Charles Labbé (1851–1889)

1997 ◽  
Vol 87 (3) ◽  
pp. 477-480 ◽  
Author(s):  
Ronald H. M. A. Bartels ◽  
Jacobus J. Van Overbeeke
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Public Records ◽  
Content Type ◽  
Extensive Search ◽  
Vein Of Labbé ◽  
First Time ◽  
Important Structure ◽  
Fine Print

✓ The vein of Labbé is a very important structure and every neurosurgeon is acquainted with its anatomy. Because of the recent increasing interest and experience in skull base surgery, the vein of Labbé has received a great deal of attention. Intraoperative damage to this vein should be avoided and several methods to prevent this have been described. Despite these developments, nothing is written in the neurosurgical literature about the man who described this vein for the first time: Charles Labbé. The authors therefore conducted an extensive search of the literature and uncovered several public records in France to learn more about Charles Labbé.

Modifications to the orbitozygomatic approach

2003 ◽  
Vol 99 (5) ◽  
pp. 924-930 ◽  
Author(s):  
G. Michael Lemole ◽  
Jeffrey S. Henn ◽  
Joseph M. Zabramski ◽  
Robert F. Spetzler
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Complete Removal ◽  
Surgical Indications ◽  
Content Type ◽  
Orbitozygomatic Approach ◽  
Technical Details ◽  
Surgical Field ◽  
Brain Retraction ◽  
Fine Print

✓ The orbitozygomatic craniotomy is one of the workhorse approaches of skull base surgery, providing wide, multidirectional access to the anterior and middle cranial fossae as well as the basilar apex. Complete removal of the orbitozygomatic bar increases the angles of exposure, decreases the working depth of the surgical field, and minimizes brain retraction. In many cases, however, only a portion of the exposure provided by the full orbitozygomatic approach is needed. Tailoring the extent of the bone resection to the specific lesion being treated can help lower approach-related morbidity while maintaining its advantages. The authors describe the technical details of the supraorbital and subtemporal modified orbitozygomatic approaches and discuss the surgical indications for their use. Modifications to the orbitozygomatic approach are an example of the ongoing adaptation of skull base procedures to general neurosurgical practice.

Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature

1999 ◽  
Vol 91 (2) ◽  
pp. 202-211 ◽  
Author(s):  
Kazunari Yoshida ◽  
Takeshi Kawase
Keyword(s):  
Skull Base ◽  
Clinical Features ◽  
Skull Base Surgery ◽  
Single Stage ◽  
Middle Fossa ◽  
Tumor Removal ◽  
Developmental Patterns ◽  
Content Type ◽  
Total Tumor Removal ◽  
Fine Print

Object. Since 1974, 27 patients with trigeminal neurinomas (TNs) have been treated at Keio University Hospital and ancillary institutes. In the present study the clinical features and developmental patterns of these 27 cases are analyzed, and the clinical features of 402 cases reported in the literature are reviewed. Based on the analysis of the developmental patterns of the TNs, the surgical strategy for a one-stage removal of TNs involving multiple fossae is described.Methods. Trigeminal neurinomas are classified into six types according to tumor location. Types M, P, and E are tumors involving a single compartment, that is, the middle fossa, posterior fossa, or extracranial space, respectively. Types MP (middle and posterior fossae), ME (middle fossa and extracranial space), or MPE (middle and posterior fossae and extracranial space) are tumors involving multiple compartments. Advances in neuroimaging technologies, such as magnetic resonance imaging, have revealed a high incidence of TNs extending into multiple fossae, namely 36.2% in cases reported since 1983 and 59% in the authors' series. All but one of the most recent 19 patients in this series underwent skull base surgery, whereas the remaining nine patients were surgically treated via the conventional subdural approach. The rate of total tumor removal and the clinical outcome were significantly better in those patients treated by skull base surgery than those treated by conventional surgery.Conclusions. The TNs extending into multiple fossae can be totally removed using the following single-stage surgical techniques: Type MP by the anterior transpetrosal approach; Type ME by the zygomatic or orbitozygomatic infratemporal approach; and Type MPE by the zygomatic transpetrosal approach. In 12 of 13 cases involving multiple fossae in this series, total tumor removal was achieved using single-stage skull base surgery.

