Block-Resection of the Orbit and Pyramid of the Temporal Bone in Spindle Cell Carcinoma of the Skull Base

V.E. Olyushin, D.A. Gulyaev, A.Yu. Shcherbuk, S.Ya. Chebotarev, N.V. Kolakutsky, O.Yu. Petropavlovskaya, N.Yu. Petropavlovskaya

(Polenov Research Neurosurgical Institute, Saint Petersburg
Pavlov State Medical University, Saint Petersburg
Faculty of Surgical Stomatology, Saint Petersburg)

Male patient D., aged 24, was ill during 4 years. The disease onset was characterized by diplopia, which appeared at a look down, headaches of a meningeal-vascular character. A mass in the area of the right orbit was diagnosed at the place of his residence. He was subject to 2 courses of radiotherapy and 6 courses of chemotherapy. There was aggravation of a state, watched during several months. It manifested itself in stronger headaches, pain in the right half of a face, more marked edema of soft tissues, anabrosis in the area of the lower lid of the right eye, loss of vision in it.

A neurological picture was conditioned by lesion of the second, third, fourth, fifth, sixth, seventh and eighth cranial nerves on the right, left-side pyramidal symptoms. EEG data were indicative of marked irritation of stem structures.

An operation for a craniofacial tumor was performed on May 6, 2004. It included removal of a tumor of the right orbit, pyramid, right temporal bone, upper jaw and replacement of a defect of soft tissues and the skull base with an advanced thoraco-dorsal flap. A postoperative course was severe and characterized by meningoencephalitis and secondary necrosis of soft tissues. There was healing by second intention. The patient was discharged in a compensated state. The flap took root completely. A score according to Karnofsky’s scale was 70.

The demonstration goal was to illustrate potentialities of block-resections of the skull base with a good postoperative functional result.