Endoscopy ; methods ; Humans ; Nose ; Perioperative Period ; Skull Base ; surgery

Endoscopy ; methods ; Humans ; Nose ; Perioperative Period ; Skull Base ; surgery

OBJECTIVETo describe the early experience of resecting skull base tumor via a radiofrequency ablation-assisted endoscopic endonasal approach, investigate the safety and feasibility of the technique, and to assess its preliminary treatment outcomes.

METHODSTen patients with skull base tumor who were admitted between September and November 2013 were operated on through a radiofrequency ablation-assisted endoscopic endonasal approach in Xuanwu hospital of capital medical university. In this study, the operative technique was described, and the degree of resection, complications and the early clinical outcomes was presented.

RESULTSComplete resection was achieved in all patients using this technique. No patient in the series experienced a new neurological deficit, cerebrospinal fluid leak or meningitis after surgery. No recurrence and death related to skull base tumor were found in the follow-up period (16-18 months). The volume of intraoperative blood loss was 60 to 1 000 ml (medium 285 ml). The duration of operations was from 42 to 150 min (medium 95 min). The hospital stay was from 14 to 19 d (average 15.7 d).

CONCLUSIONOur limited experience indicates that this technique is feasible and safe for the complete resection of some skull base tumors in selected cases.

Blood Loss, Surgical ; Catheter Ablation ; Cerebrospinal Fluid Leak ; Endoscopy ; methods ; Humans ; Neoplasm Recurrence, Local ; Nose ; Skull Base ; pathology ; surgery ; Skull Base Neoplasms ; surgery ; Treatment Outcome

OBJECTIVETo explore the upstream signal transduction mechanism responsible for the decrease of the ratio of the two glucocorticoid receptor (GR) subunits (GRα and GRβ) in nasal polyp in vitro.

METHODSThe GRα/GRβ decrease cell model was established by lipopolysaccharide (LPS)-induced human nasal epithelia (HNE) of nasal polyp in vitro. Changes in the protein and mRNA expression of GRα, GRβ and the key enzymes in the p38MAPK, ERK and JNK signal pathways were measured, respectively, before and after being induced with different doses of LPS and specific inhibitors of p38MAPK, JNK and ERK. SPSS 16.0 software (Analysis of variance, ANOVA) was used to analyze the data.

RESULTSWith the LPS induction, the GRα/GRβ ratio declined in both a time-dependent manner and a concentration-dependent manner in HNE, which demonstrated the successful establishment of a GRα/GRβ decrease model in vitro. After cultured HNE were induced with the same set of LPS, the p38MAPK, ERK and JNK signal pathways were also activated. The mRNA expression of p38MAPK and JNK in each LPS-induced group (17.14 ± 1.50, 22.34 ± 2.78, 30.12 ± 1.07; 2.51 ± 0.13, 3.79 ± 0.67, 4.41 ± 0.83; 25.62 ± 1.77, 31.33 ± 1.97, 37.25 ± 2.46) was significantly higher than that (7.39 ± 0.31, 2.04 ± 0.34, 2.38 ± 0.35) in the control group (χ² value was 15.347, 18.331, 14.671, all P < 0.01). Either a specific inhibitor (SB203580) of the p38MAPK pathway or a specific inhibitor (SP600125) of the JNK pathway increased the GRα/GRβ ratio at the meantime of inhibiting their pathways. SB203580 exhibited a much stronger increase effect on GRα/GRβ ratio than SP600125. The specific inhibitors (PD98059) of ERK had no influence on the expression of GR isoforms.

CONCLUSIONSThe above results demonstrated that the decrease of GRα/GRβ ratio in HNE induced by LPS in vitro is mediated through the p38MAPK and JNK signal pathways. It is possible to improve the treatment effect of GC resistance in nasal polyp by targeting these specific signal pathways.

Cells, Cultured ; Epithelial Cells ; metabolism ; Extracellular Signal-Regulated MAP Kinases ; metabolism ; Humans ; JNK Mitogen-Activated Protein Kinases ; metabolism ; MAP Kinase Signaling System ; Nasal Mucosa ; cytology ; pathology ; Nasal Polyps ; metabolism ; RNA, Messenger ; Receptors, Glucocorticoid ; metabolism ; p38 Mitogen-Activated Protein Kinases ; metabolism

OBJECTIVETo investigate the optimal treatment strategy with endoscopic endonasal approach (EEA) and the prognostic factors of anterior and middle skull base neuroendocrine carcinoma (NEC).

METHODFourteen patients with anterior and/or middle skull base NEC, admitted to Xuanwu Hospital between November 2006 and June 2014, were reviewed retrospectively. All patients were treated with EEA. Four cases received surgery onle. Two cases received radiotherapy and one case received chemotherapy before surgery. One case received adjuvant radiotherapy and 6 cases received chemoradiation after surgery. Survival analysis was performed by Kaplan-Meier method.

RESULTComplete resection was achieved in 12 cases, while subtotal resection was achieved in 2 cases. There was no surgical complication. Three cases were diagnosed as well-differentiated NEC, 2 cases were moderately differentiated NEC and 9 cases were small cell NEC. The patients were followed up for 6 to 97 months. Three patients died and one patient lost to follow-up. The 5-year survival rate in this group was 64.3%.

CONCLUSIONPure EEA or EEA combined with multimodality therapy, which was applied depending on the pathological type, was a feasible treatment strategy for anterior and middle skull base NEC.

Carcinoma, Neuroendocrine ; surgery ; therapy ; Combined Modality Therapy ; Endoscopy ; methods ; Humans ; Nose ; Radiotherapy, Adjuvant ; Retrospective Studies ; Skull Base ; pathology ; surgery ; Skull Base Neoplasms ; surgery ; therapy ; Survival Analysis ; Survival Rate

OBJECTIVETo investigate the feasibility of image navigation technology in endoscopic skull base surgery.

METHODSThis study consisted of 75 patients who underwent the endoscopic operations with the help of the image navigation system by the same surgeon between March 2010 and March 2013. The time to prepair image navigation system, identifying anatomical structure, complications, tumor resection, and follow-up results were analysed.

RESULTSThe application of image navigation technology in the endoscopic skull base operations was both safe and reliable for delineation of tumors and identification of vital structures hidden or encased by the tumors, such as internal carotid artery, optic canal, comb, saddle bottom, foramen rotundum, foramen ovale, foramen lacerum, jugular foramen, cerebral dura mater. The tumor was removed completely, subtotally, or partially. All patients were successfully registered with accuracy, and the preoperative time was 8-15 minutes for preparation, 11 minutes in average. The target error was less than or equal to 1.5 mm. With guidance of the image navigation system, all patients were successfully operated on without serious complication. There were 13 cases with anterior skull base tumor, all were removed completely. There were 28 cases with sella region tumor, 21 totally resected, 7 subtotally resected. There were 20 cases with petroclival region tumor, 12 totally resected, 5 subtotally resected, 3 partially resected. There were 14 cases with pterygopalatine fossa and/or infratemporal fossa region tumor, 11 totally resected, 3 subtotally resected. All patients were available for follow-up (mean = 26 months) except 6 cases.

CONCLUSIONImage navigation technology can be applied in endoscopic skull base operations with advantages of accurately locating, clearly marking, significantly decreasing incidence of complications, and maximally removing the lesions.

Carotid Artery, Internal ; Endoscopy ; Humans ; Pterygopalatine Fossa ; Skull Base ; surgery ; Temporal Bone