Surgical experience with chromophobe adenomas of the pituitary gland

1971 ◽  
Vol 34 (6) ◽  
pp. 726-729 ◽  
Author(s):  
Bronson S. Ray ◽  
Russell H. Patterson
Keyword(s):  
Radiation Therapy ◽  
Pituitary Gland ◽  
Operative Mortality ◽  
Postoperative Radiation ◽  
Surgical Experience ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Chromophobe Adenoma ◽  
First Time ◽  
Fine Print

✓ Between 1950 and 1969, 165 operations were performed on 146 patients for the treatment of chromophobe adenoma of the pituitary gland unassociated with either acromegaly or Cushing's syndrome. The over-all operative mortality was 1.2%, and no deaths occurred in 138 cases operated on for the first time. In 106 of the patients who had not received prior treatment, vision was improved in 80% of cases and returned to normal in 50%. In the group of patients whose initial treatment was surgery, postoperative radiation therapy was administered in one-half of the cases. The rate of recurrence was 8% in those who received radiation and 22% in those who did not. Recurrence of symptoms within less than 1 year often was due to a hemorrhagic cyst which could be treated better by reoperation than by radiation therapy.

Use of the radial forearm microvascular free-flap graft for cranial base reconstruction

1999 ◽  
Vol 90 (4) ◽  
pp. 651-655 ◽  
Author(s):  
Marc S. Schwartz ◽  
James I. Cohen ◽  
Toby Meltzer ◽  
Michael J. Wheatley ◽  
Sean O. McMenomey ◽  
...  
Keyword(s):  
Skull Base ◽  
Free Flap ◽  
Cranial Base ◽  
Csf Leak ◽  
Content Type ◽  
Lateral Skull Base ◽  
Csf Leakage ◽  
Radial Forearm ◽  
Microvascular Free Flap ◽  
Fine Print

Object. Reconstruction of the cranial base after resection of complex lesions requires creation of both a vascularized barrier to cerebrospinal fluid (CSF) leakage and tailored filling of operative defects. The authors describe the use of radial forearm microvascular free-flap grafts to reconstruct skull base lesions, to fill small tissue defects, and to provide an excellent barrier against CSF leakage.Methods. Ten patients underwent 11 skull base procedures including placement of microvascular free-flap grafts harvested from the forearm and featuring the radial artery and its accompanying venae comitantes. Operations included six craniofacial, three lateral skull base, and two transoral procedures for various diseases. Excellent results were obtained, with no persistent CSF leaks, no flap failures, and no operative infections. One temporary CSF leak was easily repaired with flap repositioning, and at one flap donor site minor wound breakdown was observed. One patient underwent a second procedure for tumor recurrence and CSF leakage at a site distant from the original operation.Conclusions. Microvascular free tissue transfer reconstruction of skull base defects by using the radial forearm flap provides a safe, reliable, low-morbidity method for reconstructing the skull base and is ideally suited to “low-volume” defects.

A multidisciplinary team approach to skull base chondrosarcomas

2001 ◽  
Vol 95 (2) ◽  
pp. 184-189 ◽  
Author(s):  
H. Alan Crockard ◽  
Anthony Cheeseman ◽  
Timothy Steel ◽  
Tamas Revesz ◽  
Janice L. Holton ◽  
...  
Keyword(s):  
Skull Base ◽  
Team Approach ◽  
Content Type ◽  
Mean Survival Time ◽  
Cranial Nerve Palsies ◽  
Slow Progression ◽  
The Mean ◽  
Skull Base Chordomas ◽  
Skull Base Chordoma ◽  
Fine Print

Object. The authors review their experience with treating skull base chondrosarcomas, which are much rarer than skull base chordomas and differ from them in prognosis and treatment. Methods. Seventeen patients (12 male and five female patients) with histologically verified chondrosarcomas were followed up prospectively over a 12-year period. The mean age at presentation was 35.9 years. Most patients presented with cranial nerve palsies. Seven had undergone surgery prior to referral to the authors' unit. All underwent maximum surgical cytoreduction by the most direct surgical approach; only the two patients harboring the mesenchymal variant underwent radiotherapy. Conclusions. One patient died of a pulmonary embolus; the patients harboring mesenchymal chondrosarcomas died at 20 and 36 months, respectively, after treatment. Of the remaining patients, 93% were alive 5 years postsurgery and had a projected 10-year survival rate of 84% (mean survival time 9.3 years). These data emphasize the very slow progression of this tumor compared with skull base chordoma.

Chordoma of the skull base: predictors of tumor recurrence

2003 ◽  
Vol 98 (4) ◽  
pp. 812-822 ◽  
Author(s):  
Roberto Pallini ◽  
Giulio Maira ◽  
Francesco Pierconti ◽  
Maria Laura Falchetti ◽  
Ester Alvino ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Microsatellite Instability ◽  
Skull Base ◽  
Tumor Recurrence ◽  
Doubling Time ◽  
P53 Protein ◽  
Biological Behavior ◽  
Htert Mrna ◽  
Content Type ◽  
Fine Print

Object. Chordomas of the skull base are generally regarded as slow-growing tumors; however, approximately 20% of these lesions have been shown to recur as early as 1 year postsurgery. The classic pathological paradigms are poor predictors of outcome, and additional markers are needed to identify patients at risk for early tumor recurrence. In this study the authors describe such a marker. Methods. In a series of 26 patients with chordomas of the skull base, the authors investigated the relationship between the biological behavior of the tumor, which was determined according to the interval for its recurrence and volume doubling time, and several pathological and molecular features, which included the histological variant, proliferative activity, mutation of p53 protein, expression of human telomerase reverse transcriptase (hTERT) messenger (m)RNA, loss of heterozygosity (LOH), and microsatellite instability. The major finding in this study was that hTERT mRNA expression in chordoma cells identifies those tumors that exhibit unusually fast rates of growth. The expression of hTERT mRNA was frequently associated with mutation of p53 protein, indicating that telomerase dysfunction combines with abnormal p53 function to initiate the unrestrained clonal expansion of the tumor cells. In cases in which the tumor was partially removed, mutation of p53 protein and expression of hTERT mRNA predicted increased doubling time for residual tumor as well as the probability of tumor recurrence. Cell proliferation, as investigated using the Ki-67 method, was significantly related to the tumor doubling time; however, the authors found that the pattern of cell proliferation was not homogeneous throughout the chordoma tissue, and that the proliferative index might change by a factor as high as 8 among different regions of the same tumor. The LOH and microsatellite instability do not seem to affect the prognosis of skull base chordomas. Conclusions. Reactivation of telomerase in chordomas is a reliable predictor of outcome. The ability to predict the biological behavior of chordomas might have immediate implications in the management of this disease in patients who undergo surgery.

Protective effects of steroids on the cortico-microcirculation injured by cold

1979 ◽  
Vol 51 (2) ◽  
pp. 188-200 ◽  
Author(s):  
Tohru Soejima ◽  
Y. Lucas Yamamoto ◽  
Ernst Meyer ◽  
William Feindel ◽  
Charles P. Hodge
Keyword(s):  
Blood Flow ◽  
Fluorescein Angiography ◽  
Subcortical White Matter ◽  
Protective Effects ◽  
Content Type ◽  
Small Arteries ◽  
X Ray ◽  
Ray Projection ◽  
First Time ◽  
Fine Print

✓ Early microcirculatory changes after focal cold injury of the cerebral cortex were examined in dogs with and without steroids by serial fluorescein angiography of the brain (FAB), by measurement of the diameter of epicerebral vessels, and by measurement of cerebral blood flow with the clearance method using krypton-85 and xenon-133. Changes in the transcerebral vessels were examined by x-ray projection microangiography. Within 30 minutes of the injury, the cortical area injured by a temperature of −65° C showed a reduction in blood flow of 60%. When treated with steroids and while still at the same temperature, blood flow was reduced by only 35%. Serial FAB revealed slowing and arrest of flow in the epicerebral microcirculation which could be noted first in the small veins, then in the medium-sized veins and small arteries. Fluorescein dye leaked from the epicerebral vessels, around the small veins, then around larger veins and small arteries. Some leakage of dye from medium-sized arteries was noted 2 hours after injury. This sequence of slowing and arrest of the microcirculation, with exit of dye from intact arterial vessels, identified here for the first time in relation to a cortical freezing lesion, may help to explain the development of later brain edema which spreads widely in the subcortical white matter. After steroids, improvement of the microcirculation was present as defined by cortical blood flow, fluorescein angiography, and x-ray projection microangiography.

