Intracranial chordoma: radiosurgery,hypofractionated stereotactic radiotherapy and treatment outcomes

BackgroundThe aim of the study was to assess the results of stereotactic radiosurgery and hypofractionated stereotactic radiotherapy (SRS/SRT) for skull base chordomas.Materials and methodsTwenty-three patients aged 12–75 were treated with SRS/SRT due to skull base chordoma. In 19 patients SRS/SRT was a part of the primary therapy, while in 4, a part of the treatment of recurrence. In 4 patients SRS/SRT was used as a boost after conventional radiotherapy and in 19 cases it was the only irradiation method applied. Patients were irradiated to total dose of 6–35 Gy and median total equivalent dose of 52 Gy.ResultsDuring median follow-up of 39 months, 4 patients died. One-, two- and five-year OS was 95%, 89% and 69%, respectively. In nine patients, progression of the disease was diagnosed during study period. One-, two- and five-year progression free survival (PFS) from the end of radiotherapy was 81%, 59% and 43%, respectively. Radiotherapy was well tolerated and only two patients in our group experienced moderate treatment-related toxicity.ConclusionSRS/SRT alone or in combination with surgery is a safe and effective method of irradiation of patients with skull base chordomas. High EQD₂ is necessary to achieve satisfactory treatment results.     

Stereotactic radiation therapy for skull base recurrences: Is a salvage approach still possible?

AimA literature review was performed to analyse the role of stereotactic radiotherapy given in a single shot or in a fractionated fashion for recurrent skull base tumours in order to ascertain if it can be a real salvage approach.BackgroundThe management of recurrent skull base tumours can have a curative or palliative intent and mainly includes surgery and RT.Materials and methodsOne-thousand-ninety-one articles were found in the search databases and the most relevant of them were analysed and briefly described.ResultsData on recurrences of meningioma, pituitary adenoma, craniopharyngioma, chordoma and chondrosarcoma, vestibular schwannoma, glomus jugulare tumours, olfactory neuroblastoma and recurrences from head and neck tumours invading the base of skull are reported highlighting the most relevant results in terms of local control, survival, side effects and complications.ConclusionsIn conclusion, it emerges that SRS and FSRT are effective and safe radiation modalities of realize real salvage treatment for recurrent skull base tumours.     

中国穿山甲和马来穿山甲头骨量度的测定及比较

全球共有7种穿山甲。本文报道的是中国穿山甲和马来穿山甲的头骨形态学资料,涉及头骨特征描述和一些形态学指标测定。被测定的指标主要有颅全长、基底长、腭长、眶间宽、后头宽、鼻骨长、鼻骨宽、脑颅高、听泡长和下颌长,并且在这两个物种之间进行了比较。结果表明,(1)这两个物种头骨形态十分相似,但马来穿山甲头骨细长,听泡长小于10mm(n=12),鼻骨狭长,前后部宽窄相似,两鼻骨外侧缘内凹或平行,鼻骨宽长之比值小于0 3000(0 2025～0 2811,n=12);而中国穿山甲头骨较粗短,听泡长大于11mm(n=46),鼻骨宽短,后部较前端宽,外侧缘外凸,鼻骨宽长之比值大于0 3000(0 3154～0 5325,n=33)。这些异同之处,可以作为区分这两个物种的依据。(2)中国穿山甲华南亚种与海南亚种头骨各变量之间的差异不显著(P>0 05),用颅全长是否大于83mm来区分这两个亚种不能成立,但海南亚种头骨上颌骨的颧突和鳞骨的颧突通常越过眶颞窝完全相接触,如果不是这样,则在它们之间有一个小的骨质棒状结构将它们连接起来。     

Skull base tumors: a comprehensive review of transfacial swing osteotomy approaches

