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  • By Author: Samii, Madjid x
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Amir Samii, Venelin M. Gerganov, Christian Herold, Nakamasa Hayashi, Takahiko Naka, M. Javad Mirzayan, Helmut Ostertag and Madjid Samii

Object

The goal of this study was to report on the surgical management of skull base chordomas and to evaluate both the short- and long-term treatment outcomes.

Methods

The authors retrospectively studied data from 49 patients who had undergone consecutive surgeries at a single institution. They also analyzed patterns of chordoma extension. Complications and surgery-related morbidity were recorded. A Kaplan–Meier analysis was performed to determine survival rates in patients 5 and 10 years after their first surgery. Operative approaches were selected on the basis of the predominant tumor extension.

Results

The approach used most frequently was the transethmoidal in 36.3%, followed by the pterional in 23.4% and the retrosigmoid in 23.4%. The tumor was totally removed in 49.4% and subtotally in 50.6%. The rate of total removal was highest at initial surgery (78%) and progressively declined thereafter. In 11.8% of cases a new neurological deficit developed, while the preoperative deficit remained unchanged. In 20% of cases the preoperative deficits improved, but new deficits also appeared. The 5- and 10-year survival rates are 65 and 39%, respectively.

Conclusions

With an individually tailored surgical approach, total tumor removal in 78% of the cases was achieved at the initial surgery. Radical surgery appears to increase slightly the surgical morbidity, but at the same time prolongs the recurrence-free interval. Chordomas cannot be regarded as surgically curable tumors given the 5- and 10-year survival rates in patients harboring such lesions.

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Gustavo A. Carvalho, Anette Lindeke, Marcos Tatagiba, Helmut Ostertag and Madjid Samii

✓ Granular-cell tumors are exceedingly rare neoplasms in the central nervous system. Their histogenesis has been a subject of longstanding controversy but substantial findings support the current theory of a Schwann cell origin. Other recent histopathological studies point to an astrocytic origin in those tumors which arise from the cerebral hemispheres. A case of a granular-cell tumor arising from the trigeminal nerve is described. The origin, clinical course, radiological features, and treatment of such unusual intracerebral tumors are discussed.