Somtochi Okafor, Jameel Muzaffar, David Jang, Ivan El Sayed, Ralph Abi Hachem
{"title":"Nasopharyngeal Carcinoma: Case Presentation and Literature Review of Treatment Innovation with Immunotherapy.","authors":"Somtochi Okafor, Jameel Muzaffar, David Jang, Ivan El Sayed, Ralph Abi Hachem","doi":"10.1055/s-0043-1774333","DOIUrl":"10.1055/s-0043-1774333","url":null,"abstract":"<p><p>Nasopharyngeal carcinoma (NPC), a rare head and neck malignancy, arises from the epithelial lining of nasopharyngeal mucosa. The confluence of various risk factors, such as latent Epstein-Barr virus infection, genetic susceptibility, smoking, alcohol consumption, and high nitrosamine diet, is thought to contribute to NPC pathogenesis. Radiation therapy serves as the mainstay of treatment for early stage while concurrent chemotherapy and radiation are the basis of treatment for locoregional advanced disease with overall 80% five-year survival rate. Recurrent or metastatic disease pose treatment challenges as reirradiation, repeat cycles of chemotherapy, and surgery follow with high likelihood of treatment toxicity or postoperative morbidities. Typically reserved for nonresectable recurrent or metastatic disease, immunotherapy serves as novel treatment for NPC. NPC tumor microenvironment predominated by a dense infiltrate of immune cells hosts an ideal target for immunotherapy. Several clinical trials have investigated the efficacy of anti-programmed cell death protein 1 antibodies such as pembrolizumab, nivolumab, and camrelizumab with promising results. Treatment of recurrent and metastatic NPC remains a challenge; however, the advent of immunotherapy has provided additional options and potential for preventative and therapeutic measures.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"84 3","pages":"e113-e115"},"PeriodicalIF":0.5,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natasha L Frontera, Julio Rosado-Philippi, Francisco Del Valle Díaz, Alejandra Santiago Díaz, Adriana Vázquez Medina, Arnaldo Figueroa, Natalia González, Gustavo Pradilla, Tomas Garzón, Julio Rodríguez, Luisam Tarrats, Miguel Mayol Del Valle
{"title":"TransOrbital NeuroEndoscopic Surgery for Biopsy of the Left Cavernous Sinus: A Literature Review, Case Report, and Cadaveric Proof of Concept.","authors":"Natasha L Frontera, Julio Rosado-Philippi, Francisco Del Valle Díaz, Alejandra Santiago Díaz, Adriana Vázquez Medina, Arnaldo Figueroa, Natalia González, Gustavo Pradilla, Tomas Garzón, Julio Rodríguez, Luisam Tarrats, Miguel Mayol Del Valle","doi":"10.1055/a-2155-2419","DOIUrl":"https://doi.org/10.1055/a-2155-2419","url":null,"abstract":"<p><p>The aim of this report is to describe TransOrbital NeuroEndoscopic Surgery (TONES) as a safe alternative for obtaining a cavernous sinus (CS) biopsy. We describe this technique in a patient with a diffuse large B cell lymphoma mimicking Tolosa-Hunt's syndrome. Articles were gathered querying PubMed, Embase, and Scopus databases with terms related to a \"transorbital neuroendoscopic approach.\" The literature search was performed by two independent authors (N.L.F. and J.R.), with inconsistencies resolved by the senior author (M.M.D.V.). After screening abstracts for relevance, full-length articles were reviewed for pertinent variables. A comparison was conducted with the illustrative case of a 69-year-old woman who presented to the emergency department with vertigo, ophthalmoplegia, and diplopia for 2 months. A brain magnetic resonance imaging revealed an infiltrative lesion at the left CS. A presumptive diagnosis of Tolosa-Hunt syndrome was made, but a confirmatory biopsy was performed using TONES. Based on our cadaveric study, literature review, and case report, the TONES approach was safe, effective for tissue diagnosis, and associated with minor morbidity and reduced hospital stay. Additional prospective studies are required to study its viability and safety in a larger group of patients.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"84 3","pages":"e116-e123"},"PeriodicalIF":0.5,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/57/23/10-1055-a-2155-2419.PMC10533359.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Dang, Andrew Gong, John V. Dang, Luke A. Mugge, Seth Mansinghani, Mateo Ziu, Adam L. Cohen, Nilesh Vyas