Numerous techniques have been proposed for the resection of skull base tumors, each one unique with regard to the region exposed and degree of technical complexity. This study describes the use of transfacial swing osteotomies in accessing lesions located at various levels of the cranial base. Eight patients who underwent transfacial swings for exposure and resection of cranial base lesions between 1996 and 2002 were studied. The mandible was the choice when wide exposure of nasopharyngeal and midline skull base tumors was necessary, especially when they involved the infratemporal fossa. The midfacial swing osteotomy was an option when access to the entire clivus was necessary. An orbital swing approach was used to access large orbital tumors lying inferior to the optic nerve and posterior to the globe, a region that is often difficult to visualize. Gross total tumor excision was possible in all patients. Six patients achieved disease control and two had recurrences. The complications of cerebrospinal fluid leak, infection, hematoma, or cranial nerve damage did not occur. After surgery, some patients experienced temporary symptoms caused by local swelling. The aesthetic result was considered good. Transfacial swing osteotomies provide a wide exposure to tumors that occur in the central skull base area. Excellent knowledge of the detailed anatomy of this region is paramount to the success of this surgery. The team concept is essential; it is built around the craniofacial surgeon and an experienced skull base neurosurgeon.     

幼体生长发育特征可导致橙腹田鼠的单配体制吗?

橙腹田鼠(Microtus ochrogaster)和草原田鼠(M. pennsylvanicus)是两种亲缘关系很近,但有着完全不同交配体制的田鼠。本文试图通过他们头骨的形态学比较来验证幼体生长发育(paedomorphosis)可以印证单配制交配体制进化的假说。通过几种头骨的测量,我们发现草原田鼠头骨的长与宽比例大于橙腹田鼠,说明前者具有相对狭长的头骨。进一步的测量发现,这种不同是由于草原田鼠具有相对较长的鼻骨造成的。最后,我们对同种内成年和幼年的头骨进行了比较,发现单配制的橙腹田鼠相对于多配制的草原田鼠,其成年的头骨与幼年的头骨更相似。这些测量结果说明与多配制的田鼠相比,单配制的田鼠在形态及行为上保留更多的幼年状态,而这种行为很可能与其交配体制有关。     

乙状窦后锁孔入路的内镜和显微镜下解剖学研究及临床应用

目的:通过乙状窦后锁孔入路对该区周围进行内镜和显微解剖学观察,为临床该手术入路定位提供解剖学及形态学依据。方法:应用10%甲醛溶液充分固定的成人尸头标本8例(16侧),模拟乙状窦后锁孔入路进行内镜和显微解剖学观察,并测量尸头表面标志点位置关系,确定枕下乙状窦后锁孔位置。结果:1:锁孔位置为取耳后旁4cm以上项线为上点∫形切口3.0cm～4.0cm。暴露星点后在其下方骨孔直径2.0～2.5cm,可以充分暴露桥小脑角区。2:该锁孔入路虽然通道窄小,但利用内镜和显微镜暴露范围较广,可达中上斜坡。结论:熟悉桥小脑角区神经血管解剖结构的毗邻关系,准确到达解剖目标,有助于在显露血管和神经的同时保护脑组织的重要结构,减小创伤,内镜的应用能把手术中的副损伤降低到最低点。     

Height of skull base as an indicator of living conditions in historical native populations from Europe, Australia and Africa

Flattening and lowering of the skull base in response to improper bone growth is called platybasis, and is considered a sensitive and reliable indicator of adverse living conditions such as malnutrition and disease during the prenatal period and early childhood. The degree of platybasis was assessed in three series of skulls representing geographically distinct historical native populations from Europe, Australia and Africa. Platybasis was determined by measuring the height of the base of the skull. The degree of platybasis varied among the populations examined, and was the lowest in the Australian group, and the highest in the African group. This may be due to either variability of living conditions or genetic factors, which have an influence on robusticity and cranial architecture. There were also differences among the groups in terms of the other skull measurements and indices examined. The height of the base of the skull was generally greater in males than in females, which indicates sexual dimorphism or fact that females had worse living conditions. Correlation coefficients between the height of the base of the skull and other measurements including skull length and skull width were also calculated indicating significant relationships. The differences between the height of the base of the skull and height/length index and height/width index, were statistically significant.     

