BACKGROUND: Breast cancer (BC) is a frequent malignant disease which tends to develop distant metastases, but only very rarely in the head and neck region. CASE REPORT: We present two case reports of patients with metastases of invasive BC in this area. They are of different clinical manifestation with different time relation to the primary tumor and different symptomatology. In the case of the first patient, a few years without evidence of malignant disease after treatment of primary tumor in complete remission. In the case of the second patient, as the first symptom of undiagnosed disease. Metastases were clinically observed in the skull base and maxillary sinus, manifesting neurologically with foramen jugulare syndrome and orbital symptoms, resp. In both cases, correlations between histological and clinical findings were essential for diagnosis. Palliative multimodal treatment was then employed. CONCLUSION: Metastases of BC in the head and neck region occur only very rarely. The extremely variable symptomatology depends on the location of the metastasis and the affected structures. This might be a pitfall for diagnostics, especially in cases of an unidentified primary breast tumor, which may result in a delay of correct diagnosis. In addition, the correlation between histopathological and clinical findings might be of great relevance in these cases. Key words: skull base metastasis - breast cancer - foramen jugulare syndrome.

• Klíčová slova
• skull base metastasis - breast cancer - foramen jugulare syndrome,
• MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory baze lební diagnostické zobrazování   sekundární   chirurgie   MeSH
• nádory prsu diagnostické zobrazování   patologie   chirurgie   MeSH
• počítačová rentgenová tomografie MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Even the most delicate endonasal surgery for skull base lesion causes changes in the nasal cavity, some of them permanent. Morphological changes in the nasal cavity and their consequences (changes in nasal airflow) are often studied by advanced numerical analysis called computational fluid dynamics. This review summarizes current knowledge of endoscopic transsphenoidal skull base surgery effects on nasal airflow. Several studies have shown that endoscopic skull base surgery changes nasal anatomy to the extent that nasal airflow changes significantly postoperatively. Removing any intranasal structure increases the cross-sectional area of the respective nasal meatus, leading to increased nasal airflow in this area while airflow in the narrower periphery decreases. Middle turbinate resection increases airflow in the middle meatus and reduces airflow in the superior and inferior meatus. Small posterior septectomy does not cause a significant change in nasal airflow. Nasal septum deviation is an important factor in airflow changes. Current studies describe nasal changes after rather extensive procedures (e.g., middle turbinectomy, ethmoidectomy) that are unnecessary in routine pituitary adenoma surgery. No studies have compared changes using pre- and postoperative scans of the same patients after actual surgery.

• Klíčová slova
• Computational fluid dynamics, Endoscopic surgery, Nasal airflow, Olfaction, Skull base, Transsphenoidal approach,
• MeSH
• baze lební * chirurgie   MeSH
• endoskopie * metody   MeSH
• lidé MeSH
• nosní dutina chirurgie   anatomie a histologie   MeSH
• nosní přepážka chirurgie   MeSH
• nosní skořepy chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Skull base osteomyelitis (SBO) also commonly known as malignant otitis externa was first described by Meltzer and Kelemen in 1959. Prior to the advent of the antibiotic era, this disease carried a poor prognosis with significant morbidity. It often proved fatal with mortality rates as high as 50%. Commonly seen in the immunocompromised patients, diabetes mellitus is an important associated comorbidity in the pathophysiologic development of this disease. Treatment is instituted by medical therapy with surgery having a limited role. Surgical intervention has a limited role, for example, in fungal SBO. Such cases may require local debridement and intraoperative tissue biopsies for histopathologic confirmation. This is to demonstrate fungal invasion into the skull base, as well as to exclude other sinister differential diagnoses like squamous cell carcinoma of temporal bone. In this case report, we present a rare case of candida SBO and the literature review.

• Klíčová slova
• candida, fungal, osteomyelitis, otitis externa, skull base,
• MeSH
• antibakteriální látky terapeutické užití   MeSH
• antifungální látky terapeutické užití   MeSH
• baze lební MeSH
• flukonazol terapeutické užití   MeSH
• kandidóza komplikace   MeSH
• komplikace diabetu komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteomyelitida farmakoterapie   mikrobiologie   MeSH
• otitis externa farmakoterapie   mikrobiologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH
• Názvy látek
• antibakteriální látky MeSH
• antifungální látky MeSH
• flukonazol MeSH