{"title":"Systematic review of WHO grade 4 astrocytoma in the cerebellopontine angle: the impact of anatomic corridor on treatment options and outcomes","authors":"D. Dang, Andrew Gong, John V. Dang, Luke A. Mugge, Seth Mansinghani, Mateo Ziu, Adam L. Cohen, Nilesh Vyas","doi":"10.1055/a-2172-7770","DOIUrl":"https://doi.org/10.1055/a-2172-7770","url":null,"abstract":"Background: Despite advances in multimodal oncologic therapies and molecular genetics, overall survival (OS) for high-grade astrocytomas remains poor. We present an illustrative case and systematic review of rare, predominantly extra-axial WHO grade 4 astrocytomas located within the cerebellopontine angle (CPA) and explore the impact of anatomic location on diagnosis, management, and outcomes.\u0000\u0000Methods: A systematic review of adult patients with predominantly extra-axial WHO grade 4 CPA astrocytomas was conducted following the PRISMA guidelines through December 2022. \u0000\u0000Results: 18 articles were included comprising 21 astrocytomas: 13 exophytic tumors arising from cerebellopontine parenchyma, and 8 tumors originating from a cranial nerve root entry zone. Median OS was 15 months with one-third of cases demonstrating delayed diagnosis. Gross total resection, molecular genetic profiling, and use of ancillary treatment were low. We report the only patient with an integrated IDH-1 mutant diagnosis, who, after subtotal resection and chemoradiation, remains alive at 40 months without progression.\u0000\u0000Conclusion: The deep conical-shaped corridor and abundance of eloquent tissue of the CPA significantly limits both surgical resection and utility of device-based therapies in this region. Prompt diagnosis, molecular characterization, and systemic therapeutic advances serve as the predominant means to optimize survival for patients with rare skull base astrocytomas.","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43432640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert G Power, Fred C Lam, Anthony C Whitton, Sunjay Sharma, Ekkehard M Kasper
{"title":"Surgical Management of Meningiomas Involving the Torcula, Transverse Sinus, and Jugular Bulb: A Technical Note and Review of the Literature.","authors":"Robert G Power, Fred C Lam, Anthony C Whitton, Sunjay Sharma, Ekkehard M Kasper","doi":"10.1055/s-0043-1772201","DOIUrl":"10.1055/s-0043-1772201","url":null,"abstract":"<p><p>Meningiomas that invade the confluens sinuum are rare and require extensive preoperative planning. Here, we describe the surgical and radio-oncological management of an aggressive large occipital meningioma invading the superior sagittal sinus, torcula, right and left transverse sinus down to the level of the jugular bulb in a 21-year-old female patient. Details of the surgical approach are presented to highlight the planned staged resection of this tumor at the level of the torcula to initially debulk the lesion while preserving venous outflow through the patent's sinus. Once the tumor fully occluded the confluens, a second-stage en bloc resection ensued. Postsurgical adjuvant radiation therapy was delivered via fractionated external beam therapy which has provided local control of the tumor since. This case is being discussed in the context of the pertinent literature to demonstrate the highly complex interdisciplinary and staged management of partially intravascular meningiomas involving the major venous sinuses.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"84 3","pages":"e92-e102"},"PeriodicalIF":0.6,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5b/e2/10-1055-s-0043-1772201.PMC10457152.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10107814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Somtochi I Okafor, Jameel Muzaffar, David Jang, Ivan H El-Sayed, Ralph Abi Hachem
{"title":"Nasopharyngeal Carcinoma: Case Presentation and Literature Review of Treatment Innovation with Immunotherapy","authors":"Somtochi I Okafor, Jameel Muzaffar, David Jang, Ivan H El-Sayed, Ralph Abi Hachem","doi":"10.1055/a-2148-2429","DOIUrl":"https://doi.org/10.1055/a-2148-2429","url":null,"abstract":"Abstract Nasopharyngeal carcinoma (NPC), a rare head and neck malignancy, arises from the epithelial lining of nasopharyngeal mucosa. The confluence of various risk factors, such as latent Epstein–Barr virus infection, genetic susceptibility, smoking, alcohol consumption, and high nitrosamine diet, is thought to contribute to NPC pathogenesis. Radiation therapy serves as the mainstay of treatment for early stage while concurrent chemotherapy and radiation are the basis of treatment for locoregional advanced disease with overall 80% five-year survival rate. Recurrent or metastatic disease pose treatment challenges as