Influence of the lateral ventricles and irregular skull base on brain kinematics due to sagittal plane head rotation

Two-dimensional physical models of the human head were used to investigate how the lateral ventricles and irregular skull base influence kinematics in the medial brain during sagittal angular head dynamics. Silicone gel simulated the brain and was separatedfrom the surrounding skull vessel by paraffin that provided a slip interface between the gel and vessel. A humanlike skull base model (HSB) included a surrogate skull base mimicking the irregular geometry of the human. An HSBV model added an elliptical inclusion filled with liquid paraffin simulating the lateral ventricles to the HSB model. A simplified skull base model (SSBV) included ventricle substitute but approximated the anterior and middle cranial fossae by a flat and slightly angled surface. The models were exposed to 7600 rad/s2 peak angular acceleration with 6 ms pulse duration and 5 deg forced rotation. After 90 deg free rotation, the models were decelerated during 30 ms. Rigid body displacement, shear strain and principal strains were determined from high-speed video recorded trajectories of grid markers in the surrogate brains. Peak values of inferior brain surface displacement and strains were up to 10.9X (times) and 3.3X higher in SSBV than in HSBV. Peak strain was up to 2.7X higher in HSB than in HSBV. The results indicate that the irregular skull base protects nerves and vessels passing through the cranial floor by reducing brain displacement and that the intraventricular cerebrospinal fluid relieves strain in regions inferior and superior to the ventricles. The ventricles and irregular skull base are necessary in modeling head impact and understanding brain injury mechanisms.     

广东省发现长指鼠耳蝠及其回声定位声波特征

2013年7月在广东南岭国家级自然保护区阳山县境内(24°48′39.5′′N,112°51′01.3′′E,海拔155 m)捕捉到4只雄性蝙蝠,体型小,前臂长34.1~34.7 mm,颅全长14.3~14.7 mm;体毛浓密,背毛毛基黑色,毛尖灰色,腹毛黑或棕色,毛尖奶油白,靠近肛门处腹毛浅灰色,些许白色;翼膜附着于跖部末端;后足特别延展,长度超过胫骨长之半;鉴定为长指鼠耳蝠[Myotis longipes(Dobson1873)]。同时,基于Cyt b基因序列(1 140 bp)构建的部分鼠耳蝠物种系统进化关系,进一步确认上述标本为长指鼠耳蝠,为广东省翼手目新纪录。该种蝙蝠在我国贵州、广西、重庆有分布记载,但标本和相关资料很少。本文给出了长指鼠耳蝠的外形和头骨特征测量数据,并与印度的标本进行了对比。长指鼠耳蝠的回声定位声波为调频型(FM),主频率为68.2 k Hz;此外,对其分类地位和分布状况进行了讨论。标本保存于广东省生物资源应用研究所。     

Stereotaxic: measurements of the skull cap and skull base in merino sheep (Ovis aries L.)]

On the 14 skulls of 6-month old merino labms, stereotaxical measurements were carried out. Not only individual variations were found, but they also dependent on sex. A small assymetry was found on the diagrams of frontal measurements of the skull cap and base. The point bregma is more variable than the lambda. The position of the cranial third of the skull base in 6 month old lambs is not yet constant and until adult age it will shift about 30 degrees to 35 degrees dorsalward and forward. Since the skull cap and base do not grow parallely, and their cranial part has not constant position, we do not recommended this age group for chronic experiments with implanted electrodes. Owing to smaller variations of the skull cap and base and nearer position of the sutura sagittalis toward the medial line, male lambs would be more suitable for short-term experiments and for the stereotactic atlas of deep brain structures.     

沟牙田鼠的形态特征及分类地位探讨

沟牙田鼠是分布于中国四川西部和甘肃南部的一种罕见小型啮齿动物,迄今标本收藏甚少,种、属地位存在异议,有人认为应并入田鼠属。我们根据四川九寨沟自然保护区采到的16号不同年龄、性别的沟牙田鼠,就其牙齿形态和成年雄性的阴茎结构与其它田鼠类作了比较,发现其成体和幼体在M³和M₃形态上有很大不同。其他重要区别包括：上门齿宽大;下门齿外露部分很短,下门齿总长仅及下颌长的77％左右,远比其他田鼠小;M齿环呈圆弧形或豆形亦很特殊;成年雄性的阴茎骨近支烧瓶状,远支基部膨大与田鼠类差别很大。结果表明：沟牙田鼠属是有别于田鼠属的有效属。     

江西武夷山发现亚洲宽耳蝠

本研究组于2018年1月在江西省武夷山自然保护区,使用蝙蝠竖琴网捕获到1只雄性蝙蝠,采用传统形态分类并结合系统发育学分析方法,对该蝙蝠进行物种鉴定。其主要特征为:体型中等偏小,前臂长38.29mm;外耳廓呈方形,双耳在额部相连,耳屏呈现三角形,无耳突;背毛和腹毛黑棕色且毛尖偏白色;头骨从吻端均匀上升,颅顶点隆起不明显,整体较为扁平;颧弓纤细,矢状嵴与人字嵴隐约可见,齿式为2.1.2.3/3.1.2.3=34。根据其外部形态、头骨特征及基于Cytb和ND1基因序列的系统发育树结果,将该蝙蝠鉴定为亚洲宽耳蝠(Barbastella leucomelas),为中国江西省翼手目分布新记录种。     

Chordoma: To know means to recognize

Chordoma is a rare type of bone cancer characterized by its locally aggressive and destructive behavior. Chordoma is located in one of the three primary regions: skull base/clivus, sacrum or mobile spine. Chordoma grows slowly, therefore its insidious onset leads to delayed diagnosis, accounting for the low survival rates. Treatment centers around successful en bloc resection with negative margins, though, considering the anatomically constrained site of growth, it frequently requires adjuvant radiotherapy. This article analyzes the existing literature with the aim to provide a better insight in the current state of research in chordoma classification, characteristics, and management.     

Vasoactive-intestinal-polypeptide (VIP)-like immunoreactive cells in the skull base of rats. A combined study using acetylcholinesterase histochemistry

We investigated the distribution of vasoactive intestinal polypeptide (VIP)-like immunoreactive cell bodies in relation to the major cerebral and internal carotid arteries at the skull base in rats. Acetylcholinesterase (AChE) histochemistry was also applied to investigate the localization of this enzyme. VIP staining revealed a few positive cell bodies in nerves close to the internal carotid artery at the base of the skull as well as in the cerebral arterial wall. Ganglion-like cell bodies were detectable within the greater superficial petrosal (GSP) nerve. AChE activity was observed in VIP-like immunoreactive cell bodies along the whole of the GSP nerve. These cell bodies in the GSP nerve may give rise to at least some of the perivascular VIP- and AChE-containing nerves of the internal carotid arteries at the base of the skull.     

Vasoactive-intestinal-polypeptide (VIP)-like immunoreactive cells in the skull base of rats

Summary We investigated the distribution of vasoactive intestinal polypeptide (VIP)-like immunoreactive cell bodies in relation to the major cerebral and internal carotid arteries at the skull base in rats. Acetylcholinesterase (AChE) histochemistry was also applied to investigate the localization of this enzyme. VIP staining revealed a few positive cell bodies in nerves close to the internal carotid artery at the base of the skull as well as in the cerebral arterial wall. Ganglion-like cell bodies were detectable within the greater superficial petrosal (GSP) nerve. AChE activity was observed in VIP-like immunoreactive cell bodies along the whole of the GSP nerve. These cell bodies in the GSP nerve may give rise to at least some of the perivascular VIP-and AChE-containing nerves of the internal carotid arteries at the base of the skull.     

