Table Of ContentHead and Neck Cancer Clinics
Series Editors: Rehan Kazi · Raghav C. Dwivedi
Ziv Gil
Dan M. Fliss Editors
Tumours of the
Skull Base and
Paranasal Sinuses
Head and Neck Cancer Clinics
Series editors
Rehan Kazi
Head and Neck Cancer
Manipal University
Manipal , India
Raghav C. Dwivedi
Head and Neck Cancer
Royal Marsden Hospital
London , United Kingdom
Head and Neck Cancer (HNC) is a major challenge to public health. Its management
involves a multidisciplinary team approach, which varies depending on the subtle
differences in the location of the tumour, stage and biology of disease and availability
of resources. In the wake of rapidly evolving diagnostic technologies and
management techniques, and advances in basic sciences related to HNC, it is
important for both clinicians and basic scientists to be up-to-date in their knowledge
of new diagnostic and management protocols. This series aims to cover the entire
range of HNC-related issues through independent volumes on specifi c topics. Each
volume focuses on a single topic relevant to the current practice of HNC, and
contains comprehensive chapters written by experts in the fi eld. The reviews in each
volume provide vast information on key clinical advances and novel approaches to
enable a better understanding of relevant aspects of HNC. Individual volumes
present different perspectives and have the potential to serve as stand-alone reference
guides. We believe these volumes will prove useful to the practice of head and neck
surgery and oncology, and medical students, residents, clinicians and general
practitioners seeking to develop their knowledge of HNC will benefi t from them.
More information about this series at h ttp://www.springer.com/series/13779
Ziv Gil (cid:129) Dan M. Fliss
Editors
Tumours of the Skull Base
and Paranasal Sinuses
Editors
Ziv Gil Dan M. Fliss
Head and Neck Surgery Unit Tel Aviv University
Tel Aviv University Tel Aviv
Tel Aviv Israel
Israel
ISSN 2364-4060 ISSN 2364-4079 (electronic)
Head and Neck Cancer Clinics
ISBN 978-81-322-2582-9 ISBN 978-81-322-2583-6 (eBook)
DOI 10.1007/978-81-322-2583-6
Library of Congress Control Number: 2015953340
Springer New Delhi Heidelberg New York Dordrecht London
© The Editor(s) (if applicable) and The Author(s) 2012
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Cover illustration by Dan Gibbons DCR(R), PgCert(CT)
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India (www.cancerarfoundation.org).
Pref ace
The skull base is an anatomical area located in a confl uence of vital structures and
one of the last zones to be explored surgically. It is unique not only because of its
complex anatomy, but also due to the large variety of tumours which originate in
this region. Recently, with the welcome infusion of new techniques of molecular
pathology, radiology and surgery, the skull base has become easier to study and
approach surgically. These developments have contributed to signifi cant improve-
ments in the outcome of patients with skull base tumours.
S ome textbooks give an excellent introduction to skull base surgery. Their orien-
tation is, however, more towards explaining the various surgical approaches to the
skull base than towards issues related to the clinical management of patients. On the
other hand, most of the original papers in the fi eld present detailed case series while
taking advantage of retrospectively collected data. For many clinicians and sur-
geons, these papers are tedious to read because of an emphasis on a specifi c ques-
tion. As more clinicians from different disciplines are entering the fi eld, there is a
need for a systemic introduction and summary that deals with the important issues
in skull base oncology, without requiring prior knowledge in the fi eld.
This book is committed to a vision of interdisciplinary treatment and education
in skull base surgery. It is meant to be accessible to medical students, residents and
attendings in various disciplines, including otolaryngology, head and neck surgery,
neurosurgery, plastic surgery, maxillofacial surgery and oncology. Throughout, the
emphasis is on the clinical approach to the patient rather than on surgical techniques
per se . We have tried to introduce all the major ideas that a physician involved in
treating these patients would be expected to know—with the exception of surgical
anatomy and technical issues in radiation oncology. Specifi c cases of patients are
discussed throughout this book. This book has three major parts. The fi rst intro-
duces the clinical, pathological and radiological fi ndings of patients with skull base
neoplasms. The second part is more technical and is devoted to the various open and
endoscopic approaches to the skull base. It ends with a presentation of outcomes,
morbidity and postoperative follow-up of these patients, and with proposals about
the management of common problems associated with the long-term consequences
of treatment. Each chapter may be read by itself. Major classical and contemporary
references are given, but the 580 references used here comprise less than 10 % of
the important work in this area. Hence, we must apologize in advance to our many
colleagues whose relevant work is not quoted directly.
vii
viii Preface
Many of our teachers and colleagues contributed to the development of the ideas
which are elaborated upon in these chapters. Also, this book owes much to the Skull
Base Surgery Group at the Tel Aviv Medical Center, and to the physicians, nurses and
members of the paramedical team who are committed to the multidisciplinary team
spirit in our centre. Finally, the assembly of this knowledge would not have been pos-
sible without the encouragement of our parents and the support of our spouses, who
have made a signifi cant contribution to our professional achievements.
Tel Aviv, Israel Ziv Gil
Tel Aviv, Israel Dan M. Fliss
Abbreviations
2D Two-dimensional
3D Three-dimensional
AC Adenocarcinoma
ACC Adenoid cystic carcinoma
AN Acoustic neuroma
ASBS-Q Anterior skull base surgery questionnaire
BCC Basal cell carcinoma
BERA Brainstem-evoked response audiometry
BS Brainstem
CN Cranial nerve
CPA Cerebellopontine angle
CRT Chemoradiotherapy
CSF Cerebrospinal fl uid
C-spine Cervical spine
CT Computerized tomogram
CTA CT angiography
EAC External auditory canal
EBV Epstein-Barr virus
EEA Expanded endonasal approach
EGFR Expanded growth factor receptor
EMA Epithelial membrane antigen
ENA Endonasal approach
FD Fibrous dysplasia
FESS Functional endoscopic sinus surgery
GFAP Glial fi brillary acid protein
H&E Haematoxylin and eosin
HPF High-power fi eld
HPV Human papillomavirus
IAC Internal acoustic canal
IADH Inappropriate antidiuretic hormone
IP Inverted papilloma
ITF Infratemporal fossa
JA Juvenile angiofi broma
LCH Lobular capillary haemangioma
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