reirradiation, repeat cycles of chemotherapy, and surgery follow with high likelihood of treatment toxicity or postoperative morbidities. Typically reserved for nonresectable recurrent or metastatic disease, immunotherapy serves as novel treatment for NPC. NPC tumor microenvironment predominated by a dense infiltrate of immune cells hosts an ideal target for immunotherapy. Several clinical trials have investigated the efficacy of anti-programmed cell death protein 1 antibodies such as pembrolizumab, nivolumab, and camrelizumab with promising results. Treatment of recurrent and metastatic NPC remains a challenge; however, the advent of immunotherapy has provided additional options and potential for preventative and therapeutic measures.","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135712048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abigail Funari, Seth S Jeong, Isabella L Pecorari, Isabella Flaquer, Cassidy L Anderson, Vijay Agarwal
{"title":"Infarctive Apoplexy of Previously Healthy Pituitary Glands: A Small Case Series and Literature Review.","authors":"Abigail Funari, Seth S Jeong, Isabella L Pecorari, Isabella Flaquer, Cassidy L Anderson, Vijay Agarwal","doi":"10.1055/s-0043-1770788","DOIUrl":"https://doi.org/10.1055/s-0043-1770788","url":null,"abstract":"<p><p><b>Introduction</b> We present two cases of suspected pituitary apoplexy found instead to be infarcted pituitary glands without histopathologic evidence of neoplastic cells, likely resulting from spontaneous infarction of previously healthy pituitary glands. <b>Case Presentations</b> The first case is a 55-year-old man who presented with a pulsating headache, nausea, and several months of decreased libido, polyuria, and polydipsia. Magnetic resonance imaging (MRI) revealed a rim-enhancing sellar/suprasellar mass with evidence of recent hemorrhage on the right. Testosterone, follicle-stimulating hormone, and luteinizing hormone levels were suppressed. Analysis of the resected specimen showed fibrocollagenous tissue with evidence of old hemorrhage and microscopic focus of necrotic tissue. The second case is a 56-year-old man who presented with a throbbing headache, associated nausea, and 6 weeks of polyuria and polydipsia. Testosterone levels were found to be low, and 8-hour water deprivation test showed evidence for partial diabetes insipidus. MRI revealed a mass on the right side of the pituitary gland, with evidence of likely hemorrhage on the left. Analysis of the resected specimen showed necrotic tissue without neoplastic cells. <b>Conclusion</b> When evaluating small pituitary lesions in patients presenting with indolent onset of pituitary insufficiency, there should be a high degree of suspicion for an infarcted pituitary gland.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"84 3","pages":"e71-e79"},"PeriodicalIF":0.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2e/67/10-1055-s-0043-1770788.PMC10365896.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9875701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Esthesioneuroblastoma: Management of the N0 neck.","authors":"Stephanie J Youssef, Nyssa Fox Farrell","doi":"10.1055/s-0043-1770965","DOIUrl":"https://doi.org/10.1055/s-0043-1770965","url":null,"abstract":"<p><p>Esthesioneuroblastoma is a rare sinonasal malignancy that arises from the olfactory epithelium. The overall incidence of lymph node metastases is 25%. However, neck disease can present in a delayed fashion. As such, management of the clinically negative neck is controversial, with some advocating for elective neck treatment and others recommending observation with salvage treatment if necessary. At this time, no prospective head-to-head comparisons of elective versus salvage treatment have been performed.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"84 3","pages":"e85-e86"},"PeriodicalIF":0.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/32/0f/10-1055-s-0043-1770965.PMC10411164.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9969670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kayva L Crawford, Megana Saripella, Adam S DeConde, Thomas L Beaumont
