,To access the additional media content available with this e-book via Thieme MedOne,
please use the code and follow the instructions provided at the back of the e-book.
,
,
,Controversies in Skull Base Surgery
Andrew S. Little, MD
Assistant Professor
Department of Neurosurgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona, USA
Michael A. Mooney, MD
Resident
Department of Neurosurgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona, USA
99 illustrations
On the cover
The illustration depicts three different skull base surgical options: expanded, endoscopic
endonasal surgery, transcranial microsurgery, and radiosurgery.
Thieme
New York • Stuttgart • Delhi • Rio de Janeiro
,Executive Editor: Timothy Y. Hiscock Important note: Medicine is an ever-changing science undergo-
Managing Editor: Sarah Landis ing continual development. Research and clinical experience are
Director, Editorial Services: Mary Jo Casey continually expanding our knowledge, in particular our knowl-
Production Editor: Naamah Schwartz edge of proper treatment and drug therapy. Insofar as this book
International Production Director: Andreas Schabert mentions any dosage or application, readers may rest assured that
Editorial Director: Sue Hodgson the authors, editors, and publishers have made every effort to
International Marketing Director: Fiona Henderson ensure that such references are in accordance with the state of
International Sales Director: Louisa Turrell knowledge at the time of production of the book.
Director of Institutional Sales: Adam Bernacki Nevertheless, this does not involve, imply, or express any
Senior Vice President and Chief Operating Officer: Sarah Vanderbilt guarantee or responsibility on the part of the publishers in respect
President: Brian D. Scanlan to any dosage instructions and forms of applications stated in the
book. Every user is requested to examine carefully the manufac-
Library of Congress Cataloging-in-Publication Data turers’ leaflets accompanying each drug and to check, if necessary
Names: Little, Andrew S., editor. | Mooney, Michael A. in consultation with a physician or specialist, whether the dosage
(Neurosurgeon), editor. Title: Controversies in skull base surgery schedules mentioned therein or the contraindications stated by the
/ [edited by] Andrew S. Little, Michael A. Mooney. manufacturers differ from the statements made in the present
Description: New York : Thieme, [2019] book. Such examination is particularly important with drugs that
Identifiers: LCCN 2019005266| ISBN 9781626239531 (hardcover) | are either rarely used or have been newly released on the market.
ISBN 9781626239548 (e-book) Every dosage schedule or every form of application used is entirely
Subjects: | MESH: Skull Base–surgery Classification: LCC RD529 | at the user’s own risk and responsibility. The authors and publishers
NLM WE 705 | DDC 617.5/14–dc23 LC record available at https:// request every user to report to the publishers any discrepancies or
lccn.loc.gov/2019005266 inaccuracies noticed. If errors in this work are found after publi-
cation, errata will be posted at www.thieme.com on the product
© 2019 Thieme Medical Publishers, Inc. description page.
Some of the product names, patents, and registered designs
Thieme Publishers New York referred to in this book are in fact registered trademarks or pro-
333 Seventh Avenue, New York, NY 10001 USA prietary names even though specific reference to this fact is not
+1 800 782 3488, always made in the text. Therefore, the appearance of a name
without designation as proprietary is not to be construed as a
Thieme Publishers Stuttgart representation by the publisher that it is in the public domain.
Rüdigerstrasse 14, 70469 Stuttgart, Germany
+49 [0]711 8931 421,
Thieme Publishers Delhi
A-12, Second Floor, Sector-2, Noida-201301
Uttar Pradesh, India
+91 120 45 566 00,
Thieme Publishers Rio de Janeiro, Thieme Publicações Ltda.
Edifício Rodolpho de Paoli, 25º andar
Av. Nilo Peçanha, 50 – Sala 2508
Rio de Janeiro 20020-906 Brasil
+55 21 3172-2297 / +55 21 3172-1896
www.thiemerevinter.com.br
Barrow Neurological Institute holds copyright to all diagnostic
images, photographs, intraoperative videos, animations, and art,
including the cover art, used in this work and the accompanying
digital content, unless otherwise stated. Used with permission from
Barrow Neurological Institute, Phoenix, Arizona.
Cover design: Thieme Publishing Group
Cover art: Peter M. Lawrence, MS, CMI
Typesetting by Thomson Digital, India
Printed in The Unites States of America by
King Printing Company, Inc. 54321 This book, including all parts thereof, is legally protected by
copyright. Any use, exploitation, or commercialization outside the
ISBN 978-1-62623-953-1 narrow limits set by copyright legislation, without the publisher’s
consent, is illegal and liable to prosecution. This applies in partic-
Also available as an e-book: ular to photostat reproduction, copying, mimeographing, prepa-
eISBN 978-1-62623-954-8 ration of microfilms, and electronic data processing and storage.
,This book is dedicated to my family, whose love and support has cleared the path to
complete this project and has never failed to inspire me.
Andrew S. Little
To my wife and children for their support.
To my colleagues and mentors at Barrow Neurological Institute for their inspiration.
Michael A. Mooney
,
,Contents
Video Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
Part I Vestibular Schwannoma
1 Controversies in the Natural History of Acoustic Neuromas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Mark E. Whitaker
2 Controversies in Radiosurgery for Acoustic Neuromas: Single-Session Therapy versus
Hypofractionated Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
David S. Xu, Colin J. Przybylowski, Andrew J. Meeusen, and Randall W. Porter
3 Management of Residual Vestibular Schwannoma After Subtotal Resection:
Observation, Repeat Surgery, or Radiosurgery? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Scott Brigeman and Kaith K. Almefty
4 Treatment Strategies for Small Intracanalicular Vestibular Schwannomas in Young
Patients with Good Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Daniel A. Donoho, Ben A. Strickland, Jonathan J. Russin, Rick A. Friedman, and Steven L. Giannotta
Part II Meningioma
5 Transcranial Approaches Are Preferred for Certain Tuberculum and Olfactory Groove
Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Farshad Nassiri, Suganth Suppiah, and Gelareh Zadeh
6 Endoscopic Endonasal Surgery Is the Best Treatment for Certain Anterior Fossa Skull
Base Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Douglas A. Hardesty, Alaa S. Montaser, Alexandre B. Todeschini, Ricardo L. Carrau, and Daniel M. Prevedello
7 Controversies in the Management of Petroclival Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Robert S. Heller and Carl B. Heilman
8 Does Embolization Have a Role to Play in the Treatment of Skull Base
Meningiomas? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Colin J. Przybylowski, Jacob F. Baranoski, Rami O. Almefty, Dale Ding, Andrew F. Ducruet,
and Felipe C. Albuquerque
9 The Role of Radiotherapy for Atypical and Anaplastic Meningiomas . . . . . . . . . . . . . . . . . . . . . . . 48
Brooke K. Leachman, Stephanie E. Weiss, and Leland Rogers
10 Emerging Chemotherapy and Targeted Therapy for Aggressive Meningiomas . . . . . . . . . . . . 58
Yoko Fujita, Ben K. Hendricks, and Nader Sanai
v
, Contents
Part III Pituitary Adenoma
11 The Role of Transsphenoidal Surgery Following Nondiagnostic Inferior Petrosal Sinus
Sampling in Cushing Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Pamela S. Jones and Brooke Swearingen
12 Pharmacotherapy Options After Failed Surgery for Cushing Disease . . . . . . . . . . . . . . . . . . . . . . . . 70
Kevin C. J. Yuen
13 Primary Medical Therapy for Acromegaly, Ready for Prime Time? .......................... 78
Elana V. Varlamov, Winnie Liu, Shirley McCartney, Justin S. Cetas, and Maria Fleseriu
14 The Role of Radiosurgery for Pituitary Adenomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Gabriella Paisan, Ching-Jen Chen, and Jason Sheehan
15 Exploration of the Cavernous Sinus Is Effective During Transsphenoidal Surgery for
Pituitary Adenoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Engelbert J. Knosp and Alexander S.G. Micko
16 Surgery versus Medical Management: First-Line Treatment for Pituitary Apoplexy . . . . . . . 96
Garni Barkhoudarian, Sheri Palejwala, and Daniel F. Kelly
17 Alternative Treatment Strategies for Atypical and Aggressive Pituitary Adenomas . . . . . . . 102
Gregory K. Hong
Part IV Craniopharyngioma
18 Controversies in Radical Resection versus Subtotal Resection with Radiation in
Craniopharyngioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Taylor J. Abel and James T. Rutka
19 The Role of Open and Endoscopic Approaches to Craniopharyngiomas .................... 116
Neil Majmundar, Jean Anderson Eloy, and James K. Liu
20 The Molecular Pathogenesis of Craniopharyngioma and Potential Therapeutic Targets . . 125
Douglas A. Hardesty
Part V Rathke Cleft Cyst and Other Sellar Lesions
21 Resection versus Cyst Fenestration: The Best Treatment for Rathke Cleft Cysts ........... 131
22 Headache in Patients with Rathke Cleft Cysts ................................................. 137
Justin L. Hoskin, Kevin C. J. Yuen, and Kerry L. Knievel
23 Rathke Cleft Cyst Surgery: Indications, Outcomes, and Complications ..................... 141
David L. Penn and Edward R. Laws Jr.
24 Controversies in the Management of Histiocytosis and Xanthogranulomas ............... 147
Christina E. Sarris and Ruth E. Bristol
Part VI Other Cranial Tumors
25 Surgical Approach Selection for Skull Base Chordoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Paul A. Gardner, Ahmed Jorge, Juan C. Fernandez-Miranda, Eric W. Wang, and Carl H. Snyderman
vi
please use the code and follow the instructions provided at the back of the e-book.
,
,
,Controversies in Skull Base Surgery
Andrew S. Little, MD
Assistant Professor
Department of Neurosurgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona, USA
Michael A. Mooney, MD
Resident
Department of Neurosurgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona, USA
99 illustrations
On the cover
The illustration depicts three different skull base surgical options: expanded, endoscopic
endonasal surgery, transcranial microsurgery, and radiosurgery.
Thieme
New York • Stuttgart • Delhi • Rio de Janeiro
,Executive Editor: Timothy Y. Hiscock Important note: Medicine is an ever-changing science undergo-
Managing Editor: Sarah Landis ing continual development. Research and clinical experience are
Director, Editorial Services: Mary Jo Casey continually expanding our knowledge, in particular our knowl-
Production Editor: Naamah Schwartz edge of proper treatment and drug therapy. Insofar as this book
International Production Director: Andreas Schabert mentions any dosage or application, readers may rest assured that
Editorial Director: Sue Hodgson the authors, editors, and publishers have made every effort to
International Marketing Director: Fiona Henderson ensure that such references are in accordance with the state of
International Sales Director: Louisa Turrell knowledge at the time of production of the book.
Director of Institutional Sales: Adam Bernacki Nevertheless, this does not involve, imply, or express any
Senior Vice President and Chief Operating Officer: Sarah Vanderbilt guarantee or responsibility on the part of the publishers in respect
President: Brian D. Scanlan to any dosage instructions and forms of applications stated in the
book. Every user is requested to examine carefully the manufac-
Library of Congress Cataloging-in-Publication Data turers’ leaflets accompanying each drug and to check, if necessary
Names: Little, Andrew S., editor. | Mooney, Michael A. in consultation with a physician or specialist, whether the dosage
(Neurosurgeon), editor. Title: Controversies in skull base surgery schedules mentioned therein or the contraindications stated by the
/ [edited by] Andrew S. Little, Michael A. Mooney. manufacturers differ from the statements made in the present
Description: New York : Thieme, [2019] book. Such examination is particularly important with drugs that
Identifiers: LCCN 2019005266| ISBN 9781626239531 (hardcover) | are either rarely used or have been newly released on the market.
ISBN 9781626239548 (e-book) Every dosage schedule or every form of application used is entirely
Subjects: | MESH: Skull Base–surgery Classification: LCC RD529 | at the user’s own risk and responsibility. The authors and publishers
NLM WE 705 | DDC 617.5/14–dc23 LC record available at https:// request every user to report to the publishers any discrepancies or
lccn.loc.gov/2019005266 inaccuracies noticed. If errors in this work are found after publi-
cation, errata will be posted at www.thieme.com on the product
© 2019 Thieme Medical Publishers, Inc. description page.
Some of the product names, patents, and registered designs
Thieme Publishers New York referred to in this book are in fact registered trademarks or pro-
333 Seventh Avenue, New York, NY 10001 USA prietary names even though specific reference to this fact is not
+1 800 782 3488, always made in the text. Therefore, the appearance of a name
without designation as proprietary is not to be construed as a
Thieme Publishers Stuttgart representation by the publisher that it is in the public domain.
Rüdigerstrasse 14, 70469 Stuttgart, Germany
+49 [0]711 8931 421,
Thieme Publishers Delhi
A-12, Second Floor, Sector-2, Noida-201301
Uttar Pradesh, India
+91 120 45 566 00,
Thieme Publishers Rio de Janeiro, Thieme Publicações Ltda.
Edifício Rodolpho de Paoli, 25º andar
Av. Nilo Peçanha, 50 – Sala 2508
Rio de Janeiro 20020-906 Brasil
+55 21 3172-2297 / +55 21 3172-1896
www.thiemerevinter.com.br
Barrow Neurological Institute holds copyright to all diagnostic
images, photographs, intraoperative videos, animations, and art,
including the cover art, used in this work and the accompanying
digital content, unless otherwise stated. Used with permission from
Barrow Neurological Institute, Phoenix, Arizona.
Cover design: Thieme Publishing Group
Cover art: Peter M. Lawrence, MS, CMI
Typesetting by Thomson Digital, India
Printed in The Unites States of America by
King Printing Company, Inc. 54321 This book, including all parts thereof, is legally protected by
copyright. Any use, exploitation, or commercialization outside the
ISBN 978-1-62623-953-1 narrow limits set by copyright legislation, without the publisher’s
consent, is illegal and liable to prosecution. This applies in partic-
Also available as an e-book: ular to photostat reproduction, copying, mimeographing, prepa-
eISBN 978-1-62623-954-8 ration of microfilms, and electronic data processing and storage.
,This book is dedicated to my family, whose love and support has cleared the path to
complete this project and has never failed to inspire me.
Andrew S. Little
To my wife and children for their support.
To my colleagues and mentors at Barrow Neurological Institute for their inspiration.
Michael A. Mooney
,
,Contents
Video Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
Part I Vestibular Schwannoma
1 Controversies in the Natural History of Acoustic Neuromas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Mark E. Whitaker
2 Controversies in Radiosurgery for Acoustic Neuromas: Single-Session Therapy versus
Hypofractionated Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
David S. Xu, Colin J. Przybylowski, Andrew J. Meeusen, and Randall W. Porter
3 Management of Residual Vestibular Schwannoma After Subtotal Resection:
Observation, Repeat Surgery, or Radiosurgery? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Scott Brigeman and Kaith K. Almefty
4 Treatment Strategies for Small Intracanalicular Vestibular Schwannomas in Young
Patients with Good Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Daniel A. Donoho, Ben A. Strickland, Jonathan J. Russin, Rick A. Friedman, and Steven L. Giannotta
Part II Meningioma
5 Transcranial Approaches Are Preferred for Certain Tuberculum and Olfactory Groove
Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Farshad Nassiri, Suganth Suppiah, and Gelareh Zadeh
6 Endoscopic Endonasal Surgery Is the Best Treatment for Certain Anterior Fossa Skull
Base Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Douglas A. Hardesty, Alaa S. Montaser, Alexandre B. Todeschini, Ricardo L. Carrau, and Daniel M. Prevedello
7 Controversies in the Management of Petroclival Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Robert S. Heller and Carl B. Heilman
8 Does Embolization Have a Role to Play in the Treatment of Skull Base
Meningiomas? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Colin J. Przybylowski, Jacob F. Baranoski, Rami O. Almefty, Dale Ding, Andrew F. Ducruet,
and Felipe C. Albuquerque
9 The Role of Radiotherapy for Atypical and Anaplastic Meningiomas . . . . . . . . . . . . . . . . . . . . . . . 48
Brooke K. Leachman, Stephanie E. Weiss, and Leland Rogers
10 Emerging Chemotherapy and Targeted Therapy for Aggressive Meningiomas . . . . . . . . . . . . 58
Yoko Fujita, Ben K. Hendricks, and Nader Sanai
v
, Contents
Part III Pituitary Adenoma
11 The Role of Transsphenoidal Surgery Following Nondiagnostic Inferior Petrosal Sinus
Sampling in Cushing Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Pamela S. Jones and Brooke Swearingen
12 Pharmacotherapy Options After Failed Surgery for Cushing Disease . . . . . . . . . . . . . . . . . . . . . . . . 70
Kevin C. J. Yuen
13 Primary Medical Therapy for Acromegaly, Ready for Prime Time? .......................... 78
Elana V. Varlamov, Winnie Liu, Shirley McCartney, Justin S. Cetas, and Maria Fleseriu
14 The Role of Radiosurgery for Pituitary Adenomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Gabriella Paisan, Ching-Jen Chen, and Jason Sheehan
15 Exploration of the Cavernous Sinus Is Effective During Transsphenoidal Surgery for
Pituitary Adenoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Engelbert J. Knosp and Alexander S.G. Micko
16 Surgery versus Medical Management: First-Line Treatment for Pituitary Apoplexy . . . . . . . 96
Garni Barkhoudarian, Sheri Palejwala, and Daniel F. Kelly
17 Alternative Treatment Strategies for Atypical and Aggressive Pituitary Adenomas . . . . . . . 102
Gregory K. Hong
Part IV Craniopharyngioma
18 Controversies in Radical Resection versus Subtotal Resection with Radiation in
Craniopharyngioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Taylor J. Abel and James T. Rutka
19 The Role of Open and Endoscopic Approaches to Craniopharyngiomas .................... 116
Neil Majmundar, Jean Anderson Eloy, and James K. Liu
20 The Molecular Pathogenesis of Craniopharyngioma and Potential Therapeutic Targets . . 125
Douglas A. Hardesty
Part V Rathke Cleft Cyst and Other Sellar Lesions
21 Resection versus Cyst Fenestration: The Best Treatment for Rathke Cleft Cysts ........... 131
22 Headache in Patients with Rathke Cleft Cysts ................................................. 137
Justin L. Hoskin, Kevin C. J. Yuen, and Kerry L. Knievel
23 Rathke Cleft Cyst Surgery: Indications, Outcomes, and Complications ..................... 141
David L. Penn and Edward R. Laws Jr.
24 Controversies in the Management of Histiocytosis and Xanthogranulomas ............... 147
Christina E. Sarris and Ruth E. Bristol
Part VI Other Cranial Tumors
25 Surgical Approach Selection for Skull Base Chordoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Paul A. Gardner, Ahmed Jorge, Juan C. Fernandez-Miranda, Eric W. Wang, and Carl H. Snyderman
vi
