Schwannoma
23.4 Clinical Assessment
23.5 Diagnostic Imaging
23.6 Preoperative Preparation
23.7 Surgical Technique
23.7.1 Surface Landmarks
23.7.2 Selection of the Approach: Building Block Concept
23.7.3 Positioning
23.7.4 Execution of the Approach
23.8 Tumor Resection
23.9 Closure
23.10 Postoperative Care
23.11 Complications and Their Avoidance
23.12 Follow-up and Rehabilitation
23.13 Conclusion
24 Tumors of the Petrous Apex
24.1 Introduction
24.2 Surgical Anatomy
24.2.1 Regional Pathology and Differential Diagnosis
24.2.2 The Most Frequent Petrous Apex Lesions
24.3 Clinical Assessment
24.3.1 Diagnostic Imaging
24.3.2 Preoperative Preparation
24.3.3 Surgical Approaches
24.4 Translabyrinthine Approach
24.4.1 Indications
24.4.2 Surgical Technique
24.5 Middle Fossa Approach
24.5.1 Indications
24.5.2 Surgical Technique
24.6 Endoscopic Endonasal Approach
24.6.1 Indications
24.6.2 Surgical Technique
24.7 Retrosigmoid Approach
24.7.1 Indications
24.7.2 Surgical Technique
24.8 Presigmoid (Retrolabyrinthine) Approach
24.8.1 Indications
24.8.2 Surgical Technique
24.9 Craniocervical Approach
24.9.1 Indications
24.9.2 Surgical Technique
24.10 Temporal Bone Resection
24.10.1 Indications
24.10.2 Surgical Technique
24.10.3 Postoperative Care
24.10.4 Complications and Avoidance
25 Tumors of the Cerebellopontine Angle
25.1 Introduction
25.2 Imaging
25.2.1 Computed Tomography
25.2.2 Magnetic Resonance Imaging
25.3 Surgical Anatomy
25.4 Treatment Considerations
25.5 Approaches
25.5.1 Retrosigmoid Approach
25.5.2 Translabyrinthine Approach
25.5.3 Middle Fossa Approach
25.6 Complication Avoidance
26 Tumors of the Jugular Foramen
26.1 Anatomical Background
26.2 Regional Pathology and Differential Diagnosis
26.3 Glomus Jugulare Tumors
26.3.1 Pathology
26.3.2 Clinical Presentation
26.3.3 Appearance on Diagnostic Imaging
26.3.4 Preoperative Preparation
26.3.5 Surgical Approach
26.3.6 Postoperative Care
26.3.7 Reconstruction
26.3.8 Results
26.3.9 Other Treatments
26.3.10 Complications
26.3.11 Follow-up and Rehabilitation
26.4 Schwannomas
26.4.1 Pathology
26.4.2 Clinical Presentation
26.4.3 Appearance on Diagnostic Imaging
26.4.4 Preoperative Preparation
26.4.5 Surgical Approach
26.4.6 Postoperative Course
26.4.7 Results
26.4.8 Other Treatments
26.5 Meningiomas
26.5.1 Pathology
26.5.2 Clinical Presentation
26.5.3 Appearance on Diagnostic Imaging
26.5.4 Preoperative Preparation
26.5.5 Surgical Approach
26.5.6 Results
26.5.7 Other Treatments
27 Tumors of the Craniovertebral Junction
27.1 Introduction
27.2 Surgical Anatomy
27.3 Regional Pathology and Differential Diagnosis
27.4 Clinical Assessment
27.5 Diagnostic Imaging
27.6 Preoperative Preparation
27.7 Surgical Technique
27.7.1 Posterior Midline Approach
27.7.2 Far Lateral Approach
27.7.3 Anterolateral Approach
27.7.4 Transoral Approach
27.7.5 Surgical Stabilization
27.8 Postoperative Care
27.9 Complications and Their Avoidance
27.10 Follow-up and Rehabilitation
27.11 Conclusion
28 Tumors of the Orbit
28.1 Introduction
28.2 Osteology
28.3 Regional Pathology and Differential Diagnosis
28.4 Clinical Assessment
28.5 Diagnostic Imaging
28.6 Preoperative Preparation
28.7 Surgical Technique
28.7.1 Extraorbital Transcranial Approaches
28.7.2 Extracranial Transorbital Approaches
28.8 Postoperative Care
28.9 Complications and Their Avoidance
28.10 Conclusion
Section III: Tumor-Specific Considerations
29 Squamous Cell Carcinoma of the Nasal Cavity and Paranasal Sinuses
29.1 Epidemiology
29.2 Histopathology
29.3 Disease Spread
29.3.1 Local Spread
29.3.2 Perineural Spread
29.3.3 Regional Metastases
29.3.4 Distant Metastases
29.3.5 Staging
