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 evaluate the clinical outcome of craniofacial resection for advanced malignant tumors in oral and maxillofacial regions.

METHODSForty-six patients who underwent craniofacial resection for malignancies involving the anterior and middle cranial fossa over a 20-year period between June 1978 and December 1997 at our department were evaluated. Twenty patients received radiation therapy and an adjuvant therapy after the operation. Eleven patients received chemotherapy of various types as an adjuvant therapy.

RESULTSThe 3- and 5-year survival rates were 48.8% (20/41) and 35.1% (13/37), respectively, while the 10-year survival rate was 20% (4/20).

CONCLUSIONSOur results revealed good prospects of using craniofacial resection on patients with advanced malignancies in the oral and maxillofacial regions.

Adolescent ; Adult ; Aged ; Combined Modality Therapy ; Facial Bones ; surgery ; Female ; Humans ; Male ; Maxillary Neoplasms ; surgery ; Middle Aged ; Mouth Neoplasms ; surgery ; Skull ; surgery ; Skull Neoplasms ; surgery

Numerical simulation is one of the most significant methods to predict the temperature distribution in high-intensity focused ultrasound (HIFU) therapy. In this study, the adopted numerical simulation was used based on a transcranial ultrasound therapy model taking a human skull as a reference. The approximation of the Westervelt formula and the Pennes bio-heat conduction equation were applied to the simulation of the transcranial temperature distribution. According to the temperature distribution and the Time Reversal theory, the position of the treatable focal region was corrected and the hot spot existing in the skull was eliminated. Furthermore, the influence of the exposure time, input power and the distance between transducer and skull on the temperature distribution was analyzed. The results showed that the position of the focal region could be corrected and the hot spot was eliminated using the Time Reversal theory without affecting the focus. The focal region above 60 degrees C could be formed at the superficial tis sue located from the skull of 20 mm using the hot spot elimination method and the volume of the focal region increases with the exposure time and the input power in a nonlinear form. When the same volume of the focal region was obtained, the more power was inputted, the less the exposure time was needed. Moreover, the volume of the focal region was influenced by the distance between the transducer and the skull.
Computer Simulation ; High-Intensity Focused Ultrasound Ablation ; Hot Temperature ; Humans ; Neoplasms ; therapy ; Skull

Metastatic tumors in the sellar and parasellar regions are uncommon and rarely detected in clinical practice. We present four cases of sellar and parasellar metastatic tumors, which metastasized from distant organ in one case and extended directly from adjacent structures in three. Common presenting symptoms were cranial neuropathies, headache and facial pain. Invasion into the cavernous sinus was noted in all cases. We report rare cases of sellar and parasellar metastases. Also, we should consider the possibility of metastasis in these regions for patients who showed the above clinical presentations in systemic cancer patients. In extensive diseases, transient symptomatic relief could be obtained by direct surgical management, even in restricted degree.
Adenocarcinoma/therapy ; Adenocarcinoma/radiography ; Adenocarcinoma/pathology* ; Adult ; Breast Neoplasms/radiography ; Breast Neoplasms/pathology* ; Carcinoma, Infiltrating Duct/therapy ; Carcinoma, Infiltrating Duct/radiography ; Carcinoma, Infiltrating Duct/pathology* ; Case Report ; Female ; Human ; Magnetic Resonance Imaging/methods ; Male ; Middle Age ; Nasopharyngeal Neoplasms/therapy ; Nasopharyngeal Neoplasms/radiography ; Nasopharyngeal Neoplasms/pathology* ; Palatal Neoplasms/therapy ; Palatal Neoplasms/radiography ; Palatal Neoplasms/pathology* ; Sella Turcica* ; Skull Neoplasms/therapy ; Skull Neoplasms/secondary* ; Skull Neoplasms/physiopathology