{"title":"Bilateral Inferior Turbinate Flaps for Salvage Reconstruction after Proton Beam Radiotherapy for Clival Chordoma.","authors":"Kayva L Crawford, Megana Saripella, Adam S DeConde, Thomas L Beaumont","doi":"10.1055/s-0043-1772200","DOIUrl":"https://doi.org/10.1055/s-0043-1772200","url":null,"abstract":"<p><p>Clival chordoma is a rare, aggressive, notochord-derived tumor primarily managed with surgery via an endoscopic endonasal approach (EEA) and adjuvant proton beam radiotherapy. Reconstruction is commonly performed with a nasoseptal flap (NSF) at the time of initial surgery. While failures of the NSF are rare, they can occur following the initial surgery or in the setting of osteoradionecrosis. Salvage repair typically requires transfer of alternative vascularized tissues outside of the previously radiated field including regional scalp flaps such as pericranial or temporoparietal fascial flaps, or free vascularized tissue transfer. Here we describe the case of a 29-year-old woman with a history of clival chordoma with widespread skull base osteomyelitis secondary to NSF necrosis after proton beam radiotherapy. We describe successful skull base reconstruction with intranasal bilateral inferior turbinate flaps based on the sphenopalatine artery with lateral nasal wall extension, despite prior proton beam therapy and a failed prior vascularized intranasal reconstruction.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"84 3","pages":"e87-e91"},"PeriodicalIF":0.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7c/16/10-1055-s-0043-1772200.PMC10421719.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9998986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Recurrent Nasopharyngeal Carcinoma and the Role of Surgery.","authors":"Anirudh Saraswathula, Nyall R London","doi":"10.1055/s-0043-1770966","DOIUrl":"https://doi.org/10.1055/s-0043-1770966","url":null,"abstract":"<p><p>Recurrent nasopharyngeal carcinoma (rNPC) presents unique challenges as reirradiation comes with significant treatment-related morbidity in swallowing, middle ear function, and large-vessel integrity. Advances in endoscopic technology have made surgery for rNPC an increasingly viable option for select patients and may play a role in providing a better quality of life to patients with this challenging disease. In carefully selected patients, endoscopic and open surgical approaches may provide comparable disease control while mitigating long-term treatment-related morbidity.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"84 3","pages":"e68-e70"},"PeriodicalIF":0.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/56/10-1055-s-0043-1770966.PMC10344595.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9880984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Walid Elshamy, Burak Ozaydin, Sima Sayyahmelli, M Shahriar Salamat, Mustafa K Baskaya
{"title":"A Neuroenteric Cyst of the Cavernous Sinus: A Case Report.","authors":"Walid Elshamy, Burak Ozaydin, Sima Sayyahmelli, M Shahriar Salamat, Mustafa K Baskaya","doi":"10.1055/s-0043-1772157","DOIUrl":"https://doi.org/10.1055/s-0043-1772157","url":null,"abstract":"<p><p><b>Background</b> Neuroenteric cysts (NECs) are benign lesions mostly found as intradural extramedullary lesions in the cervicothoracic spinal cord. NECs in the cavernous sinus are very rare. To the best of our knowledge, this is only the second reported case and the first in an adult. <b>Presentation</b> We present a left cavernous sinus NEC in a 75-year-old female with gradually worsening headache and facial pain unresponsive to medical treatment. Imaging revealed a cystic mass lesion in the left cavernous sinus encasing the distal petrosal and cavernous segment of the internal carotid artery. Initial differential diagnoses included more common pathologies located near the cavernous sinus, including cystic schwannoma, craniopharyngioma, and dermoid and epidermoid tumors. The patient underwent a left pterional craniotomy with an extradural transcavernous approach for surgical exploration and possible resection of this mass lesion. Histopathology revealed an NEC lined with benign respiratory-type epithelium. Postoperative imaging revealed gross total tumor resection. The patient remained neurologically intact with complete resolution of facial pain. <b>Conclusion</b> We present a rare pathology that can easily be misinterpreted as other types of lesions. NECs should be kept in mind for differential diagnosis of cavernous sinus cystic lesions. The surgical aim should be maximal safe excision.</p>","PeriodicalId":44256,"journal":{"name":"Journal of Neurological Surgery Reports","volume":"84 3","pages":"e80-e84"},"PeriodicalIF":0.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c0/2a/10-1055-s-0043-1772157.PMC10425234.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10366888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}