21st ICOMS 2013 - Abstracts: Oral Papers 1355
T33.OR001
T33.Skull Base Surgery
Trans-oral posterior maxillary craniofacial surgery to place a sphenopalatine ganglion (SPG)
neurostimulator for treatment of chronic cluster headache (CCH): pathway studies – Hamburg,
Germany surgical experience
A.T. Assaf 1,∗ , M. Blessmann 1 , J. Klatt 1 , P. Pohlenz 1 , T. Jürgens 2 , M. Heiland 1 , A. May 2
1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf,
Martinistrasse 52, 20246 Hamburg, Germany
2 Department of Systems Neuroscience, University Medical Center Hamburg Eppendorf, Martinis-
trasse 52, 20246 Hamburg, Germany
Aim: A new trans-oral surgical approach to the SPG has gained importance due to a new neu-
rostimulation therapy for the treatment of CCH, which is in clinical trials currently. In our center, we
have evaluated the morbidity of this approach for the treatment of CCH.
Methods: Patients meeting the criteria for CCH were implanted with a miniaturized neurostim-
ulator using a minimally invasive trans-oral technique in the dorsal mid facial region as a part of either
the Pathway CH-1 study or the Pathway CH Registry. All patients were implanted under general anes-
thesia with the use of intraoperative 3D CT imaging. Surgical follow-up examinations were performed
to assess adverse events related to the surgical procedure for implanting the neurostimulator.
Results: 11 patients, 9 male and 2 female, with a mean age of 45 years of age, ranged 20–67 years
of age with CCH were implanted with the ATI Neurostimulator. Most patients (10 of 11) experienced
typical side effects from this type of surgery, including post surgical swelling and loss of sensation in
the surgical area with an average time to resolution of 68.9 days, range 3–220 days, and 56.6 days,
range 31–94 days, respectively. Three patients experienced neurostimulation revision procedures, two
due to misplacement of the Neurostimulator lead and one due to lack of efficacy. Efficacy from the
implanted ATI Neurostimulator has been very good, of the 7 patients that have been implanted for 1
year, 6 have responded to SPG stimulation. Three achieve pain relief in >50% of acute headaches and
3 experience a >50% reduction in headache frequency with SPG stimulation at one year.
Conclusion: The trans-oral surgical approach for implantation of the neurostimulator for SPG
stimulation to treat CCH has surgical morbidity consistent with the morbidity reported for other
trans-oral procedures.
http://dx.doi.org/10.1016/j.ijom.2013.07.653
T33.OR002
Approximation to facial translocation: surgical approach to nasosinusal tumours with skull
base involvement
A. De Pablo García-Cuenca ∗ , D. Malet Hernández, C. Bescós Atín
Hospital Vall D’Hebrón, Department of Oral and Maxillofacial Surgery, Spain
Introduction: The facial translocation approach provides a good surgical exposure and tridi-
mensional resection of tumours located in the nasopharynx and skull base. Our aim is to present our
case series to show the surgical field obtained by facial translocation combined with other resections.
Materials and methods: A retrospective revision is presented of the facial translocation cases
(standard or either associated to maxillectomy and/or orbital exenteration) performed by our Depart-
ment. The cases included required this approach for nasosinusal tumour ablation, benign or malignant,
with skull base involvement.
Results: A total of 11 cases are presented, including 8 malignant tumours (4 sarcomas, 1 adenoid
cystic carcinoma, 2 squamous cell carcinomas, and 1 basosquamous carcinoma) and 3 benign (1
fibrous dysplasia, 1 ameloblastoma, 1 cylindroma). 8 cases included a maxillectomy and in 7 cases
and orbital exanteration was performed.
Conclusions: Facial translocation is indicated for resection of big benign and malignant low
grade tumours affecting the nasosinusal territory with skull base involvement. Its main disadvantage
is the lack of cervical neurovascular control, and it can produce aesthetic sequelae.
Key words: facial translocation; nasosinusal tumours; skull base
http://dx.doi.org/10.1016/j.ijom.2013.07.654
T33.OR003
Description of six trigeminal neurinomas with different location and extension. Analyze of
differents surgical approaches
A. Encinas Bascones 1,∗ , T. Garcia 2 , S. Rosón 3 , C. Colmenero Ruiz 3
1 Hospital Clinico San Carlos, Spain
2 Hospital Universitario de la Princesa, Spain
3 Private Practice, Madrid, Spain
Objectives: To analyze the surgical management of six trigeminal neurinomas and the different
approaches performed by our neurosurgery and maxillofacial team.
Material and methods: We present six cases of trigeminal neurinoma with a massive involve-
ment of the skull base. The tumours presented extension to the infratemporal fossa and the masticatory
space. All cases presented invasion of the cavernous sinus. One case demonstrated an invasion of the
infratemporal fossa, another the posterior fossa and one case growed along the third trigeminal branch
to the lower lip.
Discussion: The surgical approach was a facial translocation in four cases and a preauricular-
subtemporal approach in two cases. Mandibular osteotomies were performed in five cases. The skull
base defect was reconstructed in four cases with a temporalis muscle flap and in two cases with a
rectus abdominis myocutaneous microvascular flap. All cases had a total tumour excision. Only two
complications were observed: eyelid retraction and facial paresis. After a postoperative follow-up of
10 years, any tumoural recurrences were observed (0%). One patient died of malignant transformation
to neurosarcoma.
Conclusions: Radical surgery is associated with an excellent clinical outcome and a good long-
term tumour control.
http://dx.doi.org/10.1016/j.ijom.2013.07.655
T33.OR004
Sphenopalatine ganglion (SPG) neurostimulator placement for treatment of severe headaches
using a trans-oral posterior maxillary approach
S. Hillerup 2,∗ , M. Puche 3 , M. Blessmann 4 , O. Müller 5 , A. Wilmont 7 , P. Pohlenz 4 ,
D.Fontaine 6 , A. Caparso 1 , F. Papay 8
1 Autonomic Technologies, Inc., United States
2 Department of Oral and Maxillofacial Surgery, Rigshospitalet and Dental School, University of
Copenhagen, Copenhagen, Denmark
3 Department of Oral and Maxillofacial Surgery, University of Valencia, Valencia, Spain
4 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany
5 Department of Neurosurgery, University Hospital Essen, Essen, Germany
6 Department of Neurosurgery, Hôpital Pasteur, Nice, France
7 Department of Maxillofacial Head and Neck, Plastic and Reconstructive Surgery – CHR de la
Citadelle, Liège University, Liège, Belgium
8 Dermatology and Plastic Surgery Institute, Institute Chair, Cleveland Clinic, Cleveland, OH, United
States
Background and objectives: The SPG plays a primary role in the pathogenesis of pain and
autonomic symptoms associated with primary headaches. Our objective is to analyze the results from
the initial surgical experiences.
Methods: Patients were implanted with a miniaturized neurostimulator using a minimally inva-
sive trans-oral technique under general anaesthesia. The neurostimulator, which consists of an integral
lead, body and fixation plate, is implanted such that the distal lead is within the pterygopalatine fossa
and the fixation plate is anchored on the zygomaticomaxillary buttress.
Results: Ninety patients have undergone implantation of the ATITM Neurostimulator. Surgeries
have been performed by 14 surgeons; 97% of cases have resulted in successful implantation and no
infections resulting in explants occurred. With experience, the absolute time and standard deviation of
the surgical duration is reduced by a third. Typical post surgical adverse events were reported, including
sensory nerve dysfunction and pain, in most patients. These surgical sequelae are typically mild and
resolve within 90 days. These sequelae and their severities have decreased since the introduction of
a new surgical instrument.
Conclusions: The initial experience with this procedure has shown an acceptable safety profile
and risk-benefit profile for patients who suffer from severe, medically intractable headaches.
http://dx.doi.org/10.1016/j.ijom.2013.07.656