29.4 Treatment
29.4.1 Surgery
29.4.2 Management of the Neck
29.4.3 Radiation Therapy
29.4.4 Chemotherapy
29.4.5 Outcome, Prognosis, and Tumor Biology
30 Nonsquamous Cell Carcinoma of the Nasal Cavity and Paranasal Sinuses
30.1 Introduction
30.2 Adenocarcinoma
30.2.1 Incidence and Epidemiology
30.2.2 Pathology
30.2.3 Clinical Features
30.2.4 Treatment
30.2.5 Outcome and Prognosis
30.3 Salivary Gland Carcinomas
30.3.1 Adenoid Cystic Carcinoma
30.3.2 Non–Adenoid Cystic Carcinoma Salivary Tumors
30.4 Sinonasal Undifferentiated Carcinoma and Neuroendocrine Carcinoma
30.4.1 Incidence and Epidemiology
30.4.2 Pathology
30.4.3 Clinical Features
30.4.4 Treatment
30.4.5 Outcome and Prognosis
30.5 Conclusion
31 Esthesioneuroblastoma
31.1 Incidence and Epidemiology
31.2 Pathology
31.3 Staging
31.4 Treatment
31.4.1 Clinical Features
31.4.2 Imaging
31.4.3 Treatment
31.4.4 Surgery
31.4.5 Radiotherapy
31.4.6 Chemotherapy
31.5 Outcome and Prognosis
31.6 Conclusion
32 Melanoma of the Nasal Cavity and Paranasal Sinuses
32.1 Introduction
32.2 Incidence and Epidemiology
32.3 Pathology
32.4 Clinical Presentation and Findings
32.5 Staging
32.6 Treatment
32.6.1 Surgery
32.6.2 Radiation
32.6.3 Chemotherapy, Immunotherapy, and Checkpoint Inhibitors
32.7 Outcome and Prognosis
32.8 Conclusion
33 Sarcomas of the Skull Base
33.1 Incidence and Epidemiology
33.2 Pathology
33.3 Staging
33.4 Treatment
33.4.1 Surgery
33.4.2 Radiation
33.4.3 Chemotherapy
33.4.4 Doxorubicin
33.4.5 Gemcitabine and Docetaxel
33.4.6 Trabectedin
33.4.7 Eribulin
33.4.8 Pazopanib
33.5 Disease-Specific Considerations
33.5.1 Osteosarcoma
33.5.2 Rhabdomyosarcoma
33.5.3 Solitary Fibrous Tumors
33.6 Conclusion
34 Angiofibromas and Other Vascular Tumors of the Skull Base
34.1 Introduction
34.2 Incidence and Epidemiology
34.3 Pathology
34.3.1 Angiofibroma
34.3.2 Other Vascular Tumors
34.4 Staging
34.5 Treatment
34.5.1 Surgery
34.5.2 Radiation Therapy
34.5.3 Medical Therapy
34.6 Outcome and Prognosis
34.7 Conclusion
35 Chordomas and Chondrosarcomas of the Skull Base
35.1 Introduction
35.2 Epidemiology
35.3 Pathology
35.3.1 Chordomas
35.3.2 Chondrosarcomas
35.4 Staging
35.5 Treatment
35.5.1 Surgery
35.5.2 Radiation
35.5.3 Chemotherapy
35.5.4 Outcome and Prognosis
35.6 Conclusion
36 Meningiomas
36.1 Incidence/Epidemiology
36.2 Etiology
36.2.1 Trauma
36.2.2 Radiation
36.2.3 Infection
36.3 Genetics
36.3.1 Familial Meningioma Syndromes
36.3.2 Chromosomal Abnormalities
36.3.3 Next-Generation Sequencing and NF2 Wild Type Mutations
36.3.4 Gene Sequencing for Prognosis
36.3.5 Genetic Underpinnings of Meningioma Development
36.4 Tumor Biology
36.4.1 Growth Factors
36.4.2 Sex Steroid Receptors
36.4.3 Somatostatin Receptors
36.4.4 Growth Hormone Receptors
36.5 Pathology
36.5.1 WHO Grade I
36.5.2 WHO Grade II
36.5.3 WHO Grade III
36.5.4 Immunohistochemistry
36.6 Treatment
36.6.1 Surgery
36.6.2 Radiation
36.6.3 Chemotherapy
36.6.4 Hormone Therapy
36.6.5 Growth Factor Receptor Inhibitors
36.6.6 Immunotherapy
36.6.7 Targeted Molecular Therapy
36.6.8 Viral Oncolytic Therapy
36.7 Asymptomatic Meningioma
37 Schwannomas of the Skull Base
37.1 Introduction
37.2 Incidence and Epidemiology
37.3 Pathology
37.3.1 Neurofibromatosis Type 2
37.3.2 Mosaicism
37.3.3 Schwannomatosis
37.4 Staging and Presentation
37.4.1 Vestibular Schwannoma
37.4.2 Trigeminal Schwannoma
37.4.3 Facial Schwannoma
37.4.4 Jugular Foramen Schwannoma
37.4.5 Hypoglossal Schwannoma
37.5 Treatment and Outcomes
37.5.1 Vestibular Schwannoma Management
37.5.2 Management of Vestibular Schwannoma in NF2
37.5.3 Management of Trigeminal Schwannoma
37.5.4 Management of Facial Schwannomas