OBJECTIVE: To provide an analysis of patients with spontaneous skull base meningoencephaloceles (MECs) to determine whether definitive surgical treatment requires management of elevated intracranial pressure (ICP). METHODS: Data of 10 subjects with spontaneous MECs were collected and retrospectively evaluated. Measurement of ICP, prior interventions, treatment with acetazolamide, and characteristics of long-term elevated ICP, among others, were analyzed. Our own indications for cerebrospinal fluid (CSF) diversion and use of postoperative external lumbar drain were analyzed as well. RESULTS: The sphenoid region was the most common location of MECs. CSF leak was diagnosed in all subjects. The most common graphical signs of elevated ICP were empty sella and arachnoid pits, both of which were present in 90% of cases. Lumbar puncture with opening pressure measurement was performed in 7 patients. Ventriculoperitoneal shunt insertion was indicated in 4 cases before skull base repair and in 2 cases after skull base repair. Two postoperative CSF leaks were managed with external lumbar drain and subsequent shunt installation. CONCLUSIONS: Spontaneous MECs are often associated with CSF leak. ICP assessment should be a standard of care to ensure successful operative repair of MECs. Insertion of a CSF diversion device must be considered where direct or indirect signs of intracranial hypertension are present.

• Klíčová slova
• Cerebrospinal fluid leak, Intracranial hypertension, Meningoencephalocele, Skull base surgery,
• MeSH
• baze lební diagnostické zobrazování   chirurgie   MeSH
• encefalokéla komplikace   diagnostické zobrazování   chirurgie   MeSH
• intrakraniální hypertenze * etiologie   chirurgie   diagnóza   MeSH
• lidé MeSH
• meningokéla * komplikace   diagnostické zobrazování   chirurgie   MeSH
• retrospektivní studie MeSH
• rinorea mozkomíšního moku * chirurgie   MeSH
• únik mozkomíšního moku chirurgie   komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Osteosarcoma of the jaw is uncommon, occurring in about 6% to 8% of cases. The authors present the case report of a (woman 72-year-old) with osteosarcoma involving the temporomandibular joint (TMJ). Radical surgery was chosen with resection of the tumor together with the condyle, the coronoid process, the zygomatic arch and eroded bone of the skull base at the site of the joint cavity. Contact of the tumor with the dura mater was not confirmed perioperatively.Reconstruction of the TMJ was 24 months after resection. The fossa component was concurrently formed in such a way as to cover the defect in the skull base and allow the reconstruction of the fossa and resected zygomatic arch. Four years after tumor resection there are no signs of local recurrence or metastases. Two years after TMJ reconstruction, the patient is symptom-free-occlusion is satisfactory, jaw movement is within normal range.

• MeSH
• baze lební chirurgie   MeSH
• lidé MeSH
• nemoci temporomandibulárního kloubu * diagnóza   chirurgie   MeSH
• osteosarkom * chirurgie   MeSH
• protézy kloubů * MeSH
• senioři MeSH
• temporomandibulární kloub chirurgie   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• baze lební chirurgie   MeSH
• lidé MeSH
• meningeální nádory chirurgie   MeSH
• meningeom chirurgie   MeSH
• nádory baze lební chirurgie   MeSH
• nervová síť chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Objective Meningiomas are the second most common tumors in neurofibromatosis type 2 (NF-2). Microsurgery is challenging in NF-2 patients presenting with skull base meningiomas due to the intrinsic risks and need for multiple interventions over time. We analyzed treatment outcomes and complications after primary Gamma Knife radiosurgery (GKRS) to delineate its role in the management of these tumors. Methods An international multicenter retrospective study approved by the International Radiosurgery Research Foundation was performed. NF-2 patients with at least one growing and/or symptomatic skull base meningioma and 6-month follow-up after primary GKRS were included. Clinical and radiosurgical parameters were recorded for analysis. Results In total, 22 NF-2 patients with 54 skull base meningiomas receiving GKRS as primary treatment met inclusion criteria. Median age at GKRS was 38 years (10-79 years). Most lesions were located in the posterior fossa (55.6%). Actuarial progression free survival (PFS) rates were 98.1% at 2 years and 90.0% at 5 and 10 years. The median follow-up time after initial GKRS was 5.0 years (0.6-25.5 years). Tumor volume at GKRS was a predictor of tumor control. Lesions >5.5 cc presented higher chances to progress after radiosurgery ( p = 0.043). Three patients (13.64%) developed adverse radiation effects. No malignant transformation or death due to meningioma or radiosurgery was reported. Conclusions GKRS is effective and safe in the management of skull base meningiomas in NF-2 patients. Tumor volume deserve greater relevance during clinical decision-making regarding the most appropriate time to treat. GKRS offers a minimally invasive approach of particular interest in this specific group of patients.