Suture pathology in craniosynostosis

1981 ◽  
Vol 54 (3) ◽  
pp. 384-387 ◽  
Author(s):  
A. Leland Albright ◽  
Ryland P. Byrd
Keyword(s):  
Skull Base ◽  
Cranial Sutures ◽  
En Bloc ◽  
Content Type ◽  
Microscopic Evidence ◽  
Suture Fusion ◽  
Clinical Abnormality ◽  
Fine Print

✓ Gross and histological pathology of skull sutures affected by craniosynostosis was evaluated. Nineteen sutures were examined: 14 sagittal, three coronal, and two metopic. Sutures were removed en bloc, examined grossly, then sectioned perpendicular to the axis of the suture and examined microscopically. Foci of dural invagination into the sutures occurred in only four of the 19 specimens. In areas of maximum clinical abnormality, there was no microscopic evidence of the suture. The suture adjacent to the fused portion was narrowed by encroaching calvaria, and suture farther away was normal. Suture ossification was never multifocal. In infants less than 1 year old, the extent of suture fusion did not correlate with age. It is concluded that craniosynostosis is characterized by the progressive obliteration of cranial sutures by fusion of adjacent cranial bones, and that changes in the skull base angles are secondary to suture obliteration.

Intracranial hypertrophic calcification complicating neuroendoscopy

2003 ◽  
Vol 98 (1) ◽  
pp. 186-189 ◽  
Author(s):  
Simon Thomson ◽  
Atul K. Tyagi ◽  
Paul D. Chumas
Keyword(s):  
Burr Hole ◽  
Content Type ◽  
First Time ◽  
Fine Print

✓ Three cases are presented in which progressive hypertrophic calcification formed following ventricular endoscopy. After a ventricular endoscopy has been performed, it has been the authors' practice to seal the burr hole with bone dust. They believe that the calcifications formed from bone dust that fell into the track left by the endoscope. This is the first time this complication has been described.

Combined treatment of advanced stages of recurrent skin cancer of the head

2004 ◽  
Vol 100 (4) ◽  
pp. 652-658 ◽  
Author(s):  
Angelo Pompucci ◽  
Giancarla Rea ◽  
Eugenio Farallo ◽  
Marzia Salgarello ◽  
Antonino Campanella ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Cell Carcinoma ◽  
Skull Base ◽  
Residual Disease ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Content Type ◽  
Advanced Stages ◽  
Minimal Residual ◽  
Fine Print

Object. The authors investigated whether skull base resection and primary free-flap reconstruction in a single-stage surgery is oncologically effective for treating advanced stages of recurrent skin cancer (RSC) of the head. Methods. Eighteen consecutive patients were surgically treated. Twelve of them underwent an anterolateral skull base resection, which was performed using a pterional craniotomy combined with an orbitozygomatic osteotomy. Six patients underwent a posterolateral skull base resection, which was performed using an asterional craniotomy combined with a retrolabyrinthine petrosectomy. The wide postoperative defects were covered with muscular or myocutaneous free flaps. The main factor influencing survival was the extent of the resection: patients with no or minimal residual disease showed a statistically significant longer survival time than those with consistent residual disease. Basal cell carcinoma had a better prognosis than squamous cell carcinoma. A trend toward improved survival was observed in patients classified as T4M0 with negative lymph nodes (N0), but this trend was not statistically significant. Adjuvant radiotherapy significantly influenced both survival time and the rate of local recurrence. The surgical morbidity rate was 27.8%; there were two transient cerebrospinal fluid leaks and three seventh cranial nerve injuries. Late complications included radionecrosis in one patient and skin erosion requiring a second surgery in another patient. No deaths occurred during a 30-day postoperative period. Conclusions. Advances in skull base surgery and free-flap reconstruction allowed the authors to treat patients with advanced-stage RSC of the head in a rather satisfactory manner. Only when it is impossible to achieve no or minimal residual disease should aggressive treatment be considered.

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