37.5.5 Management of Jugular Foramen Schwanommas
37.5.6 Management of Hypoglossal Schwannomas
38 Paragangliomas of the Head and Neck
38.1 Introduction
38.2 Incidence and Epidemiology
38.2.1 Genetics of Head and Neck Paragangliomas
38.2.2 Malignant Paraganglioma
38.3 Pathology
38.4 Staging
38.5 Treatment
38.5.1 Observation
38.5.2 Surgery
38.5.3 Radiotherapy
38.6 Outcome and Prognosis
38.7 Conclusion
39 Pituitary Adenomas
39.1 Introduction
39.2 Prevalence, Incidence, and Epidemiology
39.3 Pathology
39.3.1 Classification
39.3.2 World Health Organization Grading
39.3.3 Pathogenesis and Biomarkers of Tumor Aggressiveness
39.4 Clinical Presentation, Diagnostic Work-up, and Remission Criteria
39.4.1 Pituitary Incidentaloma and Nonfunctional Pituitary Adenoma
39.4.2 Acromegaly
39.4.3 Cushing’s Disease
39.4.4 Prolactinoma
39.4.5 Thyrotropinoma
39.4.6 Pituitary Apoplexy
39.5 Treatment
39.5.1 Conservative Management
39.5.2 Surgery
39.5.3 Medical Therapy
39.5.4 Radiation Therapy
39.5.5 Chemotherapy
39.6 Pituitary Adenoma in Pregnancy
39.7 Outcome and Prognosis
39.7.1 Acromegaly
39.7.2 Cushing’s Disease
39.7.3 Prolactinoma
39.7.4 Thyrotropinoma
39.7.5 Pituitary Apoplexy and Nonfunctional Pituitary Adenoma
39.7.6 Follow-up Surveillance Protocol
39.8 Conclusion
40 Craniopharyngiomas
40.1 Introduction
40.2 Incidence and Epidemiology
40.3 Pathology
40.4 Staging
40.5 Preoperative Assessment
40.5.1 Clinical Assessment
40.5.2 Radiographic Assessment
40.6 Postoperative Considerations
40.7 Treatment
40.7.1 Management of Hydrocephalus
40.7.2 Perioperative Endocrine Management
40.7.3 Management of Tumor-Related Cysts
40.7.4 Presence of Calcifications
40.7.5 Relationship to Surrounding Structures
40.7.6 Degree of Lateral Extension
40.8 Surgical Approaches
40.8.1 Transcranial Approaches
40.8.2 Endoscopic Approach
40.9 Adjuvant Therapies
40.9.1 Radiation
40.9.2 Intracavitary Radiation
40.9.3 Chemotherapy
40.9.4 Targeted Therapies
40.10 Outcomes and Prognosis
40.10.1 Comparison of Surgical Approaches
40.10.2 Overall Survival
40.10.3 Morbidities Associated with Surgical Intervention
40.10.4 Overall Risk of Recurrence
40.10.5 Adjuvant Therapy
40.10.6 Management of Recurrence
40.11 Conclusion
41 Epidermoids, Dermoids, and Other Cysts of the Skull Base
41.1 Introduction
41.2 Epidermoids
41.2.1 Incidence and Epidemiology
41.2.2 Embryology
41.2.3 Pathology
41.2.4 Clinical Manifestations
41.2.5 Radiology
41.2.6 Treatment
41.2.7 Outcome and Prognosis
41.3 Dermoids
41.3.1 Incidence and Epidemiology
41.3.2 Embryology
41.3.3 Pathology
41.3.4 Clinical Manifestations
41.3.5 Radiology
41.3.6 Treatment
41.3.7 Outcome and Prognosis
41.4 Cholesterol Granulomas
41.4.1 Incidence and Epidemiology
41.4.2 Pathophysiology
41.4.3 Pathology
41.4.4 Clinical Manifestations
41.4.5 Radiology
41.4.6 Treatment
41.4.7 Outcome and Prognosis
41.5 Arachnoid Cysts
41.5.1 Incidence and Epidemiology
41.5.2 Embryology and Pathophysiology
41.5.3 Pathology
41.5.4 Classification
41.5.5 Clinical Manifestations
41.5.6 Radiology
41.5.7 Treatment
41.5.8 Outcome and Prognosis
42 Fibro-Osseous Lesions of the Skull Base
42.1 Introduction
42.2 Illustrative Case
42.3 Incidence and Epidemiology
42.4 Pathology
42.4.1 Gene Mutation
42.4.2 Histologic Findings
42.4.3 Associated Endocrinopathies
42.4.4 Pain Pathophysiology
42.5 Nonsurgical Management
42.6 Surgical Management
42.6.1 Restoration of Facial Aesthetics
42.6.2 Optic Canal Involvement
42.6.3 Control of Secondary Lesions
42.7 Outcomes and Prognosis
42.8 Secondary Disorders
42.9 Conclusion
Index
Additional MedOne Access Information
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