Endoscopic Craniofacial Resections and Endoscopic-Assisted Craniofacial Resections for Locally Advanced Anterior Skull Base Tumors. Early Experience of a Canadian Tertiary Referral Centre
Notice bibliographique
Résumé
Introduction: Tumors involving the anterior skull base are challenging due to the complex anatomy and critical structures that may be involved. Traditionally, open craniofacial resection and various trans-facial approaches have been employed in the surgical management of such tumors. Recently, Endoscopic Craniofacial Resection (eCFR) and Endoscopic-assisted Craniofacial Resection (e-aCFR) have proven to be effective in selected patients, showing similar oncologic outcomes and some significant reduction in complications and morbidities. The objective of this study was to evaluate the early outcomes, pitfalls and complications of our series of patients who underwent endoscopic, or endoscopic-assisted approaches for skull base tumors in the past 3 years. Methods: Retrospective analysis of the medical charts of patients with anterior skull base tumors treated with eCFR and e-aCFR, from January 2013 to September 2015. Results: A total of 14 patients underwent eCFR or e-aCFR for anterior locally advanced skull base tumors (9 eCFR and 5 e-aCFR). This included 11 malignant pathologies and 3 benign tumors. The malignant pathologies included 7 Esthesioneuroblastomas - 5 with very locally advanced disease (4 with T4 or Kadish C, and 1 T3 or Kadish C), 2 with moderate advanced disease (2 Kadish B or T2). 2 Adenocarcinomas (T4b), 1 Neuroendcrine carcinoma (T4b) and 1 SNUC (T4a). Of the malignant tumors, 2 were previously treated with radiotherapy and 2 were previously surgically resected. Of the benign tumors, 1 was an Inverted Papilloma (T4) and 2 Fibro-osseous lesions. For skull base reconstruction, Nasoseptal flaps were used in 8 patients (57%), Fascia Lata grafts in 6 (43%), synthetics Dural repair in 5 (36%), pericranial flaps in 3 (21%), and fat grafts in 2 (14%) and Titanium mesh in 1 case (7%). Of the malignant tumors, 4 (36%) patients underwent adjuvant treatment after surgery. 3 (27%) received a combination of Radiotherapy and Chemotherapy and 1 (9%) patient was treated with Chemotherapy alone. Only 1 (9%) patient had neo-adjuvant Chemotherapy. The average length of follow-up was 11 months (range from 1 to 18 months). All patients are alive at submission for publication. 4 (36%) of the 11 locally advanced malignant tumors developed recurrences; the average time between recurrence and surgery was 13 months. 2 (50%) of these recurrences were treated as a rescue surgery for previous radiotherapy and 3 (75%) of them did not have adjuvant treatments after surgery. There were no recurrences on the benign tumors subgroup. Compications included 3 (21%) postoperative CSF leaks, 2 immediately postoperatively and 1 delayed, presenting with meningitis (no neurological sequela). 1 patient had intractable intraoperative seizures and 1 patient developed isolated seizures during adjuvant radiotherapy. None of these patients have long-term sequela. Conclusions: For selected cases, eCFR and e-aCFR is a safe and effective alternative in the treatment of locally advanced tumors involving the anterior cranial base. Recurrences were found more frequent in previously treated patients and those who did not receive adjuvant treatment. Multidisciplinary approach to these complex lesions is essential to archive favorable outcomes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».