Choroid plexus carcinoma is a rare malignant brain tumor that occurs predominantly in childhood. A 203-day-old infant was admitted to our hospital with macrocephaly and right hemiparesis. The skull protruded diffusely in the left parietal area. Brain magnetic resonance imaging) revealed a huge mass in the left ventricle. We performed an open biopsy and discovered a choroid plexus carcinoma. The tumor bled very easily and hemostasis was difficult. After three cycles of chemotherapy, we resected the entire mass in a staged operation. Chemotherapy enabled us to resect the entire tumor by reducing its size. We report this case to stress the benefits of preoperative chemo-therapy and review the relevant literature.
Biopsy ; Brain ; Brain Neoplasms ; Choroid Plexus* ; Choroid* ; Drug Therapy ; Heart Ventricles ; Hemostasis ; Humans ; Infant* ; Macrocephaly ; Paresis ; Rabeprazole ; Skull

OBJECTIVETo analyze the clinical features and treatment of skull base osteosarcoma.

METHODSThe clinical data of 18 patients with skull base osteosarcoma, who were admitted to the CAMS Cancer Hospital from January 2005 to November 2013, were retrospectively analyzed. The patients were followed up by telephone, outpatient review and other means. Fifteen patients were followed up, 4 cases received surgery only, and 11 cases received surgery with adjuvant chemotherapy and/or radiotherapy. Kaplan-Meier survival curve analysis was used to analyze the clinical data and Log rank method was used for verification.

RESULTSNine patients died among the 15 patients who were followed up for 3-103 months (mean 25.0 months): seven patients died of local recurrence, and two patients died of distant metastasis, and six patients were still alive. Four patients received surgery only, with a median survival time of 25.0 months, and 11 patients received comprehensive treatment, with a median survival time of 47.0 months (P = 0.02). Five patients received sub-total resection, with a mean survival time of 47.0 months, and 10 patients received total resection, with a mean survival time of 45.0 months (P = 0.37). The 1- and 2-year recurrence rates were 46.6% and 68.9%, respectively. The overall 1-, 2-, 3- and 5-year survival rates were 82.4%, 61.8%, 36.0% and 36.0%, respectively, with a median survival time of 30.0 months.

CONCLUSIONSTo compare the long bone and head and neck osteosarcoma with skull base osteosarcoma, the skull base osteosarcoma has a lower total resection rate, a higher recurrence rate, and a poorer prognosis. Radical surgery and comprehensive treatment are appropriate for skull base osteosarcoma.

Bone Neoplasms ; diagnosis ; pathology ; therapy ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Humans ; Kaplan-Meier Estimate ; Neoplasm Recurrence, Local ; Osteosarcoma ; diagnosis ; pathology ; therapy ; Retrospective Studies ; Skull Base ; pathology ; Survival Rate

OBJECTIVETo clarify the clinical features, therapeutic method and outcomes of the primary endodermal sinus tumors (ESTs) in the posterior cranial fossa.

METHODSThe English literatures on EST in the posterior cranial fossa were retrieved from PubMed and reviewed. And a 4-year-old boy diagnosed with EST in our hospital was reported. The clinical manifestations, therapy, pathologic features, and prognosis of these cases were analyzed.

RESULTSOnly seven cases of the ESTs in the posterior cranial fossa were enrolled in this review, including six cases searched from the PubMed and one case from our hospital. Six patients were boy and one patient's gender was not available from the report. Ages ranged from 1 to 5 years (mean 3.14 years). The mean tumor size in our cohort was 4.4 cm. Six cases came from East Asia. Schiller-Duval bodies were found in all seven neoplasms. All tumors were positive for alpha-fetoprotein. The alpha-fetoprotein level in serum was increased to a very high level before therapy and depressed quickly after the effective chemotherapy. The mean follow-up time was 24.4 months (range 5-52 months). Six tumors were totally removed, and four of them recurred. Three cases died including one whose tumor was partially removed.

CONCLUSIONSThe serum alpha-fetoprotein level is well correlated with the severity of the tumor. A combination of operation and chemotherapy might be the effective management for EST in the posterior cranial fossa. The prognosis of extragonadal intracranial EST is poor.

Child, Preschool ; Cranial Fossa, Posterior ; Endodermal Sinus Tumor ; pathology ; therapy ; Female ; Humans ; Infant ; Male ; Skull Neoplasms ; pathology ; therapy ; alpha-Fetoproteins ; analysis

OBJECTIVETo analyze the factors affecting prognosis of the carcinoma arising from nasal and sinonasal inverted papilloma.

METHODSThe clinicopathological data of sixty-two patients treated in our hospital from January 1974 to February 2012 were retrospectively analyzed. Of the 62 cases, 10 were at stage I or II, 24 at stage III, and 28 at stage IV. Twenty-six patients were treated with surgery alone, and 36 with surgery combined with radiation therapy. Kaplan-Meier method and log-rank test were used for the survival analysis.

RESULTSThe overall 5-years survival rate was 39.6%. The 5-years survival rate was 67.5% in the stage I or II patients,51.3% in the stage III patients, and 18.3% in the stage IV patients (P<0.05). The 5-years survival rate was 65.7% in patients who had no surgical history, and 29.9% in patients who had surgery (P<0.05). The 5-year survival rate was 17.6% in the group who relapsed after the treatment, and 49.6% in the non-relapsed patients (P<0.05). The 5-year survival rate was 23.4% in the patients who had involvement of cranial base and (or) orbit, and 47.6% in the patients whose cranial base and (or) orbit were clean (P<0.05). Of the patients at the same stage (III-IV), the 5-year survival rate of patients treated with surgery alone was 32.4%, and those treated with combination therapy was 36.2%(P=0.89). The univariate analysis showed that clinical stage, surgical history before malignization, involvement of the cranial base and (or) orbit organs, and post-operative relapse are significantly correlated to prognosis of the patients (P<0.05 for all). Multivariate analysis showed that age, clinical stage, and previous history of surgery were independent factors affecting the prognosis of the patients. Distant metastasis was the major cause of death, mostly lung metastases.

CONCLUSIONSAge, clinical stage and surgical history are the main factors affecting the prognosis of the patients. The history of recurrence and involvement of cranial base or orbit also play an important role for the prognosis. Distant metastasis is the main cause of death in the patients with carcinoma arising from nasal and sinonasal inverted papilloma.

Carcinoma ; diagnosis ; therapy ; Combined Modality Therapy ; Head and Neck Neoplasms ; Humans ; Lung Neoplasms ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Papilloma, Inverted ; diagnosis ; therapy ; Papillomavirus Infections ; Prognosis ; Retrospective Studies ; Skull Base ; Survival Rate

Adolescent ; Adult ; Aged ; Child ; Endoscopes ; Female ; Humans ; Laser Therapy ; methods ; Male ; Microsurgery ; methods ; Middle Aged ; Prognosis ; Skull Base Neoplasms ; mortality ; pathology ; surgery

OBJECTIVETo investigate the diagnostic value of F-18-fluoro-deoxyglucose positron emission tomography (FDG-PET) for the recurrent or residual nasopharyngeal carcinomas in the skull base area.

METHODSNine post-irradiation nasopharyngeal carcinoma patients did FDG-PET scanning, CT/MRI imaging and underwent nasopharynx and skull base-biopsy under endoscopy. The results of FDG-PET were evaluated and compared with CT/MRI studies and biopsies.

RESULTSIn 9 cases of post-irradiation nasopharyngeal carcinoma, CT/MRI detected 7 recurrent cases and 2 suspected recurrent cases in occipital bone and clivus. All 9 cases had accumulated FDG in nasopharynx and cranial base. A definite diagnosis was made by biopsy, 3 cases were confirmed recurrence, and others 6 cases were proved mucous chronic inflammation and (or) osteoradionecrosis. The accuracy of FDG-PET was 33.3% (3/9), and the false positive rate was 66.7% (6/9).

CONCLUSIONSDiagnosis of recurrent or residual nasopharyngeal carcinomas in the skull base area with FDG-PET had high false-positive rate, final diagnosis must depend on histopathologic examination under endoscopy.

Adult ; Aged ; False Positive Reactions ; Female ; Fluorodeoxyglucose F18 ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnostic imaging ; drug therapy ; radiotherapy ; Positron-Emission Tomography ; methods ; Skull Base ; diagnostic imaging