甘肃鼢鼠种群年龄的研究

本文根据甘肃鼢鼠(Myospalax cansus)头骨无机盐含量与其已知年龄大小存在的正相关系, 采用头骨干重作为划分该种年龄的指标,并选择体重、体长、头骨颅全长及额宽检验头骨干重鉴定年龄的可靠性。结果表明：头干重是鉴定甘肃鼢鼠年龄的较为准确的可行指标。     

高流量颅外内血管搭桥技术在颅底肿瘤手术中的应用进展

颅底肿瘤尤其是侵及颈内动脉等颅内主供血血管的肿瘤治疗一直是神经外科的难题,由于此类肿瘤与重要血管的关系密切,手术风险极大,导致治愈率底下。而颅外内血管搭桥技术通过重建颅内血运,可以有效提升此类肿瘤的全切率。本文回顾了高流量颅外内血管搭桥技术的历史进展、探讨了颅外内血管搭桥技术辅助切除颅底肿瘤的意义所在,复习文献归纳了该技术应用的适应症、术中注意事项及其疗效与争议,旨在为其临床推广应用提供更多的参考依据。熟练及合理地应用颅外内血管搭桥技术,制定个体化的治疗方案,复杂颅底肿瘤的治愈率将会得到进一步提升。     

Ontogenic growth changes of the skull base in four genera of nonhuman primates.

Cross-sectional studies of the degree of the cranial base flexion were carried out in infant, juvenile and adult skulls in four genera of nonhuman primates (P. paniscus, H. lar, P. urinus, and M. mullatta). The cephalometric observations of the cranial base included linear and angular measurements of each specimen. The data obtained in this study showed that the anterior portion of the cranial base exhibits a significant shortening trend as the mammalian evolutionary scale ascends. Moreover, the growth pattern of the anterior portion of the skull base follows that of the facial bony structures. The ontogenic growth changes of the posterior portion of the skull base follows the growth pattern of the endocranial cavity. The significant trend of elongation in this area directly contributes to the posterior migration of the foramen magnum. The magnitude of these growth changes decreases as the evolutionary scale ascends. The angular measurements of the cranial flexion showed a less obtuse cranial base angle in young specimens and the ones higher on the mammalian scale. The skull kyphosis was less pronounced in these specimens and the anatomical features of the cranial base were more humanlike, including the balance of the head expressed by the position of the foramen magnum.     

颅底孔在多层CT三维重建中的测量研究

探讨颅底MSCT三维重建图像效果及主要孔的正常值,采用多层螺旋CT(MSCT),对200名正常成人(男100名,女100名)进行颅脑扫描,利用电子计算机三维重建程序立体地显示颅底外面的卵圆孔、棘孔、颈动脉管外口、破裂孔、茎乳孔、枕骨大孔,并观察其形态和测出其内径及其性差。     

Studies on orthocephalization. 2. Flexions of the rat head in the period between 14 and 60 days after gestation

The present paper considers the significance of a variety of cranial flexions in the process of orthocephalization of the rat skull between 14 and 60 days postnatally. The study is based on a sample of 27 male rats, who have been x-rayed at 14, 30 and 60 days with subsequent analyses of the photographs obtained. In this period the angle between the cranial base and the facial part of the skull becomes more obtuse, i.e. the skull becomes more orthocranial. The cranial base becomes at the same time more airobasal (lordotic). Angular changes between the individual bones in the cranial vault straightens the vault markedly. By this it becomes orthodorsal. As the angle between the basisphenoid and the parietal bones stays more or less constant between 14 and 60 days, the impression is created that both the anterior and posterior parts of the neural skull rotate upwards relative to this bone complex. Thus, orthocephalization in the period between 14 and 60 days both consists of flexions between the facial and neural parts of the skull (prebasal flexions), and may be more importantly of interosseous ventral and dorsal flexions.