• Klíčová slova
• gamma knife radiosurgery, meningioma, neurofibromatosis type 2, skull base,
• Publikační typ
• časopisecké články MeSH

Despite the importance of functional outcome, only a few scoring systems exist to predict neurologic outcome in meningioma surgery. Therefore, our study aims to identify preoperative risk factors and develop the receiver operating characteristics (ROC) models estimating the risk of a new postoperative neurologic deficit and a decrease in Karnofsky performance status (KPS). A multicentric study was conducted in a cohort of 552 consecutive patients with skull base meningiomas who underwent surgical resection from 2014 to 2019. Data were gathered from clinical, surgical, and pathology records as well as radiological diagnostics. The preoperative predictive factors of functional outcome (neurologic deficit, decrease in KPS) were analyzed in univariate and multivariate stepwise selection analyses. Permanent neurologic deficits were present in 73 (13.2%) patients and a postoperative decrease in KPS in 84 (15.2%). Surgery-related mortality was 1.3%. A ROC model was developed to estimate the probability of a new neurologic deficit (area 0.74; SE 0.0284; 95% Wald confidence limits (0.69; 0.80)) based on meningioma location and diameter. Consequently, a ROC model was developed to predict the probability of a postoperative decrease in KPS (area 0.80; SE 0.0289; 95% Wald confidence limits (0.74; 0.85)) based on the patient's age, meningioma location, diameter, presence of hyperostosis, and dural tail. To ensure an evidence-based therapeutic approach, treatment should be founded on known risk factors, scoring systems, and predictive models. We propose ROC models predicting the functional outcome of skull base meningioma resection based on the age of the patient, meningioma size, and location and the presence of hyperostosis and dural tail.

• Klíčová slova
• Karnofsky Performance Status Scale, Meningioma, Outcomes, Predictive factors, Skull base, Surgery,
• MeSH
• baze lební MeSH
• hyperostóza * MeSH
• lidé MeSH
• meningeální nádory * MeSH
• meningeom * MeSH
• nádory baze lební * MeSH
• prognóza MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

AIM: To present the technical principles of the hydrogen peroxide head preparation method, and to demonstrate the high quality of anatomical studies performed using these specimens, particularly for arachnoid exploration. MATERIAL AND METHODS: Five cadaveric heads were set with a 10% formalin solution and then injected with coloured latex. Thereafter, the heads were bleached with hydrogen peroxide solution 20%. Anatomical dissection of all specimens was performed. The skull base was drilled, dura mater gradually resected and outer arachnoid membranes examined and opened. The topographical anatomy was studied. RESULTS: All soft tissues, the brain, cranial nerves, the vasculature, the dura mater and even the arachnoid, were macroscopically intact, which enabled high-quality skull base specimens. In addition, the bone was softened, facilitating the drilling process. The topographical anatomy of anterior clinoid process was selected as an example and depicted in photos. CONCLUSION: High-quality anatomical specimens were obtained using the hydrogen peroxide head preparation. The topographic anatomy was studied from a unique downside-up angle, as well as by following the passage of the key neurovascular structures during its course. We propose the use of this method in neurosurgical training, especially to practice extradural approaches. Moreover this method seems promising as a complementary method for arachnoid studies.

• MeSH
• baze lební anatomie a histologie   diagnostické zobrazování   chirurgie   MeSH
• dura mater MeSH
• klínová kost MeSH
• lidé MeSH
• mrtvola MeSH
• neurochirurgické výkony * MeSH
• peroxid vodíku * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• peroxid vodíku * MeSH

The histological grade is crucial for therapeutic management, and its reliable preoperative detection can significantly influence treatment approach. Lacking established risk factors, this study identifies preoperative predictors of high-grade skull base meningiomas and discusses the implications of non-invasive detection. A multicentric study was conducted on 552 patients with skull base meningiomas who underwent primary surgical resection between 2014 and 2019. Data were gathered from clinical, surgical and pathology records and radiological diagnostics. The predictive factors of higher WHO grade were analysed in univariate analysis and multivariate stepwise selection logistic regression analysis. Histological analysis revealed 511 grade 1 (92.6%) and 41 grade 2 (7.4%) meningiomas. A prognostic model predicting the probability of WHO grade 2 skull base meningioma (AUC 0.79; SE 0.04; 95% Wald Confidence Limits (0.71; 0.86)) based on meningioma diameter, presence of an arachnoid plane and cranial nerve palsy was built. Accurate preoperative detection of WHO grade in skull base meningiomas is essential for effective treatment planning. Our logistic regression model, based on diameter, cranial nerve palsy, and arachnoid plane, is tailored for detecting WHO grade 2 skull base meningiomas, even in outpatient settings.

• Klíčová slova
• Case series, Meningioma, Risk factors, Skull base, Surgery, Tumor grading,
• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• meningeální nádory * patologie   chirurgie   diagnostické zobrazování   MeSH
• meningeom * patologie   chirurgie   diagnostické zobrazování   MeSH
• mladý dospělý MeSH
• nádory baze lební * patologie   chirurgie   diagnostické zobrazování   MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stupeň nádoru * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH