021 [95% CI 1.401-3.925]; p  = 0.038), but not triple modality therapy (HR 1.700 [95% CI 0.798-3.662]) when compared with surgery with RT. Conclusion  The most common treatment was surgery and RT, consistent with National Comprehensive Cancer Network (NCCN) guidelines which recommends chemotherapy (CT) only in the most concerning cases. However, we found no difference in survival among most treatment modalities when compared with triple modality therapy, with the exception of RT alone. Although margins were prognostic within these cancers, we found no evidence that adjuvant CRT provides any survival benefit over surgery and RT, though surgery alone was associated with decreased survival. © Thieme Medical Publishers.Background  Surgery for petroclival tumors is very challenging for neurosurgeons because the position of the tumor in relation to the brainstem, cranial nerves, and posterior fossa vessels greatly restricts the surgical field. Some papers have described using sigmoid sinus ligation to open the surgical field; however, pre- and intraoperative evaluations of the safety of ligation have been limited, despite the risk of complications from venous insufficiency. Here, we describe our method of preoperatively evaluating the potential safety of a retrolabyrinthine transsigmoid approach with nondominant ipsilateral sigmoid sinus ligation (RLTSwSSL). Methods  A retrospective review was conducted on petroclival tumors treated over a 5-year period with RLTSwSSL after evaluation with both an endovascular balloon occlusion test (BOT) and an open-field sinus clipping occlusion test (COT). Changes in pressure of  less then  10 mm Hg and the absence of neurodegeneration during the tests indicated that it would be safe to proceed with permanent ligation. Results  Four patients with large petroclival tumors underwent surgery via RLTSwSSL after detailed preoperative evaluations with both BOT and COT. All patients had uneventful courses of recovery without developing any complications derived from venous insufficiency. Conclusion  In our case series, we have described a protocol for using both BOT and COT to evaluate the likely outcomes after sigmoid sinus ligation and thereby to improve safety. Further studies are needed to establish definite criteria for both occlusion tests that will ensure good outcomes. © Thieme Medical Publishers.Objective  The main purpose of this article is to examine the prevalence, incidence, sociodemographic, and clinical characteristics of mental health disorders (MHDs) among patients with skull base malignancies. Design  Retrospective cohort study. Settings/Participants  Six-thousand seven-hundred sixty sinonasal/skull base cancer patients in the MarketScan database between 2005 and 2014. Main Outcome Measures  Frequency of MHDs pre- and post-diagnosis in patients harboring sinonasal/skull base malignancies. Results  A significant increase in MHDs was noted from pre- to post-cancer diagnosis (22 vs 31%, p  less then  0.0001). Despite an increase in the prevalence rate, the demographic profile of patients with MHDs post-diagnosis remained similar to pre-diagnosis. Those patients harboring MHDs were, however, more likely to be women (62.7 vs 47.4%), and carry a history of smoking (40.9 vs 26.3%) than those without MHDs. These comparisons were statistically significant ( p  less then  0.0001). Conclusion  The prevalence of MHDs increases following a diagnosis of a sinonasal/skull base malignancy. Patients with MHDs were more likely to be women and smokers. © Thieme Medical Publishers.Objectives  Pituitary carcinoma is a rare entity with fewer than 200 total cases reported in the English literature. Analysis of the population-level data from the National Cancer Database (NCDB) affords the opportunity to study this poorly understood tumor type. Methods  The NCDB was queried for site, histology, and metastasis codes corresponding to pituitary carcinoma. Statistical analyses were performed to determine factors associated with overall survival (OS). Results  A total of 92 patients with pituitary carcinoma met inclusion criteria. The 1 and 5 years of OS for all patients was 93.3% (95% confidence interval [CI] 88.2-98.6%) and 80.0% (95% CI 71.6-89.4%), respectively. Patients with invasive primary tumor behavior had 1 and 5 years of OS of 69.2% (95% CI 48.2-99.5%) and 52.7% (95% CI 31.2-89.2%), respectively. Multivariate analysis demonstrated that compared with benign primary behavior, invasive behavior had increased all-cause mortality (hazard ratio [HR], 1,296, 95% CI 15.1- > 2,000). Surgery without adjuvant radiation or chemotherapy was the most common therapy (48.9%), followed by no treatment (40.2%). Compared with surgery alone, no treatment had worse OS (HR, 11.83, 95% CI 1.41-99.56). Increasing age and female sex were both associated with increased mortality. Conclusions  The most common treatment for pituitary carcinoma is surgery alone followed by no surgery. Surgery alone has significantly better OS compared with no treatment. The efficacy of radiation, chemotherapy, and neurohormonal treatments needs to be examined with prospective studies. © Thieme Medical Publishers.Background and Purpose  This study was aimed to investigate the role of dynamic TurboFLASH gadolinium (Gd) magnetic resonance (MR) imaging in improving the differential diagnosis of skull base tumors. Methods  Eleven patients with skull base tumors underwent standard MR and ultrafast TurboFLASH sequence during gadolinium injection.  https://www.selleckchem.com/products/monastrol.html  Results  The characterization of tumor vascularity was performed. Different patterns of gadolinium uptake for each tumor type were observed. This is particularly important to identify tumors at high risk of intraoperative bleeding. All glomus tumors, typically highly vascularized, showed an enhancement at the arterial phase, reflecting the arterialization of these tumors which is not detectable on conventional MR. No signal increase at the arterial phase was instead observed in other cases in which the ruling out of a glomus tumor was important because of the location of the lesion. Moreover TurboFLASH identified the pathognomonic "filling-in" profile of cavernous sinus cavernous hemangiomas (CSCH), that is, the progressive centripetal enhancement of the lesion at the beginning of the venous phase.